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AC1 > Complications of HTN > Flashcards

Complications of HTN Flashcards

1
Q

List the cardiac complications of HTN

A
  • Increased LV mass (hypertrophy), with or without chamber dilation
  • Left atrial abnormalities
  • Myocardial ischaemia
  • Systolic and diastolic LV dysfunction
  • Atrial and ventricular arrhythmias
  • Sudden death
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2
Q

Describe the neurohormonal processes underlying cardiac damage from HTN

A
  • Activation of the RAAS
    • Increased ATII
    • Increased aldosterone
  • Enhanced adrenergic activity
  • Increased production/ decreased catabolism of biologically active molecules (ATII, cytokines, growth factors)
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3
Q

Describe the haemodynamic processes underlying cardiac damage from HTN

A
  • Increased peripheral resistance
  • Increased wall stress
  • Decreased coronary reserve
  • Increased volume load
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4
Q

Describe the vascular processes underlying cardiac damage from HTN

A
  • Endothelial dysfunction (from vascular wall stress)
  • Vascular remodelling
  • Decreased vascular compliance
  • Increased vascular reactivity
  • Coronary and peripheral vascular atherosclerosis
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5
Q

Describe the myocardial processes underlying cardiac damage from HTN

A
  • LV remodelling
  • Foetal gene expression
  • Myocyte hypertrophy
  • Alteration in ECM: fibroblasts replacing cardiomyocytes
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6
Q

List the common presenting symptoms of CHF

A
  • Dyspnoea at rest
  • Dyspnoea on exertion
  • Paroxysmal nocturnal dyspnoea
  • Effort intolerance
  • Weakess and fatigue
  • GI complaints
  • Orthopnoea
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7
Q

List some common signs of CHF

A
  • Resting tachycardia
  • Third heart sound
  • Vascular congestion
  • Peripheral oedema
  • Hypotension
  • Organomegaly
  • Pleural effusion
  • Cachexia
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8
Q

What class of drugs should be used to manage LV systolic dysfunction in hypertensive heart disease?

A

ACE inhibitors or ARBs

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9
Q

What class of drugs should be used to manage LV diastolic dysfunction in hypertensive heart disease?

A

ARBs

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10
Q

What class of drug should be used in the presence of IHD in hypertensive heart disease?

A

Beta-blockers (3rd generation)

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11
Q

What classes of drug should be used if congestive symptoms are present in hypertensive heart disease?

A

Loop diuretics or anti-aldosterone

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12
Q

In the presence of IHD in hypertensive heart disease, what combination of drugs should be used?

A
  • Beta blockers
  • Nitrates
  • ACE-I
  • CCBs (not with B blockers)
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13
Q

What should be used if AF is present in hypertensive heart disease?

A
  • Anticoagulation
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14
Q

What are the possible very early treatments for ischaemic stroke?

A
  • Thrombolysis
  • Mechanical thrombectomy
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15
Q

What are the possibly early treatments for ischaemic stroke?

A
  • Aspirin
  • Anticoagulants
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16
Q

What drugs/treatments should be used for long term prevention of ischaemic stroke?

A

Anti-platelets:

  • Aspirin
  • Clopidogrel
  • Dipyridamole

Anticoagulants:

  • Warfarin
  • NOACs (apixaban, edoxaban, rivaroxaban)

Statins

Anti-hypertensives

Re-vascularisation: stents/angioplasty, carotid endoarterectomy

17
Q

List the renal complications of HTN

A

Hypertensive kidney disease:

  • Marked by progressive kidney dysfunction
18
Q

List the non-modifiable risk factors for hypertensive kidney disease

A
  • Increasing age
  • Gender
  • Ethnicity
19
Q

Lost the modifiable risk factors for hypertensive kidney disease

A
  • HTN
  • Proteinuria/albuminuria
  • Dyslipidaemia
  • HbA1c
  • Anaemia
  • Ca:PO4
20
Q

List the haemodynamic abnormalities in HTN and CKD

A

Increased cardiac output

  • =Increased intravascular volume
    • Decreased GFR
    • Reduced Na+ excretion (therefore water excretion)
    • Increased ECF
    • Increased renal nerve activity
  • Increased myocardial performance
    • Increased adrenergic activity

Increased vasoconstriction:

  • Increased adrenergic stimulation
  • Increased AGII
  • Increased endothelin and endothelin derived clotting factors
  • Increased thromboxane

Decreased vasodilation:

  • Reduced prostacyclin
  • Reduced NO
  • Reduced endothelin-derived hyperpolarising factors
21
Q

List the stages of hypertensive retinopathy

A

Stage I-II (Mild) :

  • Arteriolar narrowing
  • Arteriolar wall opacity
  • Arteriolar nicking

Stage III (Moderate):

  • Mild retinopathy with:
    • Retinal haemorrhage/microaneurysms

Stage IV (Malignant):

  • Moderate retinopathy
  • Optic disc welling
  • Macular oedema
22
Q

List some characteristics of hypertensive heart disease

A
  • Altered coronary reserve
  • Endothelial dysfunction
  • Perivascular fibrosis
  • Systolic and diastolic dysfunction
  • Left ventricular hypertrophy
  • Cardiac dysrhythmias
  • Myocardial fibrosis- replacement of muscle cells with fibroblasts
23
Q

List the clinical consequences of hypertensive heart disease

A
  • Angina pectoris
  • Asymptomatic or symptomatic HF
  • ACS
  • Cardiac dysrhythmias
  • Myocardial infarction
  • Sudden death
24
Q

Describe the classification of CKD

A
  • Kidney damage with normal GFR (GFR>90)
  • Kidney damage with mildly reduced GFR (GFR 89-60)
  • Kidney damage with mild to moderate GFR (GFR 59-45)
  • Kidney damage with moderate GFR (GFR 45-30)
  • Kidney damage with severe GFR (GFR 30-15)
  • Kidney failure (GFR <15)- dialysis
25
Q

What are the intrarenal effects of ACE inhibitors and ARBs on GFR compared to no treatment?

A
  • Untreated: Efferent arteriolar tone increased causing glomerular hyperfiltration
  • ACE-inhibitors: Greater increase in the diameter of the efferent arteriole due to the combined effect of increased bradykinin and decreased ATII resulting in a greater drop in GFR
  • ARBs: Limited increase in efferent arteriolar tone due to ATII blockade but no effect on bradykinin resulting in reduced effect on GFR
26
Q

Describe the pathology of each of these fundoscopy images

Which stage of hypertensive retinopathy does each image correspond with?

A

A - Generalised narrowing of the arterioles (stage I)

B - …….plus focal constriction, arteriolar sclerosis with widening of the reflex stripe (stage II)

C - …….plus haemorrhages and exudates (stage III)

D - ……..plus oedema of the disc (papilloedema) (stage IV)

AC1 (32 decks)

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