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BDS2 BAMS > Chronic Cardiovascular Diseases > Flashcards

Chronic Cardiovascular Diseases Flashcards

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1
Q

What is hypertension?

A

= raised BP

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2
Q

What are Systolic and Diastolic values for patient with hypertension?

A

= Systolic, >140mmHg
= Diastolic, >90mmHg

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3
Q

How do you diagnose high blood pressure?

A

= 3 separate measurements, sitting and rested

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4
Q

What are the risk factors for hypertension?

A

= age
race
obesity
alcohol
family history
pregnancy
stress
drugs (non steroidal, corticosteroids, oral contraceptives)

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5
Q

Which condition causes the biggest risk of hypertension?

A

A stroke= cerebrovascular accident

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6
Q

Name some of the key outcomes from Hypertension

A

= accelerated atherosclerosis
- MI
- Stroke
-Peripheral vascular disease
= renal failure (blood flowing at higher pressure and will damage the vessels which lead to the kidneys)

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7
Q

What are the common triggers of hypertension?

A

= None are usually found
=likely genetic failure of autoregulation of blood vessel wall constriction

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8
Q

Name some rare triggers for hypertension

A

= renal artery stenosis
= endocrine tumours
- phaeochromocytoma (adrenaline)
- conn’s syndrome (aldosterone)
- cushing’s syndrome (cortisol)

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9
Q

What is adrenaline ?

A

= a vasoconstrictor

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10
Q

how do aldosterone and cortisol work?

A

= increase circulating blood volume

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11
Q

what are the common signs and symptoms for hypertension?

A

= usually NONE
= may get headache
= may get transient ischaemic attacks (temporary disruption in the blood supply to part of the brain)

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12
Q

How does a phaemochromocytoma result in hypertension?

A

causes the adrenal gland to produce too much adrenaline therefore increasing a patients BP

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13
Q

How does cushing’s syndrome cause hypertension?

A

ACTH (adrenocorticotropic) tells the adrenal gland to make more cortisol

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14
Q

How does Conn’s syndrome cause hypertension?

A

= the adrenal glands make too much aldosterone

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15
Q

what some indications for further investigation (hypertension)?

A

= if the patient is young
= resistant hypertension despite adequate treatment
= accelerated hypertension
= ‘unusual’ history

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16
Q

What does cushing’s syndrome cause?

A

= salt and water retention
= leads to excess fluid within circulation

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17
Q

How can renal artery stenosis cause hypertension?

A

= narrowing of the blood flow into the kidney
= the kidneys think the BP has dropped therefore will produce aldosterone which will rapidly increase BP

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18
Q

How is renal artery stenosis treated? (medication)

A

ACE inhibitors

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19
Q

What do ACE inhibitors do in relation to renal artery stenosis?

A

Blocks angiotensin (enzyme causing arteries to narrow)
= widen the blood vessels to improve blood flow

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20
Q

What are the investigations for hypertension?

A

= urinalysis
= serum biochemistry
= serum lipids
= ECG

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21
Q

what is the ideal BP which hypertensive patients should aim for?

A

< 120/90 mmHg

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22
Q

Which risk factors should be modified when treating hypertension?

A

= weight loss
= exercise

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23
Q

Which drugs might you prescribe a patient to take once daily and why might you do this?

A

= thiazide diuretic
= beta blocker
calcium channel antagonists
ACE inhibitors

increase patient compliance

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24
Q

How often should you monitor a patient with hypertension?

A

= review at least annually when stable as the treatment will change overtime

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25
What is simple definition of heart failure?
output of the heart is incapable of meeting the demands of the tissues
26
What is high output failure and give 2 examples
= demands of the system have increased beyond the capacity of the pump = anaemia and thyrotoxicosis
27
What is low output failure and give an example
pump is failing and not strong enough to force liquid around the body = cardiac defect e.g. MI, valve disease
28
What side of the heart does most of the work
LEFT
29
Difference between diastole and systole
diastole = filling systole = pumping
30
What is the aetiology of low output failure?
= heart muscle disease = pressure overload = volume overload = arrhythmias = Drugs
31
Name 2 causes of heart muscle disease?
= MI = Myocarditis
32
Name 2 conditions which involve pressure overload?
= hypertension = aortic stenosis
33
Name 2 examples of volume overload?
= mitrial incompetence = aortic incompetence
34
What arythmias can cause low output failure?
= atrial fibrillation = heart block
35
Which drugs can cause low output failure?
= b blockers = corticosteroids = anticancer drugs
36
What are the signs and symptoms of left heart failure? and what 2 things are affected
=lungs and systolic effects = dyspnoea tachycardia low BP low vol. pulse
37
What are the signs and symptoms of right heart failure? and what is elevated
= venous pressure elevated = swollen ankles =ascites = raised JVP = tender enlarged liver = poor GI absorption
38
What is the difference between symptoms and signs?
symptoms = what the patient complains about signs = what we find on examination
39
What does JVP stand for? and where can the pulse be seen
Jugular venous pressure, pulse can be seen in veins on the neck
40
Name the symptoms of heart failure?
= shortness of breath = swelling of legs and feet = chronic lack of energy = difficulty sleeping at night due to breathing problems = swollen or tender abdomen with loss of appetite = cough with frothy sputum = increased at night = confusion and/or impaired memory
41
Which symptom of heart failure would be important for dentist to be aware of? and why does this occur
SHORTNESS OF BREATH = worse when patient lies flat - ask how many pillows they sleep with and if they feel as if they are choking/drowning during sleep
42
Common signs and symptoms of left sided heart failure?
=fluid in lungs = BP in lungs increases Cough- frothy sputum (air and fluid in lungs)
43
What causes ankle swelling?
= fluid accumulated in peripheral tissues from right sided failure
44
What is pitting oedema?
fluid accumulation in superficial tissues - can be squeezed out by pressure higher the pitting is found the worse the heart failure
45
What is the treatment for acute heart failure? what is administered to the patient
Emergency hospital management = patient is acutely short of breath and gasping. Lungs filled with fluid (oedema) =oxygen, morphine, frusemide
46
what is the treatment for chronic heart failure?
= improve myocardial function = reduce compensation effects = where possible treat the cause
47
What is frusemide and how can it be used for treatment of chronic heart failure?
= diuretics = make you pass urine and relieve ankle swelling and breathlessness caused by heart failure.
48
What is emergency heart failure treatment?
= acute heart failure presentation. Raised fluid pressure in lungs and fluid moves into lung alveoli- gas exchange is not possible. BREATHLESSNESS = treat with high dose diuretic to remove fluid and breathing returns to normal
49
What is the first line treatment for heart failure? (include examples)
First treat any underlying cause to see myocardial function level = hypertension = valve disease =heart arrhythmias atrial fibrillation = anaemia = thyroid disease
50
What treatment is carried out in chronic heart failure?
= drug therapy - diuretics to increase salt and water loss - ACE inhibitor - reduce salt/water retention - nitrates - reduce venous filling pressure - inotropes - digoxin
51
What medication should be stopped in the treatment of heart failure?
= stop negative inotropes- B BLOCKERS
52
What is a rare treatment of heart failure?
= assist pump = heart transplant
53
Why must heart valves be working efficiently?
= to allow flow of blood out and into the heart in one direction
54
Which 2 valves are under the most pressure
mitral and aortic valves
55
What 2 groups of people are more likely to have heart valve disease?
=elderly = downsyndrome
56
What 4 things can cause valve disease?
= congenital abnormality = MI = Rheumatic Fever = Dilation of the aortic root
57
What is an aneurysm?
a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.
58
What can cause dilation of the aortic root?
= syphilis = aneurysm formation
59
How can a MI cause valve disease?
= papillary muscle rupture
60
How can rheumatic fever cause valve disease?
= immunological reaction to streptococci
61
What congenital abnormality can cause valve disease?
bicuspid valve
62
Which of these valves can cause valve disease? and name both
RIGHT IMAGE (tricuspid aortic valve, bicuspid valve)
63
How many valves are there?
4
64
Name the 2 left valves
= aortic = mitral
65
Name the 2 right valves
= pulmonary = tricuspid
66
Which type of valves most commonly fail and what is this called?
=left side valves = aortic stenosis = mitral stenosis
67
What type of valves treat failure problems?
prosthetic valves
68
What is valve stenosis?
narrowing of the valve opening
69
How is valve disease investigated? (2)
= Ultrasound Scan = doppler ultrasound scan
70
What do the valves separate?
Ventricles from atrium
71
When is best to carry out a valve replacement
before there is evidence of heart failure to give highest long term success
72
If patients have mechanical valves, what type of medication are they usually on?
Anticoagulants
73
What is endocarditis ?
infection of the inner lining of the heart
74
What can reduce endocarditis infection risk?
= maximise oral health = be sensitive to patient and surgeon needs = be aware of international disagreement in this area
75
Compare metal valves to tissue valves?
= METAL -longer clinical life (up to 30 years) -require warfarin anticoagulant - consider antibiotic prophylaxis - make a ticking noise (upsets some patients ) = TISSUE - shorter clinical life (usually less than 10 years) -no need for anticoagulation - consider antibiotic prophylaxis - silent action
76
What 2 things should you remember with regards to prosthetic valves?
= anticoagulation = endocarditis prevention
77
3 things to ensure with regards to endocarditis prevention?
= remove causes of oral sepsis = improve patient's OHI = improve prevention of oral disease
78
What is a Tachy Arrhythmia?
FAST = atrial fibrilation = ventriculat tachycardia
79
Which drug can induce bradyarryhthmia - what pulse does this commonly cause
Beta blocker - 50bpm
80
What is pro-longed on an ECG for a patient with bradyarryhthmia
prolonged p-q interval
81
How does a heart block cause a bradyarryhthmia?
slow/no conduction through the AV node to ventricles of impulse from SA
82
How is a heart block classified (bradyarrythmia) ?
the length of signal delay = 1st 2nd and 3rd degree = 3rd degree is also termed complete heart block as no impulse passed to the ventricles

BDS2 BAMS (8 decks)

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