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MRCP Part 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Aetiology of primary HTN

A

Age main risk factor
Modifiable risk factors
- smoking
- alcohol
- sedentary lifestyle
- T2DM
- high salt diet
Genetic polymorphisms

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2
Q

How does T2DM increase HTN risk

A

Insulin increases Na retention

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3
Q

Genetic polymorphisms leading to HTN

A

Increased SNS activation
Increased RAAS activation
Endothelial system
- reduced nitric oxide
- increased endothelin-1
Naturietic system
Main problem is increased Na retention

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4
Q

How is RAAS system different in black people

A

Reduced activation
Renin levels at baseline lower

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5
Q

Why is age such a risk factor for HTN

A

Reduced elastin and increased collagen in aorta means stiff aorta so get isolated SYSTOLIC HTN

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6
Q

Causes of secondary HTN

A

Vascular (reduced renal perfusion)
- aortic dissection
- bilateral renal artery stenosis
Endocrine
- cushings
- phaeos and neuroblastomas
- raised oestrogen (PCOS and pregnancy)
- conns
- hypercalcaemia
- hypo/hyperthyroid
Renal parenchymal disease
- glomerulonephritis
- interstitial diseases (PCKD)
Drugs

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7
Q

Which drugs can cause secondary HTN

A

MAOi
COCP/HRT
NSAIDs
Cocaine

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8
Q

How can renal disease cause HTN

A

Impaired Na handling
Impaired handling components in NO and endothelin pathways

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9
Q

How does hypercalcaemia cause HTN

A

Ca a peripheral vasoconstrictor

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10
Q

Complications of HTN

A

Vascular
- atherosclerosis
- aneurysms
- aortic dissection
CKD
Hypertrophic heart
Brain
- lacunar infarcts
- aneurysms (large and small vessels)
Hypertensive retinopathy

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11
Q

What is arteriosclerosis vs atherosclerosis

A

Arteriosclerosis is general word for hardening of vessels
Atherosclerosis is hardening of vessels due to atheromatous plaques

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12
Q

How does HTN causes renal disease

A

Hyaline arteriosclerosis (arteries stiffened from increased hyaline production)
- in response to high pressure there is increased ECM production and get leakage of plasma contents into vessels

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13
Q

How does HTN cause lacunar infarcts

A

Hyaline arteriosclerosis of small vessels

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14
Q

How does HTN affect brain

A

Lacunar infarcts
Aneurysms of small and large vessels
Large vessel aneurysms, berry aneurysms, can lead to SAH
Small vessel aneurysms, charcot-bouchard aneurysms, can lead to intracerebral bleeds

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15
Q

What is name of small vessel aneurysms in brain

A

Charcot-bouchard aneurysms (lead to intracerebral bleeds)

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16
Q

What indicates secondary HTN over primary

A

Under 40
Refractory HTN
Severe nature
Sudden onset

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17
Q

What is malignant HTN and how classify

A

BP > 180/120
Hypertensive urgency (malignant HTN with no end organ damage)
Hypertensive emergency (malignant HTN with end organ damage evidence)

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18
Q

What can be symptoms of HTN

A

Visual disturbances
Neuro
- confusion
- headache
- seizures
Signs of MI/HF
- oedema
- chest pain etc

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19
Q

How investigate malignant HTN

A

Fundoscopy looking for papilloedema or retinopathy signs
ECG looking for LVH or MI
Urine dip looking for protein but ACR betterN

20
Q

NICE stages to HTN (clinic)

A

Stage 1= >140/90
Stage 2= >160/100
Stage 3= >180/110

21
Q

NICE stages to HTN (A/HBPM)

A

Stage 1= >135/85
Stage 2= >155/95

22
Q

Ambulatory vs home BPM

A

Ambulatory
- measures twice hourly in waking hours over 24 hours
Home
- measure twice a day over 4-7 days

23
Q

What tests do once diagnose HTN

A

ECG
Urine dip
Fundoscopy
Bloods
- U&Es
- HbA1c
- Lipid profile

24
Q

RAAS pathway

A

Angiotensinogen by liver is cleaved by renin to form angiotensin
Angiotensin cleaved to form angiotensin II by ACE
Angiotensin II binds to angiotensin receptors in adrenal zona glomerulosa to release aldosterone and also in vascular smooth muscles which causes vasoconstriction

25
Q

Where does angiotensin II bind

A

Zona glomerulosa in adrenal to form aldosterone
Vascular smooth muscle causing vasoconstriction

26
Q

What triggers renin release

A

Increased SNS innervation
Low sodium in juxtaglomerular apparatus
Low perfusion pressure

27
Q

What releases renin

A

Macula densa cells in juxtaglomerular apparatus

28
Q

Side effects of ACEi

A

Cough (bradykinin accumulation)
Angioedema (bradykinin is vasodilator -> oedema)
Postural drop from naturesis
Hyperkalaemia
Reduction in GFR

29
Q

How do ACEi affect kidneys

A

Dilates efferent arteriole which reduces glomerular pressure

30
Q

When are ACEi contraindicated

A

Bilateral renal artery stenosis
History of angioedema to ACEi
Pregnancy
Hyperkalaemia

31
Q

ARB side effects

A

Postural drop
Hyperkalaemia

32
Q

When give ACEi/ARBs in day

A

Evening as reduces postural drop

33
Q

What are 2 types of CCB

A

Dihydropyridines- amlodipine, nifedipine
Non-dihydropyridines- verapamil

34
Q

MOA of dihydropyridines

A

Block calcium into vascular smooth muscle leading to reduced vasoconstriction

35
Q

Side effects of dihydropyridine

A

Pedal odema
Flushing
Gingival hypertrophy
Reflex tachycardia

36
Q

Rare adverse effects of thiazides

A

Pancreatitis
Agranulocytosis

37
Q

What is difference between thiazides and thiazide like diuretics

A

Thiazides have benzothiadiazine core whereas thiazide like are sulphonamide derived

38
Q

MOA of thiazides

A

Secreted into PCT and act on DCT cells
Block Na-Cl symporter from tubule to interstitium therefore leading to naturesis

39
Q

How do thiazides increase serum uric acid concentrations

A

Compete with uric acid for channel to be secreted into PCT

40
Q

How do thiazides lead to hypocalcaemia

A

On tubule side of DCT, Na-Cl symporter is blocked
On interstium side is Na-Ca exchanger where Na brought into tubule cell
As Na conc low in tubule cell due to thiazide more calcium is exchanged out of cell for sodium meaning more influx of calcium form tubule

41
Q

Examples of thiazide vs thiazide like diuretic

A

Thiazide= bendroflumethazide
Thiazide like= indapamide, chorlatidone

42
Q

Blood gas of thiazide diuretic use and cause

A

Hypokalaemic metabolic alkalosis
If increased Na detected in urine then more K+ and H+ secreted into urine in collecting duct

43
Q

Metabolic side effects of thiazides

A

Hyponatraemia
Hypokalaemia
Hypocalcaemia
Hyperuricaemia
Hyperglycaemia
Hyperlipidaemia
Alkalosis

44
Q

Who are thiazides contraindicated in

A

Gout
Sulphonamide allergy as thiazide like diuretics are sulphonamide derivatives

45
Q

Rare adverse side effects of thiazides

A

Pancreatitis
Agranulocytosis

MRCP Part 1 (2 decks)

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