Cardiac - Hypertension and lipid disorders Flashcards
Hypertension
Definition
Cut-offs
Hypertension
Define ambulatory and white coat hypertension
Hypertension
Define malignant hypertension
ABCDEF:
* Azotemia
* BP ≥220/120
* Cardiac failure
* Distress
* Encephalopathy
* Fundus
Clinical presentation: ↑BP + rapidly progressive TOD
□ Retina: papilloedema, retinal haemorrhages and exudates
□ HTN encephalopathy: severe headache, vomiting, visual disturbances, transient paralyses, convulsions, stupor and coma
□ Heart: acute LV failure
□ Kidneys: acute RF with oliguria, proteinuria
Define urgency hypertension
Define emergency hypertension
Primary/ Essential hypertension
Risk factors
Secondary hypertension
Causes
Hypertension
Physiological variation of BP
Hypertension
Clinical presentation, target organ damage
Hypertension
Diagnosis
on
Hypertension
History taking questions
Hypertension
P/E
`
Hypertension
Biochemical Ix
Hypertension
Radiological Ix
Hypertension
Treatment target
General lifestyle modifications
Lifestyle modifications:
- Weight reduction
- Diet: Low sodium, Low fat, High fruit/ vegetables, High K, DASH diet
- Exercise: 30min/day
- Alcohol: moderation ≤2 (M) or ≤1 (F) drinks/day
- Medical therapy: Change dose/ combination therapy accordingly
First line: ACEI/ARB, CCB, thiazide diuretic (+/- BB)
Second line: Alpha blocker, Aldosterone antagonist or vasodilator
Adjunctive drugs: Aspirin (lower CVD risk), Statins (hyperlipidemia)
Substitute drugs: Methyldopa, hydralazine for pregnancy; Loop diuretics for CKD
Compelling indications: DM, CKD, CAD, LV dysfunction, Ischemic stroke
ACEi
Examples
MoA
S/E
C/I
ARB
Examples
MoA
S/E
C/I
B-blockers
Examples
MoA
S/E
C/I
CCB
Examples
MoA
S/E
C/I
Loop diuretics
Examples
MoA
S/E
C/I
Thiazide diuretics
Examples
MoA
S/E
C/I
Potassium sparing diuretics
Examples
MoA
S/E
C/I
Hypertension
Drug choice combinations
A= ACEi/ ARB
B = B-blocker
C = CCB
D = Diuretics
Hypertension
Drug combination for asymptomatic organ damage
Hypertension
Drug combinations for stroke, MI, stable angina, HF, AA, Afib
Hypertension
Drug combination for isolated systolic HTN, metabolic syndrome, DM, pregnancy
Hypertension
Contraindication of ACEi/ARB
Hypertension
Contraindications of BB, CCB
Hypertension
Contraindications of diuretics
Hypertensive urgency
Treatment
Hypertensive emergency
Treatment
Hypertension
Macrovascular complications
Hypertension
Microvascular complications
Hypertension
Risk factors for poor prognosis
histological findings of renal disease induced by hypertension?
Lipoprotein
Classes and functions
Lipid profile
Metrics
Procedure
Lipoprotein pattern
Metrics
Procedure
Hyperlipidemia
Investigations (apart from lipoprotein pattern and profile)
Reference lipoprotein levels
CHD risk equivalent
Definition
Risk factors of major coronary event
Hyperlipidemia
Major risk factors that modify LDL-C target
Hyperlipidemia
Risk categories and corresponding LDL targets
Hyperlipidemia
Phenotypes and associated defects
Primary Hyperlipidemia
Phenotypes associated with CHD, pancreatitis
Familial hypercholesterolemia
Types
Genetic causes
Pathophysiology
Familial hypercholesterolemia
Clinical manifestations
Diagnosis
Treatment
Statins
MoA
Effect on lipid profile
S/E
Example
Fibrates
MoA
Effect on lipid profile
S/E
Example
Resins
MoA
Effect on lipid profile
S/E
Examples
Niacin
MoA
Effect on lipid profile
S/E
Example
Cholesterol absorption inhibitors
MoA
Effect on lipid profile
S/E
Example
Summary of lipid lowering drug effect on lipid profile
What can contribute to hypertriglyceridemia?
P/E for secondary hypertension
Indicators of secondary hypertension
Resistant HTN
Definition
Diagnosis
Treatment
Definition
Poor HTN control under 3 antihypertensive with 1 diuretic
HTN only controlled by ≥4 drugs
Diagnosis: Exclude pseudoresistance:
→ Adherence
→ Timing of drugs
→ Home and ambulatory BP
→ Exclude secondary hypertension
→ Identify confounding factors: diet, obesity, drugs
Treatment:
* Increase dosage of existing therapy
* Use second-line drugs: Aldosterone blockers, Loop diuretics
* Alter combination of therapy
Differentiate hypertensive emergency with hypertensive urgency
Hypertensive emergency (i.e. with TOD)
* BP >180/120 + worsening/new TOD
* Indication for acute BP control
* e.g. aortic dissection, pheochromocytoma, eclampsia
Hypertensive urgency (i.e. no TOD)
* Malignant HTN without TOD
* HT with grade III or IV retinal changes
* e.g. Hypertension with pre-op/ perioperative bleeding, Hypertension complicated by pregnancy, AMI, unstable angina
* e.g. Catecholamine excess or sympathomimetic overdose
Indications for immediate treatment of hypertension
Investigations for target organ damage due to hypertension
Indications for emergency BP reduction with IV treatments
