Chronic CV Diseases - 1 Flashcards
What is hypertension?
raised blood pressure
What are the values for hypertension?
systolic >140mmHg
diastolic >90mmHg
What do ambulances measure?
mean arterial pressure
What are the risk factors for hypertension?
- Age
- Race
- Obesity
- Alcohol
- Family History
- Pregnancy
- Stress
- Drugs
What drugs cause hypertension?
- NSAIDs
- corticosteroids
- oral contraceptives
- sympathomimetics
What can hypertension do to atherosclerosis?
accelerates it leading to
* Myocardial Infarction
* Stroke
* Peripheral Vascular disease
What can hypertension do to the kidneys?
renal failure
What are rare triggers that cause hypertension?
- Renal Artery Stenosis
- Endocrine Tumours
- Phaeochromocytoma (adrenaline)
- Conn’s Syndrome (aldosterone)
- Cushing’s Syndrome (cortisol)
What is the most common reason hypertension occurs?
Likely genetic failure of autoregulation control of blood vessel wall constriction
What are the signs and symptoms of hypertension?
- Usually NONE
- May get headache
- May get Transient Ischaemic Attacks ‘mini strokes’ with full recovery in 24 hours
What are indications for further investigation?
- Young patient
- Resistant hypertension despite ‘adequate’ treatment
- Accelerated hypertension
- ‘unusual history’
What is phaeochromocytoma?
adrenergic tumour that releases adrenaline excess causing vasoconstriction
How does cushing’s syndrome cause hypertension?
Cortisol creates salt and water retention
How does renal artery stenosis cause hypertension?
narrowing of artery causes reduced blood flow which causes autoregulation to promote renin > RAAS to correct precieved low blood pressure
What are tests to diagnose hypertension?
- Urinalysis
- Serum Biochemistry
(electrolytes, urea & creatinine) - Serum Lipids
- ECG
occasionally - renal ultrasound, renal angiography, hormone estimations
What is the goal BP after treatment?
< 120/90 mm Hg
What are the treatments for hypertension?
- Modify risk factors - weight loss, exercise
- Single daily drug dose – thiazidediuretic, betablocker, calcium channel antagonist, ACE inhibitor
What are the individual side effects of the daily drugs?
- thiazidediuretic (gout)
- betablocker (worsen COPD & Asthma)
- Calcium Channel antagonist (gingival hyperplasia)
- ACE inhibitor (cough)
What is heart failure?
output of the Heart is incapable of meeting the demands of the tissues
What is high output failure and what are examples of it?
High output failure – demands of the system have increased beyond the capacity of the pump
* anaemia, hyperthyroidism
What is low output failure and what are examples of it?
Low output failure – pump is failing and not strong enough to force liquid around the body
* cardiac defect e.g. MI, valve disease
What are the sites of heart failure called?
- Left Heart Failure
- Right Heart Failure
- Congestive heart failure – both sides
What are the causes of low output failure?
Myocardial weakness (MI)
Pressure overload (hypertension)
Irregular heartbeat (arrythmias)
Drugs
What are the drugs that can cause low output heart failure?
anticancer drugs
corticosteriods
beta blockers
What are the symptoms and signs of heart failure (depending on side affected)?
Left Heart (lungs & systolic effects)
dyspnoea (shortness of breathe)
tachycardia (to compensate)
fatigue
low urine output (to maintain BP and as reduced BF in kidneys)
build up of fluid in lungs due to backing up
Right Heart (venous pressure elevated)
swollen ankles (due to backing up of blood)
ascites (fluid in abdomen)
raised JVP
tender enlarged liver (impaired blood flow to liver)
poor GI absorption
What is pitting oedema?
Fluid accumulation in superficial tissues – can be squeezed out of the way by pressure
The higher the ’pitting’ is found, the worse is the heart failure. Thigh > Calf > Ankle in severity
What is the acute treatment of heart failure?
emergency hospital management
* Patient is acutely short of breath and gasping. Lungs filled with fluid (oedema)
* Oxygen, morphine, frusemide (loop diureric to rapidly remove the fluid)
What are drugs used in treatment of chronic heart failure?
- Diuretics - increase salt and water loss
- ACE inhibitor - reduce salt/water retention
- Nitrates - reduce venous filling pressure
- Inotropes - digoxin
What drugs are stopped for heart failure?
negative inotropes - beta blockers
What is the less common treatment of heart failure?
assist pumps
heart transplant
What valves are under the highest pressure?
mitral and aortic valves
What are the causes of valve disease?
- Congenital abnormality
- Myocardial infarction
- Rheumatic Fever
- Dilatation of the aortic root (syphilis, aneurysm formation)
What is the usual congenital abnormality?
bicuspid aortic valve instead of tricuspid
What side valves most commonly fail?
aortic and mitral
What does valve stenosis cause?
narrowing of the valve opening
What are the tests done for valve disease?
ultrasound scan
doppler ultrasound scan
What is the treatment and when is it done?
prosthetic valve replacement
done before there is evidence of heart failure to give highest long term success rate
If the prosethetic is mechanical, what is also prescribed?
anticoagulants to avoid clots (warfarin)
What are the two types of valves?
tissue valve (porcine, pig)
metal valve
What valve lasts longer?
metal lasts up to 30 years
tissue lasts less than 10 years
What valve makes a noise?
metal causes a ticking noise
To avoid endocarditis risk what is sometimes given before valve replacement?
antibiotic prophylaxis
