Basic Cardiology & Hypertension

Question 1

How does blood flow through the body?

Answer 1

Superior and inferior vena cava to right atrium then right ventricle then pulmonary artery to the lungs for gas exchange then back to the left atrium via the pulmonary vein (only vein that carries oxygenated blood) (pulmonary circulation) then to the left ventricle to the aorta to the rest of the body (systemic circulation)

Question 2

What is ischemia?

Answer 2

Decreased blood flow to a certain organ, has degrees leading all the way to infarction where zero blood flow leads to death

Question 3

Reasons for ischemia?

Answer 3

1. Thrombus, like atherosclerosis which grows in the artery by time and causes ischemia , it has many risk factors , obesity and high lipid profile etc
   Also occurs when there is a thrombosis
2. Embolus, like blood clot or embolus comes from somewhere in the body and causes a blockage to an artery or so

Question 4

DVT most common cause?

Answer 4

• post operative for people that took GA ma3ah recumbency + any other risk factors like obesity or cancer patient or keda
• leads to stasis of blood due to dilation of blood vessels and not a lot of movement. So blood clots

Question 5

Cliinical picture and symptoms of DVT?

Answer 5

For example if its in the lower limbs,
- swollen
- tender
-tense
- red

Sometimes there maybe no clinical picture since it can be in a really deep vein like pelvic veins

Question 6

Pulmonary embolism cause

Answer 6

• DVT travels to right atrium then right ventricle then pulmonary artery then goes to small branches in the lung and causes a blockage so less blood circulation to lung and to body

Question 7

Pulmonary embolism signs and symptoms?

Answer 7

1. Tachycardia (for more oxygen)
2. Dyspnea and tachypnea again for more oxygen
   3.chest pain
3. Haemoptysis due to death of part of the lung which leads to bleeding

Question 8

What is the difference between ischemia and DVT/pulmonary embolism?

Answer 8

Ischemia = arterial
DVT or PE = venous

Question 9

Diagnosis of PE?

Answer 9

1. CT angiography (sabgha, will stop 3and el heta el fiha embolus
2. Ventilation/ perfusion scan, inhalation of radioactive material and seeing airflow in the lungs and then injecting radioactive material to see the blood flow in the lungs , if here is ventillation perfusion mismatch then there is a PE

Question 10

Medical treatment of PE?

Answer 10

1. Anticoagulant: can also be used prophylactic and preventative if given post op 3alatool with people who are at risk, and then if there is already a DVT it will prevent its progression to PE
2. Thrombolytic therapy: however it has strict criteria , eg people that are old will be at risk of bleeding so can’t
3. Elastic stoking or intermittent pneumatic leg compression devices ( inflated and deflated to prevent stagnation of blood and help venous return)
   Surgical intervention/ pulmonary embolectomy; within 3 to 4 hours of happening hayehsalo restoration of blood flow

Question 11

What is the classification of hypertension?

Answer 11

1. Normal; <120mm Hg systolic and <80 mm Hg
2. Elevated: 120 - 129 mmHg and <80 mm hg
3. Stage 1 hypertension: 130-139 mmHg OR 80-89 diastolic
4. Stage 2 hypertension: more or = 140mmhg systolic OR more or = 90mmhg

Question 12

What are the causes of hypertension ?

Answer 12

1. Essential hypertension: Mainly haga men etnein , salt and water retention or stress / excessive sympathetic stimulation , or baa genetics obesity,lack of exercise.
2. Secondary hypertension , secondary to another disease like renal disease or aldosterone issue . Of foxed then hypertension is fixed

Question 13

How to evaluate high blood pressure? (Extent)

Answer 13

• Assessments of patients cardiovascular risk status , obese ,diabetic , atheroscelrosis
• exclusion of secondary reasons for hypertension
• extent of end organ damage

Question 14

How can hypertension damage other organs and how to tell if they are damaged?

Answer 14

1.blood vessels: leading cause of atheroscelrosis , helps deposition.
How can i tell if there’s BV damage, lipid profile
2.brain stroke: narrowing of BV-> reduced blood flow to brain
3. Heart failure: hypertrophy of left ventricle then hay weaken , not enough blood supply -> coronary heart disease.
Via ECO , law fi hypertrophy
4. Vision loss/hypertensive retinopathy, capillaries in retina rupture
Via fundus examination
5. Hypertensive glomeuloscelerosis/ kidney failure/ nephropathy, shrinkage of vessels due to hypertension

Question 15

Why is to high blood pressure sp significant?

Answer 15

• major risk factor for stroke, myocardial infarction , chronic kidney disease, premature death
  Each 2 mm Hg rise in systolic blood pressure increases mortality risk 7% heart disease and 10% by stroke

Question 16

How to manage hypertension?

Answer 16

1. Lifestyle changes, less salt and caffeine , more exercise
2. Lipid lowering drugs/statins to lower lipid profile
3. Law fi diabetes , control it

Question 17

Drug groups normally used for hypertension?

Answer 17

1. Calcium channel blockers: calcium is needed for contraction of blood vessels so this drug inhibits influx of calcium to blood vesssel walls and myocardial tissues -> vasodilation
2. ACE inhibitors (angiotensin converting enzyme): angiotensin 2 is a potent vasoconstrictor and promotes production of aldosterone from adrenal gland which increases salt and water retention -> vasodilation and indirectly inhibits salt and water retention
3. Thiazide diuretics: promote urination since inhibits water and salt/ sodium and chloride reabsorption in kidneys .
4. Beta blockers: blocks beta 1 receptor on cardiac tissue so its anti sympathetic which will lower heart rate and contractility

Question 18

If drugs are not very effective in controlling hypertension which is better combination of drugs or increasing dosages?

Answer 18

Combination since it will work with more than one mechanism of action and attack more than one cause of hypertension + less side effects