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Internal Medicine > CARDIOLOGY -HYPERTENSION > Flashcards

CARDIOLOGY -HYPERTENSION Flashcards

1
Q

Definition of hypertension (CPG)

A

persistent elevation of systolic BP of 140mmHg or greater and /or diastolic BP of 90mmHg

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2
Q

Imagine if the patient have white coat hypertension or mask hypertension , so do you want to rule out ?

A

24-hour ambulatory blood pressure monitor

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3
Q

Mechanism for primary hypertension

A

a)Increase in sympathetic activity > release of epinephrine / norepinephrine
- this then will act on the HEART , KIDNEY ,VESSEL

b)Increase renin activity
> renin stimulate angiotensin

c) Increasing age
> older people have less elastin to be present within the blood vessels
> collagen deposition > rigidity > decreased compliance

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4
Q

Risk factors for hypertension

A

1)Old age
2) High insulin
3)High alcohol consumption
4)Lots of stress
5) High sodium diet
6) High Lipids
7)Sedentary lifestyle

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5
Q

Young age , sudden onset of and having refractory hypertension which means he or she did not respond to the first second and third drugs prescribed , what did you suspect ?

A

Secondary hypertension

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6
Q

When it comes to secondary hypertension , what is the big causes of it

A

Renal causes
-renal vascular problem ( renal artery stenosis and fibromuscular dysplasia )

-when there is reduction of renal blood flow , JG cells will detect this and release renin , renin will be converted into angiotensin II

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7
Q

How diabetic nephropathy cause hypertension?

A

reduction in GFR , trigger JG cells to release renin then renin stimulate angiotensin then increase sodium retention > hypertension

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8
Q

Target organs changes

A

Microvascular injuries : retinopathy , nephropathy ,vascular dementia

Macrovascular injuries : stroke , heart attack ( myocardial infarction )

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9
Q

Besides , renal causes what other causes can cause secondary hypertension?

A

Endocrine causes
-hyperthyroidism
-cushing syndrome

Cardiovascular causes
-coarctation of aorta
-takayasu arteritis

Respiratory causes
-sleep apnea

Drug-induced
-oral contraceptives
-erythropoietin
-steroids
-NSAIDs

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10
Q

What is the range for Stage 1 hypertension ?

A

140-159 SBP
90-99 DBP

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11
Q

What is the range for Stage 2 hypertension?

A

160-179 SBP
100-109 DBP

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12
Q

How do you want to access for target organ damage ?

A

Retinopathy - Funduscopy

Proteinuria - Urinalysis

Renal failure - Renal profile

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13
Q

What is the necessary investigations for hypertension ?

A

-FBC
-Blood glucose (Rfs : diabetes)
-Renal profile (TOC: renal failure)
-Fasting lipids (Rfs : high cholesterol)
-Uric acid
-Urinalysis (TOD : proteinuria)
-ECG (TOC : heart failure)

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14
Q

Management for Stage 1 Hypertension

A

-can be treated with monotherapy
-first line agents : ACEI , ARB , CCB , diuretic
-allow 6 weeks of treatment and reassess clinical improvement

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15
Q

If after a sufficient period of
treatment (up to six weeks) with monotherapy BP is still not controlled, what do you plan to do ?

A
  • increase the dose of the initial drug
    -substitute with another class of drug
    -second drug can be added
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16
Q

What is the first line therapy for stage 2 hypertension

A

should be started with combination of therapy

17
Q

Non pharmacological management

A

-Weight reduction
-Dietary sodium restriction < 2g/day
-Increase dietary fruits
-Limit alcohol intake
-Stops smoking

18
Q

What is your target BP ?

A

For all patients above 80 y/o : <150/90 mmHg

For patients below 80y/o : 140/90mmHg

19
Q

How about the follow up plan ?

A

-at six week after initiation of antihypertensive
-3-6 monthly once BP has been stable

20
Q

When do you want to refer your patients to Family Medicine Specialists ?

A

-severe hypertension
(>180/110mmHg)
-suspected secondary hypertension
-resistant and refractory hypertension

21
Q

What is the function of CHADVASC score ?

A

to calculate the stroke risk for patients with atrial fibrillation

22
Q

What is the component of CHADSVASC score ?

A

Congestive Heart Failure - 1 point
Hypertension - 1 point |
Age more than or equal to 75 - 2 points
Diabetes - 1 point
Stroke /TIA/Thromboembolism - 2 points
Vascular disease - 1 point
Age 65-74 - 1point
Sex category (Female) - 1 point

23
Q

What is the significant of CHADVASC score ?

A

The higher the score . the higher the risk of stroke

24
Q

How do you plan for the treatment based on CHADVASC score ?

A

0 point - low risk - consider no anticoagulation

1 point - low moderate - consider antiplatelet or even anticoagulation

2+ points - moderate -high - candidate for anticoagulation

Internal Medicine (14 decks)

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