Cardiac Flashcards
Aetiology of HTN
95% essential Renal artery stenosis Hyperthyroidism PCKD Chronic pyelonephritis Diabetic nephropathy RCC Cushing's Phaeochromocytoma Hyperaldosteronism
Symptoms
Asymptomatic
May get headaches
Stages of HTN
Stage 1 > 140/90 ABPM >135/85
Stage 2 > 160/100 ABPM > 150/95
Stage 4 >180/120
Signs
Retinal haemorrhage Papilloedema
Risk factors
Age 65 yo - men 65 - 74 - female Black African and Asian FHx Social deprivation Lifestyle - smoking and alcohol Anxiety and emotional stress
Complications
Increased risk of: Heart failure. Coronary artery disease Stroke Chronic kidney disease Peripheral arterial disease Vascular dementia
Diagnosis
If blood pressure measured in the clinic is 140/90 - 180/120mmHg: ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension
Person’s blood pressure is 180/120 mmHg or higher
Refer for same-day specialist assessment if there are:
- Signs of retinal haemorrhage and/or papilloedema
- new onset confusion, chest pain, signs of HF or AKI
if not:
- Ix for organ damage e.g. eGFR for kidney damage
- tarting antihypertensive drug treatment immediately if organ damage
If no target organ damage is identified:
- repeat blood pressure measurement within 7 days
Assess for target organ damage
Urine dipstick:
- haematuria
- alb: Cr ratio
HbA1C
ECG
Serum LDL - QRISK
Mx
Lifestyle advice
- diet and exercise
- reduce caffeine
- reduce salt
- smoking and alcohol cessation
Antihypertensives
Antihypertensive procedure
Stage 1 - ACEi/ARB
- if have T2DM
- less than 55 yo
Stage 1 - CCB
- over 55 yo
- Afro-carribean
Stage 2 - ACEi/ARB +CCB
Stage 3 - ACEi/ARB +CCB + thiazide like diuretic
Stage 4 ACEi/ARB +CCB + thiazide like diuretic + beta blocker or alpha/beta blocker if K+ >4.5 mmol/l
Target BP for 80 years and over
< 150/90 mmHg.
Annual review
Adherence
BP
eGFR
QRISK
Pre - eclampsia
BP > 140/90 after 20 wks gestation
- Proteinuria
- Severe headache
- Visual disturbances
Complications:
- Renal insufficiency
- Liver issue - ALT/AST
- eclampsia
Risk factors for pre - eclampsia
PMHx of pre - eclampsia CKD T1/T2DM HTN SLE 40+ Obese FHx
Mx of pre-eclampsia
Aspirin 75 - 150mg prescribed form 12 wks - if high risk
Labetalol
Urine dipstick
- proteinuria 30mg
- haematuria
When to suspect familial hypercholesterolaemia
Total cholesterol conc > 7.5 mmol/L
Personal or FHx of premature CHD < 60yo
Signs of hypercholesterolaemia
Xanthelasma
Corneal arcus
Tendon xanthoma
Secondary hyperlipidaemia
Caused by: T2DM Obesity Nephrotic syndrome Alcoholism Cushing's syndrome Hypothyroidism
Drugs:
Corticosteroids
Thiazide diuretic
Cardiovascular risk reduction
Primary reduction:
QRISK > 10%
Atorvastatin 20mg
Secondary reducation:
Atorvastatin 80mg
Contraindicated - ezetimibe 10mg
Follow up bloods 3 months and 12 months after starting statin
Familial hypercholesterolaemia diagnosis
Adults: LDL cholesterol 13+ mmol/L.
Child: LDL cholesterol 11+ mmol/L
Use the Simon Broome criteria or the Dutch Lipid Clinic Network
Dutch Lipid Clinic Network
Definite’ FH > 8
‘Probable’ FH 6–8
‘Possible’ FH 3–5
‘Unlikely’ FH < 3
When is Qrisk not needed
TIDM and 40+
Has had diabetes for 10+ years
Has established nephropathy
Has other CVD risk factors
Causes of angina
Insufficient blood supply to the myocardium:
- Previous MI
- Atherosclerosis - coronary artery disease
Risk factors for angina
Male Age FHx Ethnicity - Black and asian Increased QRISK Smoking High cholesterol and lipids HTN, DM, CKD
Symptoms of angina
Stable: Pain when exerting, relieved at rest
Relieved by GTN spray
Unstable angina: Pain at rest too
Atypical symptoms:
- GI discomfort
- Dyspnoea
- Nausea