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3rd year > Cardio core conditions > Flashcards

Cardio core conditions Flashcards

1
Q

What is the presenting complaint for a patient with unstable angina?

A

Angina with increased frequency , unpredictability or at rest
Pain lasts <20mins

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2
Q

What is the minimum amount of time for chest pain to last to consider the cause being a STEMI or an nSTEMI?

A

> 20mins

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3
Q

What will an ECG show in unstable angina?

A

May be normal

May show ST depression or T wave changes

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4
Q

What is acute coronary syndrome?

A

Unstable angina and an evolving MI (STEMI or NSTEMI)

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5
Q

What will an ECG show in a STEMI?

A

ST elevation

T wave inversion

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6
Q

What will an ECG show for an NSTEMI

A

ST depression or T wave inversion

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7
Q

What happens to troponin levels in UA, STEMI, NSTEMI?

A

UA: normal

STEMI and NSTEMI: elevated

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8
Q

What do the majority of patients with ST elevation develop?

A

Q wave MI

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9
Q

What are the the symptoms of an MI? 6

A 
1- chest pain >20mins often unresponsive to GTN spray
2-radiates to neck and down left arm 
3- nausea
4-sweating 
5- dyspnoea 
6-palpitations
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10
Q

How do elderly or diabetic patients present with an MI? 9

A 
1- dyspnoae 
2-fatigue
3-syncope
4-epigastric pain 
5-oliguria
6-pulmonary oedema 
7-acute confused state 
8-stroke 
9- diabetic hyperglycaemic attacks
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11
Q

What will the pulse feel like in an MI?

A

Thready= a weak pulse that is difficult to feel or obliterated easily with slight pressure

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12
Q

What happens to BP in MIs?

A

It decreases

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13
Q

What other signs will be seen in an MI (aside from low BP and thready pulse)? 5

A 
1- 4th heart sounds 
2- signs of heart failure= increased JVP, 3rd heart sound, basal crepitations 
3- pansystolic murmur 
4- later a pericardial friction rub 
5- later peripheral oedema may develop
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14
Q

What are the risk factors for an MI? 9

A 
1- age >65 
2- Male
3- Fh of IHD 
3- smoking 
4- hypertension
5- DM 
6- hyperlipidaemia 
7-obesity 
8- stress 
9- type A personality
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15
Q

What will an ECG show in a STEMI over time?

A

Hours: T wave peaks, ST segments may begin to rise

within 24 hours: T wave inverts as ST elevation begins to resolve

within a few days: pathological Q waves form, these usually persist

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16
Q

What will a CXR show in a MI?

A

Cardiomegaly
pulmonary oedema
widened mediastinum

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17
Q

What biochemical markers are tested for an MI? 3

A

Creatine kinase MB
Troponin
Myoglobin (useful for rapid diagnosis of ACS, but not specific- also found in muscles)

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18
Q

Why is creatine kinase tested less frequently now?

A

As there are low levles in the serum of normal people and people with skeletal damage, prolonged exercise, Afro-carribeans, hypothermia and hypothyroidism

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19
Q

Which parts of troponin are tested for in an MI?

A

mAB against troponin T

mAB against troponin I

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20
Q

What do each of the parts of troponin do?

A

T: attaches the complex to tropomyosin
C: binds calcium during excitation contraction coupling
I: inhibits the myosin binding site of the actin. Isn’t found in normal people

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21
Q

When do Troponin T levels peak and for how long post MI can they be detected?

A

12-24 hours

for a week

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22
Q

What are the criteria for MI diagnosis?

A

2/3 of:
chest pain/ typical history
ECG changes
cardiac enzyme ris

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23
Q

How do you manage high death risk patients with an MI?

A

urgent coronary angiography?

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24
Q

How do you manage low risk MI patients?

A

aspirin, clopidpgrel, beta blockers and nitrates

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25
Q

Whats the immediate treatment for MI patients?

A 
ROMANCE(E)
Reassure 
Oxygen 
Morphine + anti-emetic 
Aspirin- 300mg 
Nitrates- GTN 
Clopidogrel- 300mg 
Enoxaprin
ECG
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26
Q

Do you give thrombolysis to STEMI or NSTEMI patients?

A

STEMI

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27
Q

How do you manage STEMI patients?

A

Urgent-ish Percutaneous coronary intervention (PCI)= angioplasty
If this isn’t available then TPA (tissue plasminogen activator)/ streptokinase

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28
Q

How do you manage NSTEMI patients?

A

elective PCI after 48-72hrs stabilisation

Stabilisation= ACE-I, B-blockers, statin, LMWH

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29
Q

What are the complications of an MI? 9

A 
1-Heart failure- LVF
2- myocardial rupture and aneurismal dilation--> death 
3- ventricular septal defects
4- mitral regurgitation 
5-VF- common in STEMI and reperfusion 
6-AF 
7-sinus bradycardia (treat with atropine) 
8- bundle branch blocks 
9-Dressler's syndrome
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30
Q

What is Dressler’s syndrome and how do you treat it?

A 
recurrent pericarditis 
pleural effusions 
anaemia 
increased ESR 
Fever 
1-3 weeks post MI 
Rx= NSAIDs and steroids
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31
Q

What are the features of angina chest pain?

A

Heavy/tight/ gripping chest pain

can range from mild ache to very severe pain that –>sweating and fever
often associated with breathlessness

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32
Q

Where is the pain in angina?

A

Central/ retrosternal

radiates to jaw and left arm

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33
Q

What are the features of classical/exertional angina?

A

Triggered by exercise, especially after meal and in the cold

pain fades within minutes of rest

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34
Q

What are the features of decubitus angina? And what causes it?

A

Occurs when lying down

Linked with impaired L ventricle function due to severe CAD (coronary artery disease)

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35
Q

What are the features of nocturnal angina? And what causes it?

A

May wake patient
provoked by vivid dreams
occurs in pts with critical CAD

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36
Q

What are the features of Variant (prinzmetal’s angina)? What causes it? and is it more common in M or F?

A 
Angina without provocation 
usually at rest 
due to coronary spasm 
will have ST elevation during pain 
F>M
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37
Q

What is Cardiac syndrome X?

A

A good history of angina
+Ve exercise test but angiographically normal arteries
F>M
Myocardium shows abnormal response to stress

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38
Q

What are the features of unstable angina?

A

angina of recent onset <1 mnth

worsening angina or angina at rest

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39
Q

What are the signs of angina?

A

Usually no findings
4th heart sound may be heard
Look for signs of anaemia, thyrotoxicosis
Hyperlipidaemia- corneal arcus, xanthelasma, tendon xanthoma

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40
Q

What will an angiogram show in angina?

A

That collateral vessels have grown

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41
Q

What is the main cause of angina?

A

atherosclerosis

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42
Q

what investigations are done in angina?

A

Exercise ECG- confirms diagnosis and gives severity of CAD
Cardiac scintigraphy- myocardial perfusion scans at rest and exercise
CT coronary angiography- good for diagnosing CAD and excluding other causes e.g. PE, also for helping find out where exactly needs revascularisation

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43
Q

What prognostic therapy is available for angina?

A

75mg OD aspirin- decreases risk of coronary event in pts with CAD
Statin- if cholesterol >4,8

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44
Q

What is the symptomatic treatment for angina?

A

GTN spray- works in 5 mins, lasts for 20-30mins

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45
Q

What surgical options are there for angina?

A

Perutaneous transluminal coronary angioplasty (PTCA)-
dilating coronary artery stenosis using a balloon inserted through the femoral, radial or brachial artery

Coronary artery bypass grafting (CABG)-
autologous veins or arteries are anastomosed to the ascending aorta and to the native coronary arteries distal to the stenosis

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46
Q

What are the symptoms of AF? 6

A 
Highly variable 
30% asymptomatic
Chest pain 
palpitations 
dyspnoea
faintness 
some decrease in exercise capacity
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47
Q

What are the signs of AF? 2

A 
Irregularly, irregular pulse
Apical pulse (heard at heart) is greater than radial pulse
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48
Q

What are the causes of AF?

A 
Hypertension= most common cause 
Rheumatic heart disease 
alcohol intoxication 
thyrotoxicosis 
hyperthyroidism
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49
Q

What is paroxysmal AF?

A

recurring sudden episodes of symptoms

comes and goes within 7 days but usually <2

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50
Q

What is persistent AF?

A

Lasts >7days
Unlikely to revert back to normal without cardioversion treatment
Even with treatment it may return

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51
Q

What is permanent/ established AF?

A

present long term

Heart hasn’t reverted back to normal rhythm

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52
Q

What investigations should you do in AF?

A 
ECG 
TFTs 
U&amp;Es 
Cardiac enzymes 
Echocardiogram
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53
Q

What will an ECG of AF show?

A

Absent P waves
Irregular, rapid QRS
fast ventricular rate- 120-180 BPM

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54
Q

What might an echocardiogram show in AF?

A

L atrial enlargement
Mitral valve disease
structural abnormalities

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55
Q

How do you treat acute AF (<48 hrs)?

A 
Very ill and haemodynamically unstable--> 
O2 
Bloods 
Cardoversion- if available 
If not amiodarone
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56
Q

What do you give patients with paroxysmal AF to take PRN (as needed)?

A

Flecainide an antiarrythmic agent

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57
Q

Who do you offer ventricular rate control to in chronic AF?

A 
>65 
primary accepted AF 
persistent tachycardias 
failed previous cardioversion attempts 
AF >1yr 
On going reversible cause e.g. thyrotoxicosis
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58
Q

What is the ventricular rate control treatment in chronic AF?

A

B-blocker or Ca2+ channel blocker (diltiazem)

warfarin

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59
Q

How do you check if rate control treatment for chronic AF is working?

A

ECG in elderly

ambulatory 24hr holter monitor and exercise stress test in younger pts

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60
Q

When do you offer rhythm control therapy in AF?

A

If symptomatic
in CCF
younger pts presenting for the first time

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61
Q

What are the rythm control options?

A

Cardoversion:
DV shock
or IV infusion of flecainide or amiodarone} if structural abnormality

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62
Q

Are biphasic or monophasic shocks better in AF?

A

Biphasic

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63
Q

What is the main risk of AF and how is this managed?

A

Stroke

Warfarin or NOAC

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64
Q

What is the INR target in AF?

A

2.0-3.0

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65
Q

What are the indications for giving warfarin in AF?

A

1 of the major factors or 2 of the moderate ones:

Major:
Prosthetic heart valve
rheumatic mitral valve disease
history of CVA/TIA

Moderate: 
age >75yo
Congestive heart failure 
Hypertension 
Diabetes mellitus
66
Q

What is the CHADS2 score?

A 
To determine whether to give warfarin or aspirin in AF 
Congestive heart failure 
Hypertension 
Age >75 
DM 
Previous stroke/ TIA- scores 2 
score 0= aspirin 
score 1= use clinical judgement 
2= warfarin
67
Q

What are the symptoms of hypertension?4

A

often asymptomatic
sweating
palpitations
headaches

68
Q

What are the symptoms of severe hypertension? 5

A 
headaches
epistaxis 
nocturia 
SOB 
angina
69
Q

What is normal BP?

A

<120/<80

70
Q

What is pre HTN?

A

130-139 and/or 85-89

71
Q

What is grade 1 (mild) HTN?

A

140-159/ 90-99

72
Q

what is grade 2 (mod) HTN?

A

160-179/ 100-109

73
Q

What is grade 3 (severe) HTN?

A

> 180/ >110

74
Q

What will be seen in fundoscopy of grade 1 HTN?

A

Tourtuous renal arteries with increased reflectiveness (silver wiring)

75
Q

What will be seen in fundoscopy of grade 2 HTN?

A

Grade 1 + AV nicking

76
Q

What will be seen in fundoscopy of grade 3 HTN?

A

Grade 2 + splinter haemorrhages and soft exudates (cotton wool) due to infarcts

77
Q

What will be seen in fundoscopy of grade 4 HTN?

A

Grade 3 + pailloedema (blurring margins of optic disc)

78
Q

What are grade 3 and 4 HTN diagnostic of?

A

malignant hypertension

79
Q

Is HTn more common in F or M?

A

M

80
Q

What are the risk factors for HTN? 6

A 
Age 
obesity 
smoking 
alcohol
stress 
sodium/salt
81
Q

What are the metabolic causes/risk factors of HTN? 5

A 
DM 
Glucose intolerance 
decrease HDL 
hypertriglyceridaemia 
central obesity
82
Q

What are the congenital causes of HTN? 3

A

adrenal hyperplasia
aortic coarctation
II hydroxylase deficiency

83
Q

What are the renal causes of HTN? 5

A 
diabetic nephropathy 
chronic glomerulonephritis 
adult polycystic kidney disease 
chronic tubulointestinal nephritis 
renovascular disease e.g. renal artery stenosis
84
Q

What are the endocrine causes of HTN? 5

A

Conn’s syndrome (primary hyperaldosterone)

Adrenal hyperplasia

Phaeochromocytoma- tumour of the adrenal gland

Cushing’s syndrome- high cortisol

acromegaly

85
Q

Which drugs cause HTN? 4

A

The pill
NSAIDs
cyclosporine
steroids

86
Q

What are the signs of pre-eclampsia?

A

preganncy induced HTN + proetinuria

87
Q

What investigations should you do in HTN?

A

ECG
urine dipstick- protein and blood
Fasting blood for lipids (total and HDL) and glucose
serum urea
creatinine and electrolytes
CXR- if coarctation of the aorta is suspected

88
Q

When do you not treat severe HTN?

A

if it’s malignant

89
Q

when do you treat moderate HTN?

A

If CV complications
DM
Target organ damage
Once HTN has been confirmed over 4 weeks

(if mild HTN do the same but confirm over 12 weeks)

90
Q

Who is likely to have low-renin HTN?

A

Black pts and >55yo

91
Q

What is the first line Rx for <55s?

A

ACEis e.g. inopril, benazepril, captopril

If this isn’t tolerated the ARBs e.g. candesartan, losartan

92
Q

When do you use ARBs preferentially?

A

Chronic kidney disease

93
Q

What is the first line for black pts and >55s?

A

Calcium channel blockers e.g. amlodipine, diltiazem

or Thiazide diuretics e.g. hydochlorothiazide, chlorthalidone

94
Q

What is the second line therapy for anyone with HTN?

A

ACEIs+ thiazide diuretics

or ACEIs+ Ca channel blockers

95
Q

What are the complications of HTN?

A 
Cerebrovascular disease
CAD 
prone to renal failure 
Peripheral vascular disease
PAD
96
Q

What are the symptoms of a DVT? 7

A 
65% asymptomatic 
Calf pain 
swelling 
redness 
warmth 
engorged superficial veins 
ankle oedema
97
Q

What is Homan’s sign?

A

Dorsiflexion of the foot in the presence of a DVT –> calf pain
Shouldn’t be done as may dislodge the clot

98
Q

What happens if a DVT completely occludes the vein?

A

cyanotic discolouration

severe oedema

99
Q

What does chronic venous obstruction in DVT lead to?

A

single swollen limb and may lead to ulceration= post phlebitis syndrome

100
Q

where do the majority of DVTs occur?

A

in deep veins of the legs around the valves

101
Q

What are the majority of the thrombi?

A

Red cells + fibrin= red thrombi

102
Q

what are the risk factors for DVT? 19

A
  • varicose veins
  • age
  • obesity
  • stasis
  • pregnancy
  • thrombophilia
  • Any blood clotting disorder eg. thrombphilia, protein C or S deficiency, factor V leiden etc
  • Sickle cell anaemia
  • recent MI or stroke
  • IBD
  • nephrotic syndrome
  • central venous catheter
  • paroxysmal nocturnal haemoglobinuria
  • paraproteinaemia
  • myeloproliferative disorders
  • resp failure
  • surgery
  • malignancy
  • trauma
103
Q

What does a negative D-dimer test show?

A

rules out thrombosis

104
Q

What should be done following a positive D-dimer test?

A

Compression USS of leg

Lung scintigraphy/CT

105
Q

What might cause false positives of D-Dimer tests? 8

A 
Liver disease
high rheumatoid factor 
inflammation 
malignancy 
trauma 
pregnancy
recent surgery 
age
106
Q

When should you do a thrombophilia test in DVT?

A

If there are no known risk factors
if they have recurrent DVTs
or FH of DVTs

107
Q

How do you treat DVTs?

A

LMWH then warfarin
LMWH is kept until INR is in the correct range (2-3 normally)
Warfarin is normally continued for 3 months

108
Q

What happens in LV failure?

A

decreased cardiac output and increased pulmonary venous pressure

109
Q

What are the symptoms of LV failure? 10

A 
Productive cough- frothy or blood tinged mucus 
decreased urine output 
sleep with several pillows- reduce SOB 
fatigue, weakness, faintness 
Irregular or rapid pulse 
palpitations 
SOB
paroxysmal nocturnal dyspnoea 
fluid retention 
Displaced apex beat
110
Q

What are the signs of LV in infants? 3

A

failure to thrive
weight loss
poor feeding

111
Q

What are the two types of LVF?

A

Systolic and diastolic

112
Q

What happens in systolic LVF?

A

The left ventricle loses it’s ability to contract normally.

The heart can’t pump with enough force to push enough blood into circulation

113
Q

What happens in diastolic LVF?

A

The LV can’t relax (muscles are stiff).

Heart can’t properly fill with blood during the resting period between each beat

114
Q

What are the causes and risk factors of LVF? 7

A 
Alcohol 
MI 
Myocarditis 
hypertension 
hypothyroidism 
narrowed or leaking heart valves 
Children- congenital causes
115
Q

What investigations should you do in LVF? 7

A 
TFTs
LFTs 
Kidney function 
coronary angiogram 
ECG 
heart stress test 
echocardiogram
116
Q

What is are the consequences of LVF? 3

A

RVF
pulmonary oedema
circulatory collapse

117
Q

What is backward cardiac failure?

A

Ventricle fails to pump blood rapidly enough to prevent the atria from overfilling
–> backpressure in the pulmonary system rises

118
Q

What is forward failure>

A

Ventricles fail to pump enough blood to maintain normal circulation
–> Renin-angiotensin system retains sodium and water

119
Q

What causes acute failure?

A

happens within mins of an MI, often due to valvular collapse

120
Q

What is a common cause of chronic RH failure?

A

Mitral stenosis

Chornic obstructive lung disease= Cor pulmonale

121
Q

What is a common cause of chronic failure?

A

ischaemia

122
Q

Which occurs first LVF or RHF?

A

LHF

123
Q

What is low output cardiac failure?

A

decreased cardiac output that fails to increase normally on exercion

124
Q

What are the symptoms of RHF? 5

A 
Increase JVP (due to tricuspid regurg)
Gravitational oedema- ankle oedema, sacral if lying down 
Hepatic congestion= nutmeg liver 
--> ascites 
RV parasternal heave
125
Q

What are the signs of CCF? 8

A 
elevated JVP 
tachycardia at rest 
tachypnoea 
hypotension
bi-basal end-inspiratory crackles/ wheeze
ankle oedema 
ascites 
tender hepatomegaly- in triscupid regurg
126
Q

What is the most common causes of CCF?

A

Coronary heart disease and hypertension

127
Q

What are the cardiac causes of CCF? 4

A

valvular heart disease
Coronary heart disease
MI
ischaemia

128
Q

What drugs can cause CCF? 4

A

B-blockers
Calcium antagonists
anti-arrhythmics
cytotoxics

129
Q

What are the endocrine causes of CCF? 6

A 
DM 
Hypo and hyperthryoidism 
Cushing's 
adrenal insufficiency 
excessive growth hromone 
phaeochromocytoma
130
Q

What are the nutritional deficiencies that can cause CCF? 3

A

Thiamine
selenium
Carnitine

131
Q

What are the infiltrative causes of CCF? 5

A 
Sarcoidosis 
amyloidosis 
haematochromatosis 
Loffler's eosinophilia 
connective tissue disease
132
Q

What are the infective causes of CCF? 2

A

Chaga’s disease

HIV

133
Q

What are the causes of high output failure? 6

A 
anaemia
pregnancy 
hyperthyroidism 
Paget's bone disease
arteriovenous malformations
Beri-Beri
134
Q

What investigation should be done in CCf with previous MI?

A

Doppler echocardiograpphy within 2 weeks

If there is no obvious abnormality test serum natriuretic peptides

135
Q

What investigations should be done in CCF? 16

A

b-type natiruretic peptide (BNP)
N-terminal pro-BNP (NT-proBNP)
^ both are released into blood when myocardium is stressed

12 lead ECG

Echocardiography- if raised BNP or NT-proBNP or abnormal ECG

FBC, U&Es, creatinine, fasting lipids, glucose, TFTs

Cardiac enzymes if MI possible

CXR

Urinalysis

Lung function tests

Cardiac MRI

exercise testing

Ct angiography

136
Q

What will a CXR show in CCF? 7

A 
Cardiomegaly 
Ventricular hypertrophy 
prominent upper lobe veins 
peribronchial cuffing 
Diffuse interstitial or alveolar shadowing- bats wings 
Fluid in fissures 
pleural effusions
137
Q

How do you treat stage a, high risk with no symptoms, CCF?

A

reduce risk factors
treat hypertension, DM, dyslipidaemia
May star ACEis or ARBs in some

138
Q

How do you treat stage B, structural heart disease no symptoms?

A

ACEis or ARBs in all patients

B-blockers in selected ones

139
Q

How do you treat stage C, structural disease previous or current symptoms?

A 
ACEis and ARBs in all patients 
Dietary Na restriction 
Diuretics 
digoxin (if they have AF)
Cardiac resynchronisation if they have bundle branch block
revascularisation 
Mitral valve surgery
140
Q

What is the most prevalent valvular disease?

A

aortic stenosis

the mitral regurg, aortic regurg, mitral stenosis

141
Q

What are the causes of aortic stenosis? 3

A

Degenerative
congenital
rheumatic

142
Q

What are the causes of aortic regurg? 5

A 
congenital 
rheumatic 
infective endocarditis 
aortic dissection 
Marfan's3
143
Q

What are the causes of mitral stenosis?4

A

mainly rheumatic
malignancy
rheumatoid arthrtis
SLE

144
Q

What are the causes of mitral regurg? 6

A 
Mitral valve prolapse 
rheumatic fever 
infective endocarditis 
IHD 
Marfan's 
SLE
145
Q

What are the risk factors for valvular disease? 3

A

age
IHD
heart failure

146
Q

Which of AS, AR, MS and MR are more in common in M or F?

A

AS and MR= M (Mr looks like mister)

AR and MS and rheumatic heart disease= F

147
Q

What are the signs and symptoms of atrial stenosis? 6

A 
Angina 
exertional syncope 
exertional dyspnoea 
small and slow rising pulse 
4th heart sound 
Ejection systolic murmur radiating to both carotids
148
Q

What are the signs and symptoms of atrial regurgitation? 6

A 
exertional dyspnoea 
paroxysmal nocturnal dyspnoea 
orthopnea
collapsing pulse 
pistol shots heard over femoral artery 
De Musset sign- head nodding with every heart beat
149
Q

What are the signs of mitral stenosis? 10

A 
Dyspnoea 
cough 
haemoptysis 
chest pain 
systemic embolism 
AF 
raised JVP 
diastolic thrill 
Mid diastolic murmur- opening snap and low pitched rumbling
150
Q

What are the signs of mitral regurgitation? 3

A

Dyspnoea
Pansystolic murmur
Systolic click due to mitral valve prolapse

151
Q

What investigations should you do in valvular disease?

A

ECG-
AF can complicate valvular lesions and worsen symptoms in AS and MS
AS shows LV hypertrophy

CXR
-may show cardiomegaly or pulmonary congestion

152
Q

What is the commonest organism to cause infective endocarditis?

A

Strep viridans

153
Q

What other organisms cause infective endocarditis? 3

A

enterococci
staph A
epidermidis

154
Q

What are the risk factors for infective endocarditis? 6

A 
Poor dental hygiene 
IVDU 
soft tissue infection 
dental treatment 
cannulas 
Heart surgery
155
Q

What are the symptoms of infective endocarditis? 15

A

Fever + new murmur= infective endocarditis until proven otherwise

Septic signs:
Fever
rigors 
night sweats 
weight loss 
anaemia 
splenomegaly 
clubbing

Embolic events e.g. RHS may –> pulmonary abscess

Haematuria
glomerulonephritis

janeway lesions
Osler’s nodes
splinter haemorrhages
Roth spots

156
Q

What investigations should be done in infective endocarditis?

A

FBC- normocytic, normochromic anaemai and leucocytosis

U&Es- renal dysfunction common in sepsis

LFTs
CRP
ESR- all raised

Urine dipstick- haematuria, proteinuria

CXR- HF or in RHS pulmomnary emboli or abscess

Echo

157
Q

How do you manage infective endocarditis?

A

Long course 4-6weeks ABx:
Penicillins
or vancomycin or teicoplanin if allergic

Surgery if: 
in HF 
valve obstruction 
repeated emboli 
fungal endocarditis 
persistent bacteraemia
myocardial abscess 
unstable prosthetic valve
158
Q

What is postural hypotension?

A

Drop in systolic BP >20mmHg or diastolic >10mmHg after standing for 3mins

159
Q

What causes postural hypotension? 9

A

Hypovolaemia- early sign

Drugs:
nitrates
diuretics
antihypertensives

Addison's disease
Hypopituitarism- decrease in ACTH 
DM 
Multisystem atrophy 
idiopathic orthostatic hypotension
160
Q

When is postural hypotension worse?

A

After prolonged bed rest

and in the mornings

161
Q

How do you do a lying and standing BP?

A

Lie patient down for 5 mins - take BP

stand for 1 min- Take BP

3rd year (9 decks)

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