1 Hypertension, CHD Flashcards
Blood pressure equation
Blood pressure = cardiac output x peripheral resistance
blood pressure definition
force exerted by circulating blood on artery walls
systolic measurement
contraction of left ventricl
diastolic measurement
relaxation of ventricles
blood occlusion
when measuring BP, when the cuff pressure blocks blood flow
primary hypertension
95% cases, idiopathic (no clear underlying cause)
examples of secondary hypertension
renal disease, pregnancy, hormonal medications
RAAS role
Renin Angiotensin-Aldosterone System
Occurs when decrease in BP in kidneys, aim to increase water and electrolyte reabsorption
- renin release
- angiotensinogen -> angiotensin 1
- angiotensin 1 -> angiotensin 2
- Aldosterone retains sodium and water
How to reduce BP
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
Alpha blockers
relaxes arteries
beta blockers
heart, vascular selective, reduces heart rate, used in emergency setting
eg. bisoprolol
ABPM
ambulatory bp measurement:
wear cuff for 24h, measurement taken every 30’
HBPM
home bp measurement:
wear cuff morning and before bed for 7 days. takes average reading
stage 1 hypertension
clinic: >140/90 mmHg
ABPM/HBPM: >135/85 mmHg
stage 2 hypertension
clinic: >160/100 mmHg
ABPM/HBPM: >150/96 mmHg
severe hypertension
clinic: >180/110 mmHg or higher
modifiable risk factors
healthy diet, smoking, exercise, weight loss, reduce alcohol intake, salt intake (reduces water content)
ACE inhibitors
eg. ramipril (causes dry cough)
decrease aldosterone secretion and angiotensin 2 production
drop in BP
side effects of ACE inhibitors
hyperkalemia (high potassium)
hypotension
headache
non-productive cough
coronary heart disease
when coronary arteries become narrowed resulting in reduced blood supply to heart muscle
aka Coronary artery disease, ischemic heart disease
arteries affected in CHD
right coronary artery, left main coronary artery, circumflex coronary artery, left anterior descending coronary artery
atherosclerosis
cause of CHD
build up of fatty material atheroma inside coronary arteries
if it breaks off, can cause blood clot formation
causes of CHD
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)
Classifications of CHD
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
