1 Hypertension, CHD

Question 1

Blood pressure equation

Answer 1

Blood pressure = cardiac output x peripheral resistance

Question 2

blood pressure definition

Answer 2

force exerted by circulating blood on artery walls

Question 3

systolic measurement

Answer 3

contraction of left ventricl

Question 4

diastolic measurement

Answer 4

relaxation of ventricles

Question 5

blood occlusion

Answer 5

when measuring BP, when the cuff pressure blocks blood flow

Question 6

primary hypertension

Answer 6

95% cases, idiopathic (no clear underlying cause)

Question 7

examples of secondary hypertension

Answer 7

renal disease, pregnancy, hormonal medications

Question 8

RAAS role

Answer 8

Renin Angiotensin-Aldosterone System

Occurs when decrease in BP in kidneys, aim to increase water and electrolyte reabsorption

1. renin release
2. angiotensinogen -> angiotensin 1
3. angiotensin 1 -> angiotensin 2
4. Aldosterone retains sodium and water

Question 9

How to reduce BP

Answer 9

ACE inhibitor or low cost angiotensin 2 receptor block (ARB) if under 55 y/o

calcium-channel blocker if african/caribbean or over 55

thiazide-like diuretic for further assessment

alpha/beta blockers

Question 10

Alpha blockers

Answer 10

relaxes arteries

Question 11

beta blockers

Answer 11

heart, vascular selective, reduces heart rate, used in emergency setting

eg. bisoprolol

Question 12

ABPM

Answer 12

ambulatory bp measurement:
wear cuff for 24h, measurement taken every 30’

Question 13

HBPM

Answer 13

home bp measurement:
wear cuff morning and before bed for 7 days. takes average reading

Question 14

stage 1 hypertension

Answer 14

clinic: >140/90 mmHg
ABPM/HBPM: >135/85 mmHg

Question 15

stage 2 hypertension

Answer 15

clinic: >160/100 mmHg
ABPM/HBPM: >150/96 mmHg

Question 16

severe hypertension

Answer 16

clinic: >180/110 mmHg or higher

Question 17

modifiable risk factors

Answer 17

healthy diet, smoking, exercise, weight loss, reduce alcohol intake, salt intake (reduces water content)

Question 18

ACE inhibitors

Answer 18

eg. ramipril (causes dry cough)
decrease aldosterone secretion and angiotensin 2 production

drop in BP

Question 19

side effects of ACE inhibitors

Answer 19

hyperkalemia (high potassium)
hypotension
headache
non-productive cough

Question 20

coronary heart disease

Answer 20

when coronary arteries become narrowed resulting in reduced blood supply to heart muscle
aka Coronary artery disease, ischemic heart disease

Question 21

arteries affected in CHD

Answer 21

right coronary artery, left main coronary artery, circumflex coronary artery, left anterior descending coronary artery

Question 22

atherosclerosis

Answer 22

cause of CHD
build up of fatty material atheroma inside coronary arteries
if it breaks off, can cause blood clot formation

Question 23

causes of CHD

Answer 23

atherosclerosis (aging, diabetes mellitus (Sugar damages the nerves), tobacco, arterial hypertension)

inflammation

coronary microvascular dysfunction (eg. SARS-CoV-2)

vasospasm (when blood vessel in brain narrows)

Question 24

Classifications of CHD

Answer 24

CHD - cardiac ischemia
Stable ischemic heart disease - chronic angina
Acute coronary syndrome - acute chest pain
STEMI - ST elevations
NSTEMI - No ST elevations, Troponin +ve
Unstable angina - no ST elevations, troponin -ve

Question 25

coronary angiogram

Answer 25

uses contrast dye
x-ray

Question 26

treatment for CHD

Answer 26

coronary angioplasty (catheter w balloon etc.)
drug therapies
thrombolytic therapy
ACE inhibitors
anticoagulants
vasodilators, nitrates (GTN spray)

Question 27

Troponin

Answer 27

marker for heart attack

Question 28

Aspirin

Answer 28

antiplatelet agent
irreversible
thromboxane inhibitor
decreases clotting

Question 29

Atorvastatin

Answer 29

cholesterol lowering medicine

Question 30

antiplatelet agent and anticoagulant

Answer 30

anticoagulant (eg. warfarin) slows down blood clotting process
antiplatelets prevent platelets from clumping together