Chronic Cardiovascular Diseases Flashcards
What is hypertension?
= raised BP
What are Systolic and Diastolic values for patient with hypertension?
= Systolic, >140mmHg
= Diastolic, >90mmHg
How do you diagnose high blood pressure?
= 3 separate measurements, sitting and rested
What are the risk factors for hypertension?
= age
race
obesity
alcohol
family history
pregnancy
stress
drugs (non steroidal, corticosteroids, oral contraceptives)
Which condition causes the biggest risk of hypertension?
A stroke= cerebrovascular accident
Name some of the key outcomes from Hypertension
= accelerated atherosclerosis
- MI
- Stroke
-Peripheral vascular disease
= renal failure (blood flowing at higher pressure and will damage the vessels which lead to the kidneys)
What are the common triggers of hypertension?
= None are usually found
=likely genetic failure of autoregulation of blood vessel wall constriction
Name some rare triggers for hypertension
= renal artery stenosis
= endocrine tumours
- phaeochromocytoma (adrenaline)
- conn’s syndrome (aldosterone)
- cushing’s syndrome (cortisol)
What is adrenaline ?
= a vasoconstrictor
how do aldosterone and cortisol work?
= increase circulating blood volume
what are the common signs and symptoms for hypertension?
= usually NONE
= may get headache
= may get transient ischaemic attacks (temporary disruption in the blood supply to part of the brain)
How does a phaemochromocytoma result in hypertension?
causes the adrenal gland to produce too much adrenaline therefore increasing a patients BP
How does cushing’s syndrome cause hypertension?
ACTH (adrenocorticotropic) tells the adrenal gland to make more cortisol
How does Conn’s syndrome cause hypertension?
= the adrenal glands make too much aldosterone
what some indications for further investigation (hypertension)?
= if the patient is young
= resistant hypertension despite adequate treatment
= accelerated hypertension
= ‘unusual’ history
What does cushing’s syndrome cause?
= salt and water retention
= leads to excess fluid within circulation
How can renal artery stenosis cause hypertension?
= narrowing of the blood flow into the kidney
= the kidneys think the BP has dropped therefore will produce aldosterone which will rapidly increase BP
How is renal artery stenosis treated? (medication)
ACE inhibitors
What do ACE inhibitors do in relation to renal artery stenosis?
Blocks angiotensin (enzyme causing arteries to narrow)
= widen the blood vessels to improve blood flow
What are the investigations for hypertension?
= urinalysis
= serum biochemistry
= serum lipids
= ECG
what is the ideal BP which hypertensive patients should aim for?
< 120/90 mmHg
Which risk factors should be modified when treating hypertension?
= weight loss
= exercise
Which drugs might you prescribe a patient to take once daily and why might you do this?
= thiazide diuretic
= beta blocker
calcium channel antagonists
ACE inhibitors
increase patient compliance
How often should you monitor a patient with hypertension?
= review at least annually when stable as the treatment will change overtime
What is simple definition of heart failure?
output of the heart is incapable of meeting the demands of the tissues
What is high output failure and give 2 examples
= demands of the system have increased beyond the capacity of the pump
= anaemia and thyrotoxicosis
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
What side of the heart does most of the work
LEFT
Difference between diastole and systole
diastole = filling
systole = pumping
What is the aetiology of low output failure?
= heart muscle disease
= pressure overload
= volume overload
= arrhythmias
= Drugs
Name 2 causes of heart muscle disease?
= MI
= Myocarditis
Name 2 conditions which involve pressure overload?
= hypertension
= aortic stenosis
Name 2 examples of volume overload?
= mitrial incompetence
= aortic incompetence
What arythmias can cause low output failure?
= atrial fibrillation
= heart block
Which drugs can cause low output failure?
= b blockers
= corticosteroids
= anticancer drugs
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
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
What is the difference between symptoms and signs?
symptoms = what the patient complains about
signs = what we find on examination
What does JVP stand for? and where can the pulse be seen
Jugular venous pressure, pulse can be seen in veins on the neck
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
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
Common signs and symptoms of left sided heart failure?
=fluid in lungs
= BP in lungs increases
Cough- frothy sputum (air and fluid in lungs)
What causes ankle swelling?
= fluid accumulated in peripheral tissues from right sided failure
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
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
what is the treatment for chronic heart failure?
= improve myocardial function
= reduce compensation effects
= where possible treat the cause
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.
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
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
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
What medication should be stopped in the treatment of heart failure?
= stop negative inotropes- B BLOCKERS
What is a rare treatment of heart failure?
= assist pump
= heart transplant
Why must heart valves be working efficiently?
= to allow flow of blood out and into the heart in one direction
Which 2 valves are under the most pressure
mitral and aortic valves
What 2 groups of people are more likely to have heart valve disease?
=elderly
= downsyndrome
What 4 things can cause valve disease?
= congenital abnormality
= MI
= Rheumatic Fever
= Dilation of the aortic root
What is an aneurysm?
a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.
What can cause dilation of the aortic root?
= syphilis
= aneurysm formation
How can a MI cause valve disease?
= papillary muscle rupture
How can rheumatic fever cause valve disease?
= immunological reaction to streptococci
What congenital abnormality can cause valve disease?
bicuspid valve
Which of these valves can cause valve disease? and name both
RIGHT IMAGE
(tricuspid aortic valve, bicuspid valve)
How many valves are there?
4
Name the 2 left valves
= aortic
= mitral
Name the 2 right valves
= pulmonary
= tricuspid
Which type of valves most commonly fail and what is this called?
=left side valves
= aortic stenosis
= mitral stenosis
What type of valves treat failure problems?
prosthetic valves
What is valve stenosis?
narrowing of the valve opening
How is valve disease investigated? (2)
= Ultrasound Scan
= doppler ultrasound scan
What do the valves separate?
Ventricles from atrium
When is best to carry out a valve replacement
before there is evidence of heart failure to give highest long term success
If patients have mechanical valves, what type of medication are they usually on?
Anticoagulants
What is endocarditis ?
infection of the inner lining of the heart
What can reduce endocarditis infection risk?
= maximise oral health
= be sensitive to patient and surgeon needs
= be aware of international disagreement in this area
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
What 2 things should you remember with regards to prosthetic valves?
= anticoagulation
= endocarditis prevention
3 things to ensure with regards to endocarditis prevention?
= remove causes of oral sepsis
= improve patient’s OHI
= improve prevention of oral disease
What is a Tachy Arrhythmia?
FAST
= atrial fibrilation
= ventriculat tachycardia
Which drug can induce bradyarryhthmia - what pulse does this commonly cause
Beta blocker
- 50bpm
What is pro-longed on an ECG for a patient with bradyarryhthmia
prolonged p-q interval
How does a heart block cause a bradyarryhthmia?
slow/no conduction through the AV node to ventricles of impulse from SA
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
