Cardiovascular 1

Question 1

Name the three layers of the heart

Answer 1

[From inside out] Endocardium, Myocardium and Pericardium (made up of viseral layer, pericardial cavity, parietal layer and fibrous pericardium)

Question 2

Name the three layers of a blood vessel

Answer 2

[From inside out] Tunica Intima, Tunica Media and Tunic Adventitia/Externa

Question 3

Name some structural differences between arteries and veins

Answer 3

Arteries transport blood away from the heart
Veins carry blood towards the heart.

Arteries = high pressure
Veins = Low pressure

Both have three layers

Arteries = narrow lumen
Veins = wider lumen

Arteries have a thicker tunica media (more elastic tissue)

Veins have valves to control blood flow

Question 4

Initial investigations for hypertension?

Answer 4

Rule out secondary causes of HTN

Calculate Cardiovascular Disease Risk (QRISK)

Urinalysis: Test for the presence of proteinuria and haematuria and urine sample for Albumin:Creatinine ratio

Bloods: FBC, HbA1C, Haematocrit, eGFR, Lipid profile, TFTs, U&Es

Fundoscopy (hypertensive retinopathy)

Arrange for a 12-lead ECG

Question 5

What organs are affected by chronic hypertension?

Answer 5

Heart, Brain, Kidneys, Eyes, Peripheral arteries

Question 6

Examples of end organ damage/disease?

Answer 6

Renal failure/End stage kidney disease, Left ventricular hypertrophy, Heart failure, Myocardial infarction

Question 7

Factors that can increase blood pressure?

Answer 7

Obesity, Race, Insulin resistance, High alcohol intake, High salt intake, Smoking, Aging, Sedentary lifestyle, Low potassium and low calcium intake.

Question 8

According to NICE Guidance, what blood pressure measurements confirms a diagnosis of hypertension?

Answer 8

Clinic BP - 140/90 or higher AND A/HBPM average of 135/85 or higher

Question 9

What is an ACE inhibitor? Explain it’s MOA

Answer 9

Works by blocking Angiotensin Converting Enzyme (ACE), which normally contributed to Angiotensin II production.

Angiotensin II is a vasoconstrictor and triggers water retention which both contribute to increasing blood pressure.

Question 10

Hypertensive patient who is African/Caribbean - what is the first line antihypertensive medication?

Answer 10

Calcium Channel Blocker, e.g. Amlodipine

Question 11

Common side effect of Calcium Channel Blockers?

Answer 11

Ankle swelling/oedema

Question 12

Caucasian hypertensive patient who is over 55 years old - what is the first line antihypertensive medication?

Answer 12

Calcium Channel Blocker, e.g. Amlodipine

Question 13

African/Caribbean, currently taking Amlodipine for HTN. HTN not under control - what are the two options for add-on antihypertensive medication?

Answer 13

CCB + ARB
OR
CCB + Thiazide-like Diuretic

Question 14

Caucasian, under 55 and currently taking Ramipril for HTN. HTN not under control - what are the two options for add-on antihypertensive medication?

Answer 14

ACEi + CCB
OR
ACEi + Thiazide-like Diuretic

Question 15

A patient who is under 80 years old has persistent hypertension. According to NICE Guidance, drug treatment should be considered when the patient has one for more of the following (5)…

Answer 15

1. Estimated CVD risk of 10% or more
2. Target organ damage
3. Established cardiovascular disease
4. Renal disease
5. Diabetes

Question 16

When treating hypertension, what is the target blood pressure measurement to maintain if the patient is UNDER 80 years old, according to NICE Guidance?

Answer 16

Below 140/90 mmHg

Question 17

When treating hypertension, what is the target blood pressure measurement to maintain if the patient is OVER 80 years old, according to NICE Guidance?

Answer 17

Below 150/90 mmHg

Question 18

Why is blood pressure measured on both arms at the first visit?

Answer 18

To find three major health conditions:

Coarctation of the aorta

Subclavian artery stenosis

Thoracic aortic dissection