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)
