1 LOBS Flashcards
Define blood pressure. How would you describe what blood pressure is to patients
(avoiding medical jargon).
High blood pressure (hypertension) means that your blood is pumping with more force than normal through your arteries. The added stress on the arteries can speed up the clogging of arteries with fatty plaques (atherosclerosis). Atherosclerosis contributes to many illnesses, such as heart attack and stroke.
What happens when blood pressure is too low? Too high? Review how blood
pressure is regulated.
Blood pressure which is too high or too low can lead to a wide range of pathology (e.g. ruptured blood vessels, reduced perfusion to organs).
Define essential hypertension
persistently elevated arterial blood pressure that has no underlying (secondary) cause
Define Iatrogenic hypertension
high blood pressure caused by a chemical substance or medicine.
Define Secondary Hypertension
It is high blood pressure that’s caused by another medical condition. It can be caused by conditions that affect the kidneys, arteries, heart or endocrine system.
What are the 5 common causes of secondary hypertension?
- Obesity
- Pregnancy
- Kidney disease - Glomerulonephritis, Diabetic nephropathy and Renal cell carcinoma
- Vascular disease - Diabetic nephropathy and Renal cell carcinoma
- Endocrine disease - Hyper/hypothyroidism and Cushing’s syndrome
- Drugs - Alcohol, Illicit drugs (e.g. cocaine), Corticosteroids, Non-steroidal anti-inflammatories (NSAIDs) and Venlafaxine
- AND other causes like Connective tissue disorders (e.g systemic sclerosis, systemic lupus erythematosus and polyarteritis nodosa) and Obstructive sleep apnoea
Define Malignant/Accelerated hypotension
Clinic BP is usually higher than 180/120 mmHg with signs of papilloedema and/or retinal haemorrhage.
Can be fatal due to heart failure, cerebral haemorrhage, or renal failure.
Define masked hypertension
Masked hypertension is defined as a normal blood pressure (BP) in the clinic or office (<140/90 mmHg), but an elevated BP out of the clinic (ambulatory daytime BP or home BP>135/85 mmHg)- within the hypertensive range
Define white-coat hypertension
This condition occurs when blood pressure readings at a health care provider’s office are higher than they are in other settings, such as at home. Home or ambulatory blood pressure monitoring readings are lower, with a discrepancy of > 20/10 mmHg.
They may also exhibit signs in clinic such as tachycardia, sweating, or palpitations.
Review the types of antihypertensive medications in common practice
- Patients aged <55 years who are not of Black African or African-Caribbean descent: offer an ACE inhibitor such as ramipril.
-If an ACE inhibitor is not tolerated offer an angiotensin-II receptor blocker such as losartan.
OR - Patients aged ≥55 years and patients of Black African or African-Caribbean descent: offer a calcium channel blocker such as amlodipine.
- Patients already taking an ACE inhibitor or angiotensin-II receptor blocker: offer a calcium channel blocker such as amlodipine or a thiazide-type diuretic such as indapamide.
- Patients already taking a calcium channel blocker: offer an ACE Inhibitor such as ramipril or a thiazide-type diuretic such as indapamide.
If an ACE Inhibitor is not tolerated offer an angiotensin-II receptor blocker such as losartan.
Angiotensin-II receptor blockers preferred in patients Black African or African-Caribbean descent.
- Offer a combination of an ACE inhibitor or angiotensin-II receptor blocker plus a calcium channel blocker and thiazide-type diuretic.
What are the long-term implications of uncontrolled hypertension?
Please focus on
end-organ disease, specifically the brain, heart, kidneys and eyes (hypertensive
retinopathy).
Heart: left ventricular hypertrophy, angina/previous myocardial infarction, previous coronary revascularization, and heart failure
Brain: stroke or transient ischemic attack, dementia
Chronic kidney disease
Peripheral arterial disease
Retinopathy
List the modifiable and non-modifiable risk factors that predispose a patient to
coronary artery disease.
Smoking. (M)
Lack of exercise. (M)
Diet. (M)
Obesity. (M)
High blood pressure. (M and NM)
High LDL or low HDL cholesterol levels. (M and NM)
Family history of heart disease or other cardiovascular disease. (NM)
Age (NM)
What is metabolic syndrome and why is it important?
Metabolic syndrome is the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity. or
The metabolic syndrome is the name of a cluster of risk factors that, when they appear together, dramatically raise your risk of heart disease, heart failure, stroke and diabetes, as well as other non-cardiovascular conditions.
What is dyslipidaemia and how can we measure and treat it?
Dyslipidemia is the imbalance of lipids such as cholesterol, low-density lipoprotein cholesterol, (LDL-C), triglycerides, and high-density lipoprotein (HDL).
Dyslipidaemia is a broad term describing a number of conditions, including hypercholesterolaemia, hyperlipidaemia and mixed dyslipidaemia, in which disturbances in fat metabolism lead to changes in the concentrations of lipids in the blood.
The most commonly used options for pharmacologic treatment of dyslipidemia include bile acid–binding resins, HMG-CoA reductase inhibitors, nicotinic acid and fibric acid derivatives.
What lifestyle advice is customary to give to individuals with cardiovascular risk
factors?
What are some techniques clinicians can use to successfully encourage
individuals to change their behaviours?
What are some strategies available to medical providers to encourage smoking
cessation?
- Nicotine replacement therapy
- Counselling
- Acupuncture
- Physical activity
- Relaxation techniques like yoga
Develop a differential diagnosis for palpitations.
Arrhythmias:
Atrial fibrillation/flutter
Bradycardia caused by advanced arteriovenous
block or sinus node dysfunction
Bradycardia-tachycardia syndrome (sick sinus syndrome)
Multifocal atrial tachycardia
Premature supraventricular or ventricular contractions
Sinus tachycardia or arrhythmia
Supraventricular tachycardia
Ventricular tachycardia
Wolff-Parkinson-White syndrome
Psychiatric causes:
Anxiety disorder
Panic attacks
Drugs and medications:
Alcohol
Caffeine
Certain prescription and over-the-counter agents (e.g., digitalis, phenothiazine, theophylline, beta agonists)
Street drugs (e.g., cocaine)
Tobacco
Nonarrhythmic cardiac causes:
Atrial or ventricular septal defect
Cardiomyopathy
Congenital heart disease
Congestive heart failure
Mitral valve prolapse
Pacemaker-mediated tachycardia
Pericarditis
Valvular disease (e.g., aortic insufficiency, stenosis)
Extracardiac causes:
Anemia
Electrolyte imbalance
Fever
Hyperthyroidism
Hypoglycemia
Hypovolemia
Pheochromocytoma
Pulmonary disease
Vasovagal syndrome
Describe the pathophysiology of atrial fibrillation and link it to the typical ECG
findings.
Atrial fibrillation (AF) is a cardiac arrhythmia characterised by disorganised electrical activity within the atria resulting in ineffective atrial contraction and irregular ventricular contraction.
AF is a type of supraventricular cardiac arrhythmia meaning the origin of the arrhythmia arises from above the ventricles.
What are the risk factors for essential hypertension?
- Sex - up to 65 M>W, 65-74 W>M
- Ethnicity: people of Black African and Black Caribbean origin are at a higher risk of developing HTN.
- Age: blood pressure rises with increasing age.
- Lifestyle factors: cigarette smoking, excess alcohol consumption, excess dietary salt intake, obesity and lack of physical activity.
- Genetic factors
- Social deprivation
- Stress and anxiety
What are the risk factors for essential hypotension?
Sex: up to 65 years women tend to have lower blood pressures than men, however, between the ages of 65-74 years women tend to have higher blood pressures.
Ethnicity: people of Black African and Black Caribbean origin are at a higher risk of developing HTN.
Age: blood pressure rises with increasing age.
Lifestyle factors: cigarette smoking, excess alcohol consumption, excess dietary salt intake, obesity and lack of physical activity.
What are the risk factors for cardiovascular disease, including social History and family history?
High blood pressure
Smoking
High cholesterol
Diabetes
Lack of physical activity
Being overweight or obese
Family history of CVD
Ethnic background
Age
Gender
Diet
Alcohol
What is meant by the term pack year?
A pack-year is used to describe how many cigarettes you have smoked in your lifetime, with a pack equal to 20 cigarettes.
Is gender considered a CVS risk factor?
YES.