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CVS > 1A > Flashcards

1A Flashcards

1
Q

What are the types of hypertension

A

Essential
Isolated systolic
Secondary
Iatrogenic
Malignant/accelerated

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2
Q

What is essential hypertension?

A

blood pressure >140/90 mmHg with no secondary cause identified

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3
Q

What is the classification of HTN?

A

STAGE 1: 140/90 ABPM: 135/85
STAGE 2: 160/100 ABPM: 150/95
STAGE 3: systolic>180 diastolic>120

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4
Q

What is normal blood pressure?

A

<80 yrs: <140/90 ABPM: <135/85
>80 yrs: <150/90 ABPM: <145/90

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5
Q

Pathophysiology of HTN?

A

Increase in salt and water retention leads to volume overload
increased vascular resistance means pressure in vessels are high

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6
Q

BP= ?

A

BP= CO x TPR

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7
Q

longterm effects of high blood pressure?

A

end-organ damage

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8
Q

Risk factors of hypertension

A

Age
Salt intake
Genes/family history
Alcohol
Smoking- changes in vascular wall increases resistance
Obesity
Diabetes

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9
Q

Sign and symptoms of hypertension

A

Usually asymptomatic - has a family history of hypertension
If symptomatic: persistent headache or eye pain

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10
Q

Diagnosis of hypertension

A

3 BP readings and record lowest
eliminate white coat effect
Fundoscopy
BMI
Examine heart and lungs
ABPM for white coat effect

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11
Q

DDx of hypertension

A

Pheochromocytoma
Polycystic kidney disease
Obstructive uropathies

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12
Q

Investigations for Hypertension

A

Bloods: glucose, electrolytes, eGFR, Lipids, protein creatine ratio, Qrisk
CXR- cardiomegaly
ECG- left ventricular hypertrophy

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13
Q

Management of hypertension

A

Conservative: weight loss, salt reduction, smoking cessation, exercise

Drug treatment depending on stage/severity of hypertension

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14
Q

When should stage 2 hypertension be treated?

A

<80 yrs with:
end organ damage
diabetes, renal disease
Qrisk >10%

treat 2 of any age

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15
Q

Name drugs used to treat hypertension

A

Angiotensin-Converting Enzyme inhibitor
Angiotensin Receptor Blocker
Calcium Channel Blocker
Thiazide-like Diuretics
beta blocker

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16
Q

Step 1 treatment for Hypertension

A

ACE/ARB if: diabetic, <55 and not African or African Caribbean origin

CCB: all other groups (or cannot tolerate side effects fo ACE)

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17
Q

Step 2 treatment of HTN

A

1) add CCB or thiazide-like diuretics
2) add ACE, ARB or thiazide-like diuretics

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18
Q

Step 3 treatment of HTN

A

Combination treatment with ACE/ARB, CCB, and thiazide-like diuretic

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19
Q

Step 4 treatment of HTN

A

If K+ <4.5 mmol/l add spironolactone (K sparing diuretics)
If K+ >4.5 mmol/l add a higher dose thiazide-like diuretic or alpha or beta blocker

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20
Q

Name an ACEi

A

Ramipril, Lisinopril

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21
Q

Name an ARB

A

Losartan, candesartan

22
Q

Name a CCB

A

Amlodopine

23
Q

Name a thiazide-like diuretics

A

Indapamide

24
Q

What are the two drugs used in step 4 hypertension?

A

if K+ <4.5 spironolactone
if K+ >4.5 add alpha/ beta blocker or higher dose of indapamide

25
Q

Side effects of Ramipril

A

Dry cough
dizziness
worsening of kidney disease

26
Q

Dose of Ramipril

A

2.5mg/day and titrated up to max 10mg

27
Q

Side effect or ARB

A

dizziness and nausea
worsening of kidney disease

28
Q

Dose of ARB

A

12.5mg OD up to 100mg

29
Q

Side effect of CCB

30
Q

Dose of CCB

A

5mg-10mg OD

31
Q

side effects of beta blocker

A

constipation, bradycardia, confusion

32
Q

Name a beta blocker

A

Bisoprolol

33
Q

What happens before and after increasing dosage?

A

Monitor blood pressure and kidney function test before and 2/3 weeks after

34
Q

Complications of hypertension?

A

Heart failure
Stroke
Coronary artery disease
Vascular Dementia

35
Q

What is isolated hypertension?

A

systolic >140 diastolic <90

36
Q

pathophysiology of isolated hypertension

A

compliance of aorta/arteries reduces with age causing ventricles to work against stiffer aorta/arteries

37
Q

longterm of isolate hypertension

A

left ventricular hypertrophy

38
Q

Risk factors of isolated hypertension

A

Old age
Diabetes
Atherosclerosis
Smoking

39
Q

Symptoms of Isolated HTN

A

Asymptomatic
Symptomatic: headaches, palpitation (ventricular hypertrophy), blurred vision (increased retinal arterial pressure)

40
Q

Examination of Isolated HTN

A

Displaced Apex beat if left ventricular hypertrophy
BP >140 systolic <90 diastolic
widespread cardiac wheeze/crackles if left ventricular impairment

41
Q

DDx of isolated HTN

A

Pheochromatocytoma
Iatrogenic hypertension
pulmonary hypertension

42
Q

Investigations of HTN

A

Bloods: lipids, LFTs, U+Es, TFT
CXR- cardiomegaly
ECG- left ventricular hypertrophy, arrhythmia
echocardiogram: assess cardiac function

43
Q

Management of isolated HTN

A

same as essential HTN

44
Q

Complication of isolated HTN

A

Heart failure
Arrhythmia
Cerebrovascular accident

45
Q

Define iatrogenic HTN

A

Hypertension caused by medical treatment/drugs

46
Q

What drugs can cause iatrogenic ulcer

A

NSAIDs
Steroids
Stimulants (alcohol or amphetamines)
Supplements (ginseng, liquorice)
Antidepressant
Immunosuppressant (e.g. tacrolimus)

47
Q

Risk factors of Iatrogenic Hypertension

A

Chronic pain
Alcohol/substance abuser
Organ transplant recipient
Alternative medicine users
Comorbodies (COPD, Asthma)

48
Q

Examination of Iatrogenic HTN

A

If steroid-induced: Buffalo humps, facial plethora
If alcohol-induced: cerebellar ataxia, tremor, confusion: Nystagmus
If antidepressant-induced: depression, low mood

49
Q

DDx of Iatrogenic HTN

A

Essential HTN
Secondary non-iatrogenic hypertension

50
Q

Investigations for iatrogenic HTN

A

Rule out secondary causes:
Acromegaly- increase in tissue and bone growth hormones
CKD
Renal artery stenosis or Polycystic kidney disease
Conn syndrome- too much aldosterone
Diabetes

Insulin
Growth factor
Us+Es
Renal ultrasound
Renin-aldosterone ratio
HbA1c

51
Q

Management of Iatrogenic HTN

A

Review medication and make safer alternatives
Lifestyle changes: alcohol reduction

CVS (5 decks)

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