Cardio Flashcards
What is hypertension?
Hypertension is a chronic medical condition in which the blood pressure is elevated > 140/90
What is essential hypertension vs secondary?
Primary hypertension = no medical cause is found.
Secondary - other cause
What are the signs and symptoms of hypertension?
Symptoms - usually asymptomatic - headaches - epistaxis - sweating Signs - elevated BP
What are the renal causes of hypertension?
Diabetic nephropathy
Chronic glomerulonephritis
Polycistic kidneys
Renal vascular disease
What drugs can cause hypertension?
NSAIDs
Oral contraceptives
Steroids
Liquorice
What are the endocrine causes of hypertension?
Conn’s syndrome
Phaeochromocytoma
Adrenal hyperplasia
Cushing’s syndrome
What are the risk factors for hypertension?
Lifestyle factors - diet, smoking, obeisty, alcohol, no exercise
age, sex, family history Ethnic group Diabetes Kidney disease High cholesterol
What is the non-pharmacological treatment for hypertension?
Reduce risk factors Lose weight Exercise Reduce salt Stop drinking/smoking
What is the pharmacological treatment for hypertension?
ACI/ARB (first line in under 55s)
CCB/diuretic above (or black/pregnant)
Combination therapy if needed
What are ACEIs?
Angiotensin converting enzyme inhibitors e.g. Ramipril, Captopril • Blocks the conversion of angiotensin 1 into angiotensin 2 which is a potent vasoconstrictor. S/E → Hypotension Dry cough
What are CCBs?
Calcium channel blockers e.g. Amlodipine, nifedipine • Causes arteriole dilatation and reduces the force of heart contractions S/E → Headaches >Sweating >Palpitations >Flushing
What are diuretics (used for hypertension)?
Thiazide type generally used
• Increases water secretion from the body by not absorbing Na therefore Na remains int he filtrate and water follows
S/E → Increases cholesterol levels
>Impaired glucose tolerance
What is malignant hypertension?
Malignant hypertension is a complication of hypertension characterized >very elevated blood pressure that occurs rapidly, >organ damage in the eyes, brain, heart and/or kidneys.
Systolic and diastolic blood pressures are usually greater than 220mmHg and 120mmHg, respectively.
What are the signs of malignant hypertension?
The eyes may show >papilloedema,
>retinal haemorrhage,
>or exudates
• The brain shows
>increased ICP,
• Patients will usually suffer from left ventricular dysfunction
• The kidneys will be affected,
> haematuria,
>proteinuria,
>and acute renal failure.
What is emergency blood pressure control?
Should not bring down the BP too quickly as there is a risk of cerebral, retinal, renal, MI complications
IV Sodium nitroprusside
IV iabetalol
What is angina?
Angina: radiating chest pain caused by insufficient blood flow to an area of the heart.
- STABLE: occurs upon exertion and fades with rest
- UNSTABLE: occurs suddenly and spontaneously with no exertion
What are the signs and symptoms of angina?
Symptoms
- Tight, dull heavy chest discomfort
- Retrosternal or radiating to the left arm, neck, back or jaw
- Breathlessness
- Nausea
- Epigastric discomfort that is not relieved with antacidsSigns
- Usually none!
- Hypercholesterolaemia (xanthalasma, corneal arcus)
- Anaemia (pallor, tachy)
- Thyrotoxicosis (carotid bruits)
- Hypertension
What is the pathogenesis of atheroma?
Increased lipid levels Inflammaotry process - infiltration of macrophages Macrophages form foam cells >Through uptake of mdified LDLs Forms fibrous cap >Reduces blood flow, can rupture
What is the content of atheromatous plaques?
Collagens (produced by smooth muscle cells) in cap provide structural strength
Inflammatory cells (macrophages, lymphocytes, mast cells) reside in fibrous cap: recruited from arterial endothelium
Soft “foamy” macrophages rim (foamy due to uptake)
What are the S&S of major hyperlipidaemia?
Conreal arcus (premature)
Tendon Xanthomata (knuckles, Achilles)
Xanthelasmata (fatty lumps in skin, often in arms)
Risk/premature/family history MI/athermoa
What are the risk factors for atheroma?
Male Smoking Drinking High cholesterol Obesity Diabetes Hypertension
How do you investigate agina?
ECG/exercise ECG
Myocardial perfusion scans
CT coronary angiogram
What drugs are used to manage angina?
Symptomatic - GTN spray
>Max 3 doses before ambulance should be called
Acute
>Long acting nitrates
Long term >Betablockers >Long acting nitrates >CCBs >K+ channel activators
What are the S&S of unstable angina?
Symptoms:
1) Occurs at rest
2) Severe and new onset
3) Crescendo pattern (more severe & prolonged)
Signs:
1) Heart sound
2) Basal crackles
3) Hypotension
4) Murmurs