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Cardiology > 1: HTN > Flashcards

1: HTN Flashcards

1
Q

What defines HTN

A
  1. Persistent clinical BP reading of >140/90

2. Ambulatory BP reading of >135/85

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2
Q

What are the types of HTN

A
  • Essential (primary)
  • secondary
  • white coat
  • malignant
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3
Q

What % of HTN is essential

A

95%

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4
Q

What % of HTN is secondary

A

5

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5
Q

Define white coat HTN

A

Clinical BP reading of >140/90. But an ambulatory BP reading of <135/85

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6
Q

Define essential HTN

A

HTN of unknown cause

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7
Q

What are the 3 aetiological categories of secondary HTN

A

Renal
Endocrine
Other

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8
Q

What % of renal HTN is due to intrinisic renal disease

A

75

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9
Q

What are the 5 types of intrinsic renal disease

A 
Chronic pyelonephritis
Systemic sclerosis
Polyarteritis nodosa
Adult polycystic kidney disease 
Glomerulonephritis
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10
Q

What % of renal HTN is vascular

A

25

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11
Q

What is the main cause of renovascular HTN

A

Renal artery stenosis

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12
Q

What are the 5 endocrine causes of HTN

A
  • Cushing’s disease
  • Pheochromocytoma
  • Conn’s syndrome
  • CAH
  • Acromegaly
  • Liddle’s syndrome
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13
Q

What are 2 other causes of HTN

A

Medications

Co-arctation of the aorta

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14
Q

What medications can cause HTN

A 
Glucocorticoids
MAOIs 
COCP
NSAIDs
Cocaine + Amphetamines
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15
Q

What is malignant HTN

A

Sudden increase in BP leading to vascular damage

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16
Q

What BP defines malignant HTN

A

180/120

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17
Q

What is the pathological hallmark of malignant HTN

A

fibrinoid necrosis

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18
Q

What are 3 non-modifiable risk factors for HTN

A

Age
FHx
Ethnicity

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19
Q

What are the modifiable risk factors for HTN

A 
Obesity
Diabetes
Smoking
Excess alcohol intake
Excess caffeine intake 
High sodium diet 
Physical inactivity 
Psychological stress
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20
Q

How does HTN present clinically

A

Asymptomatic. Unless malignant

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21
Q

How can HTN present

A

Headache, visual disturbances, seizures

22
Q

What is first-line Ix for HTN

A

Clinical BP reading - in both arms

23
Q

If BP is high at the first measurement what should be done

A

Take a second measurement during the consultation

24
Q

If someone has a clinical reading >140/90mmHg what should be done

A

ABPM

25
Q

If someone has an ABPM of <135/85 what should be done

A

Nothing - they are normotensive

26
Q

If someone has an ABPM of >135/85 what stage of HTN do they have

A

Stage I

27
Q

If someone has an ABPM of >135/85 what should be done

A

If they are <80y AND have one of the following they should be treated

  1. Diabetes
  2. 10y cardiovascular risk of >20%
  3. Evidence of end-organ damage
  4. Renal disease
  5. Established cardiovascular disease
28
Q

If someone has a BP of >150/95 what should be done

A

Treat, regardless of age and co-morbidities

29
Q

If someone has malignant HTN what is first line

A

Sodium nitroprusside

30
Q

If an individual has HTN and signs of papilloedema or retinal haemorrhage - what should be done

A

Refer to specalist same day

31
Q

What is stage I HTN

A

Clinical BP: >140/90

ABPM: >135/85

32
Q

What is stage II HTN

A

Clinical BP: > 160/100

ABPM: >150/95

33
Q

What is stage III HTN

A

> 180/110

34
Q

What is the justification for other Ix in HTN

A

To look for evidence of end-organ damage

35
Q

What other investigations may be done in HTN and why

A 
Opthalmoscopy - retinal haemorrhage 
U+E - renal damage
Urinanalysis - renal damage
ECG- IHD of LVH
HbA1c - CV risk 
Lipids - CV risk
36
Q

What is the lifestyle advice for someone with HTN

A
  • Limit salt intake <6g/d
  • Reduce caffeine
  • Physical activity
  • Reduce alcohol
  • More fruit + veg
  • Weight loss
37
Q

If someone is <55 and NOT afro-carribean what should they be given first-line for HTN

A

ACEi

38
Q

If someone is >55 or Afro-Carribean what is first line for HTN

A

Calcium channel blocker

39
Q

What is second line for HTN

A

ACEi + Calcium channel blocker

40
Q

What is third line for HTN

A

ACEi + Calcium channel blocker + Thiazide diuretic

41
Q

If someones K+ is <4.5 what is given 4th line

A

Spirinolactone

42
Q

If someones K+ is >4.5 what is given 4th line

A

Increase dose of thiazide

43
Q

If individual does not respond to 4th line what should be done

A

Refer to specialist

44
Q

What are 4 complications of HTN

A
  1. HTN retinopathy
  2. Stroke
  3. CVS disease - HF, IHD
  4. HTN nephrosclerosis
45
Q

What is grade I HTN retinopathy

A

Tortous arteries with thick shiny walls

46
Q

What is grade 2 HTN retinopathy

A

AV nicking

47
Q

What is grade 3 HTN retinopathy

A

Flame haemorrhage and cotton wool spots

48
Q

What is grade 4 HTN retinopathy

A

Papilloedema

49
Q

How will HTN nephropathy present

A

microalbuminuria

50
Q

How may HTN nephropathy present later

A

Nephrosclerosis and proteinuria

Cardiology (13 decks)

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