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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Name 3 complications of hypertension

A
  • Aneursym
  • Vascular disease
  • Heart Disease
  • kidney failure
  • respiratory failure
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2
Q

Name three causes that could contribute to primary hypertension

A
  • genetic susceptibility
  • excessive sympathetic nervous system activity
  • abnormalities of Na/K membrane transport
  • high salt intake
    Abnormalities of RAAS
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3
Q

Name four causes of secondary hypertension.

A

C - coarctation of the aorta (narrowing)
R - renal disease and hypertension (chronic kidney disease, renal artery stenosis, glomerulonephritis)
E - endocrine causes (adrenal tumour, Cushing’s syndrome)
E - eclampsia (during pregnancy)
E - essential (primary - cause unknown)
P - pill (or other drugs eg. steroids, cocaine, amphetamines)

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4
Q

What clinical blood pressure requires acting upon?

A

> 140/90

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5
Q

At what clinical BP should anti-hypertensives be given immediately?

A

> 180/110

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6
Q

What is the name of the condition where BP is higher in clinical setting?

A

White coat hypertension

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7
Q

What actions should be carried out when a patient has clinical BP > 140/90?

A

Offer ambulatory BP monitoring (ABPM) and calculate risk of end organ damage

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8
Q

What actions should be carried out when a patient has clinical BP > 180/110?

A

Consider immediate anti-hypertensive drugs and referral. Offer Ambulatory BP monitoring and calculate risk of end organ damage.

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9
Q

Patient has ABPM of > 135/85 and end organ damage

A

Give anti-hypertensive

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10
Q

Patient has ABPM of > 150/95 but no end organ damage

A

Give anti-hypertensive

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11
Q

Patient has ABPM of > 135/85 but no end organ damage

A

Normotensive

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12
Q

Tests relating to hypertension

A
  • Ambulatory blood pressure monitoring or home BP
  • ECG or echo
  • Urinalysis
  • Eye exam
  • Fasting glucose
  • Serum cholesterol
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13
Q

Why would you do an ECG or echo on a patient with hypertension?

A

To detect left ventricular hypertrophy

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14
Q

Why would you do urinalysis on a patient with hypertension?

A

To detect proteinuria

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15
Q

Why would you do an eye exam on a patient with hypertension?

A

To detect retinopathy

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16
Q

What should be the goal BP in a patient with hypertension?

A

< 140/90 (or < 130/80 in diabetes)

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17
Q

Name three lifestyle changes for a patient with hypertension

A
  • stop smoking
  • low-fat diet
  • reduce alcohol intake
  • reduce salt intake
  • increase exercise
  • reduce weight (if overweight)
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18
Q

1st line drug for a white patient with hypertension aged under 55?

A

ACE-i (or ARB if not tolerant to ACE-i)

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19
Q

1st line drug for black patient with hypertension?

A

Calcium channel blocker OR Thiazide

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20
Q

1st line drug for white patient with hypertension aged over 55?

A

Calcium channel blocker OR Thiazide

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21
Q

Combination drug therapy for hypertension?

A
  • ACE-i AND calcium channel blocker OR diuretic.
  • ACE-i AND calcium channel blocker AND thiazide
  • Add spirolactone or high-dose thiazide. Check U+Es.
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22
Q

What is malignant hypertension?

A

A rapid rise in BP that leads to vascular damage

23
Q

What are the signs and symptoms of malignant hypertension?

A

Symptoms: headache, visual disturbance
Signs: severe hypertension (usually > 200/130), bilateral haemorrhages.

24
Q

Name 4 risk factors for atherosclerosis

A
  • age
  • smoking
  • high serum cholesterol
  • obesity
  • diabetes
  • hypertension
  • family history
25
Describe the mechanism of atherosclerosis
- initiated by injury to endothelium. - LDL passes into the cells, causing endothelial dysfunction - chemoattractants are released from the site of inflammation - Leukocytes accumulate and transmigrate into the vessel wall, leading to inflammation - these are fatty streaks (lipid laden macrophages, T cells) - progress to intermediate lesions (plus vascular smooth muscle, platelets, extracellular lipid) - progress to fibrous plaque which impede blood flow and are prone to rupture - rupture exposes collagen and necrotic material forms a thrombus
26
What is the definition of ischaemic heart disease?
imbalance between oxygen supply and demand in the myocardium
27
Causes of oxygen imbalance in ischaemic heart disease
- blood supply is impaired - myocardium has greater demand for blood supply - there is increased distal resistance - reduced oxygen-carrying capacity of blood
28
What is the most common cause of ischaemic heart disease?
Coronary atherosclerotic plaque that causes impairment of blood flow. Vessel diameter has to reduce by 75% before symptoms occur.
29
What percentage does a vessel have to be reduced by to cause symptoms in Ischaemic heart disease?
75%
30
What are the effects of ischaemia on the myocardium?
- reduced contractility | - damage the myocardial cells
31
What are the three features a patient has to have to be classed as typical angina?
- chest pain and discomfort (typically heavy central that can radiate up the arms, jaw and neck) - symptoms brought on by exertion - symptoms relieved by 5mins rest or using GTN spray
32
What is decubitus angina?
Angina that is precipitated by lying flat.
33
What is the difference between stable and unstable angina?
stable angina - induced by effort relieved by rest, good prognosis unstable angina - increasing frequency or severity, occurs on minimal exertion or at rest, increased risk of MI
34
What is variant angina?
Angina caused by coronary artery spasm, can occur in normal arteries
35
What tests would you do to assess someone with query angina?
ECG - usually normal, may show signs of past MI Examination - usually normal Blood tests - FBC, U+Es, lipids, HbA1c, thyroid function tests Consider Chest X-ray and echo
36
What secondary prevention measures should be used in patients with ACS?
- stop smoking - 75mg aspirin daily - address hyperlipidaemia - consider ACE-i
37
What is PRN symptom relief?
Pro re nata. When necessary symptom relief. e.g. GTN spray
38
Anti-anginal drugs?
1st line: B-blocker or Ca channel blocker | Other drugs: long-acting nitrates, ivabradine, ranolazine, nicorandil
39
What revascularisation should be given to patients with Ishcaemic heart disease?
- Percutaneous coronary intervention (PCI) | - Coronary Artery Bypass Graft (CABG)
40
What are the main management steps for patients with ischaemic heart disease?
- address exacerbating factors eg anaemia - secondary prevention - PRN symptom relief - Anti-anginal drugs - revascularisation
41
What is Acute Coronary Syndromes?
Unstable angina and myocardial infarctions. They share a common pathology of plaque rupture, thrombosis and inflammation.
42
Name 5 risk factors for ACS
Non-modifiable - age, gender, family history Modifiable - smoking, hypertension, diabetes mellitus, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use Controversial - stress, type A personality, left ventricular hypertrophy, increased fibrinogen, hyperinsulinaemia
43
What are the symptoms of ACS?
Acute central chest pain lasting >20 mins, often associated with nausea, sweatiness, dyspnoea, palpitations Can have MI that is silent.
44
Name 4 signs of ACS?
- distress - anxiety - pallor - sweatiness - pulse change - blood pressure change - 4th heart sound - signs of heart failure
45
What tests should be done on a patient to confirm ACS?
- ECG - STEMI or NSTEMI - chest X-ray - Blood tests - FBC, U+Es, glucose, lipids, cardiac enzymes - Echo - regional wall abnormalities
46
What is the urgent non-hospital management for ACS (NSTEMI or STEMI)?
M - morphine O - oxygen if sats <95% or breathless A - aspirin 300mg immediately N - nitrates (long-lasting)
47
What is the urgent hospital management of ACS?
- make diagnosis - bed rest - morphine - aspirin - oxygen therapy - restore coronary perfusion - anti-coagulation - B-blockers
48
What is the non-urgent management for ACS?
- symptom control - modify risk factors - optimise cardioprotective medications - revascularisation - manage complications - discharge
49
Should a patient who drives a lorry go back to driving immediately after discharge?
No. They should not continue driving, but they may be able to start again after functional tests.
50
What is the definition of heart failure?
When cardiac output is inadequate for the body's requirements
51
Name 4 causes of heart failure
- Ischaemic heart disease - hypertension - alcohol excess - cardiomyopathy - valvular heart disease - endocardial or pericardial causes
52
What are the two main types of heart failure?
- Heart failure with reduced ejection fraction (systolic failure) - Heart failure with maintained ejection fraction (diastolic failure)
53
Describe heart failure with reduced ejection fraction (systolic failure)
The ventricles do not contract normally, resulting in reduced cardiac output
54
Describe heart failure with maintained ejection fraction (diastolic failure)
The ventricles do not relax and fill normally, resulting in increased filling pressures

Phase 2a (2 decks)

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