Cardiovascular Flashcards
What BP reading would suggest a diagnosis of htn?
above 140/90
Secondary causes of hypertension
R – Renal disease
O – Obesity
P – Pregnancy-induced hypertension or pre-eclampsia
E – Endocrine
D – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice)
What is the clinical reading for:
Stage 1 htn
Stage 2 htn
Stage 3 htn
Stage 1 htn - Above 140/90
Stage 2 htn - Above 160/100
Stage 3 htn - Above 180/120
What is end organ damage?
Severe impairment of major body organs due to high blood pressure or states of low blood pressure or low blood volume.
How to assess for end organ damage?
Urine albumin:creatinine ratio for proteinuria
+
Dipstick for microscopic haematuria to assess for kidney damage
Bloods for HbA1c, renal function and lipids
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities, including left ventricular hypertrophy
Pharmacological Tx for htn
Step 1:
Aged under 55 or T2 diabetic use A.
(can use ARB is A not tolerated)
Aged over 55 or Black African use C.
Step 2:
A + C
Alternatively, A + D or C + D.
Step 3:
A + C + D
Step 4:
A + C + D + fourth agent (K level)
If serum potassium level:
< 4.5 mmol/L - spironolactone
> 4.5 mmol/L - alpha blocker (e.g., doxazosin) or a beta blocker (e.g., atenolol)
Note:
A – ACE inhibitor (e.g., ramipril)
B – Beta blocker (e.g., bisoprolol)
C – Calcium channel blocker (e.g., amlodipine)
D – Thiazide-like diuretic (e.g., indapamide)
ARB – Angiotensin II receptor blocker (e.g., candesartan)
What is the function of aldosterone?
Aldosterone’s primary function is to act on the late distal tubule and collecting duct of nephrons in the kidney, favouring sodium and water reabsorption and potassium excretion
What kind of medication is spironolactone and what is its mode of action?
Spironolactone is a potassium-sparing diuretic. It works by blocking the action of aldosterone in the kidneys, resulting in sodium excretion and potassium reabsorption.
It can be helpful when thiazide diuretics are causing hypokalaemia.
Describe the pathophysiology of A fib
SAN produces organised electrical activity that coordinates the contraction of the atria
A fib occurs when this electrical activity is disorganised
So contraction of the atria becomes uncoordinated, rapid and irregular.
Resulting in irregularly irregular ventricular contraction.
Uncoordinated atrial activity = stagnant blood in atria = thrombus formation = block cerebral artery = ischaemic stroke
How can A fib lead to an increased risk of stroke?
Uncoordinated atrial activity = stagnant blood in atria = thrombus formation = block cerebral artery = ischaemic stroke
Cx of A fib
S – Sepsis
M – Mitral valve (stenosis or regurg)
I – Ischaemic heart disease
T – Thyrotoxicosis
H – Hypertension
Sx of A fib
Palpitations
Shortness of breath
Dizziness or syncope (LOC)
ECG findings in atrial fibrillation?
Absent P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm
Tx of A fib (rhythm control)
If unstable: DC cardioversion
Long-term:
Beta blockers - 1st line
Dronedarone - 2nd line
Amiodarone - (if px have HF)
Tx of A fib (rate control)
Beta blocker first-line (e.g., atenolol or bisoprolol)
Calcium-channel blocker (e.g., diltiazem or verapamil) (not preferable in HF)
Digoxin (only in sedentary people with persistent atrial fibrillation or HF)
What is paroxysmal A fib?
Intermittent episodes of atrial fibrillation that reoccur and spontaneously resolve back to sinus rhythm. These episodes can last between 30 seconds and 48 hours.
What risk score is used to assess stroke risk in patients with A fib?
CHA2DS2-VaSc
C - congestive heart failure
H - hypertension
A -
age ≥75 (2 pts)
age 65 to 74 (1pt)
D - diabetes
S - stroke (doubled)
Va - vascular disease (MI, PAD etc)
Sc - sex category (female).
What is the surgical Tx for A fib is drug Tx unsuccessful?
Left atrial ablation - radiofrequency ablation (heat) is applied to burn the abnormal area of electrical activity in left atrium.
Atrioventricular node ablation and a permanent pacemaker - AVN ablation and pacemaker used to control ventricular contraction.
Plus use ANTICOAGs to prevent embolism:
1st line - DOACs
2nd line - warfarin
Define:
1. Left sided heart failure
2. Right sided heart failure
- The left ventricle of the heart is unable to pump blood effectively to the rest of the body.
- The right ventricle is unable to pump blood effectively to the lungs for oxygenation and therefore can lead to venous congestion as blood backs up into the veins.
Cx of:
1. Left sided heart failure
2. Right sided heart failure
- Coronary artery disease, high blood pressure, valvular heart diseases, myocardial infarction (heart attack)
- Consequence of left-sided heart failure, Pulmonary hypertension, Chronic lung diseases
Sx of:
1. Left sided heart failure
2. Right sided heart failure
- SOB on exertion.
Fatigue and weakness.
Persistent coughing or wheezing - frothy white/pink sputum.
Orthopnoea, SOB when lying flat.
Paroxysmal nocturnal dyspnoea
2.
Peripheral oedema.
Enlarged liver.
Ascites.
Jugular venous distension - inc JVP.
Chest X-ray findings for HF
A - alveolar oedema
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe lung
E - effusions (pleural)
What is GS Ix for HF
Echocardiogram
other Ix include:
N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test
ECG
Tx for HF
A – ACE inhibitor (e.g., ramipril) titrated as high as tolerated
B – Beta blocker (e.g., bisoprolol) titrated as high as tolerated
A – Aldosterone antagonist when symptoms are not controlled with A and B (e.g., spironolactone or eplerenone)
L – Loop diuretics (e.g., furosemide or bumetanide) - if they have severe oedema
How do NSAIDs cause HTN?
By blocking prostaglandins (prostaglandins cause vasodilation)
