5. Hypertension and Heart Failure

Question 1

Definition of hypertension (HTN)

Answer 1

BP > 140/90mmHg

Question 2

HTN risk factors (8)

Answer 2

Age
Race
Obesity
Alcohol
Family history
Pregnancy
Stress
Drugs

Question 3

Drugs that are HTN risk factors (4)

Answer 3

NSAIDs
Corticosteroids
Oral contraceptives
Sympathomimetics (adrenaline)

Question 4

HTN outcomes (2)

Answer 4

Accelerated atherosclerosis (MI, CVA, PVD)
Renal failure

Question 5

Types of HTN (2)

Answer 5

Primary HTN

Secondary HTN

Question 6

Causes of essential HTN (3)

Answer 6

Usually none
Renal artery stenosis (leads to renovascular HTN - secondary HTN)
Endocrine tumours (phaeochromocytoma, Conn's sybdrome, Cushing's syndrome)

Question 7

Clinical signs of HTN (3)

Answer 7

Often none
Headaches (more common in malignant HTN)
TIA

Question 8

Indications for further investigation (4)

Answer 8

Young patient (cause)
Resistant HTN
Accelerated HTN
Unusual medical/family history

Question 9

HTN investigations (5)

Answer 9

Urinalysis (kidney disease)
Serum biochemistry (adrenal gland, electrolytes, urea, creatinine)
Serum lipids
ECG
Renal ultrasound, renal angiography, hormone estimations

Question 10

Aim of HTN treatment

Answer 10

Reduce BP < 120/90mmHg

Question 11

Types of HTN treatment (2) and drugs (4)

Answer 11

Modify risk factors

Singe daily drug dose (ACE inhibitors, Ca-channel blockers, B-blockers, diuretics)

Question 12

Aetiology of heart failure

Answer 12

When heart output is incapable of meeting demands of tissues

Question 13

Types of heart failure (2)

Answer 13

High output failure

Low output failure

Question 14

Causes of high output HF (2)

Answer 14

Anaemia

Thyrotoxicosis

Question 15

Cause of low output HF

Answer 15

Cardiac defect (MI, valve disease)

Question 16

Aetiology of low output failure (5) and two examples each

Answer 16

Heart muscle disease (MI, diabetes)
Pressure overload (HTN, aortic stenosis)
Volume overload (mitral/atrial incompetence)
Arrhythmias (AF, heart block)
Drugs (B-blockers, corticosteroids)

Question 17

Symptoms and signs of left HF (5)

Answer 17

Lungs and systolic effects
SoB
Tachycardia
Hypotension
Low volume pulse

Question 18

Symptoms and signs of left HF (6)

Answer 18

Venous pressure elevated
Swollen ankles
Ascites
Raised JVP
Tender enlarged liver
Poor GI absorption

Question 19

Acute HF treatment and drugs (3)

Answer 19

Emergency hospital management

Oxygen, morphine, frusemide

Question 20

Chronic HF treatment (2) and drugs (5)

Answer 20

Community-based
Drug therapy (diuretics, ACE inhibitor, nitrates, inotropes, stop negative inotropes)

Question 21

Examples of negative inotropes (2)

Answer 21

B-blocker (slow HR, reduce efficiency)

Corticosteroids (increase fluid retention)