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Cardiovascular > Clinical lectures > Flashcards

Clinical lectures Flashcards

1
Q

What are the 4 CV risk factors?

A

High BP, Hypercholesterolemia, smoking, diabetes/obesity

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2
Q

What is the exogenous metabolite pathway?

A

Dietary impact–> conversion into chylomicrons–> broken down in liver–> LDL

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3
Q

What molecule is increased in expression through statin mechanism and what is the effect?

A

NO, vasodilation

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4
Q

What pathway do statins block?

A

conversion of HMG-CoA to Mevalonic acid

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5
Q

What are the 2 classifications of hypertension?

A

Essential (90% and idiopathic) and secondary

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6
Q

Name some of the diseases attributable to secondary hypertension

A

blindness, heart failure, aortic aneurysm, MI, coronary heart disease, stroke, preeclampsia

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7
Q

Name some drugs which lower BP and explain how they should be prescribed

A

Thiazides, Beta blockers, ACE, ARB

Many drugs with lose doses more beneficial than monotherapy

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8
Q

What is metabolic syndrome?

A

All major risk factors, life habit factors and emerging risk factors

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9
Q

What are the factors which influence metabolic syndrome?

A

abdominal obesity, triglycerides, HDL lowered, increased BP, increased fasting glucose

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10
Q

What are the treatments for Ischaemia at the target?

A

Antianginal medications: Beta blockers, Nitrates, Ca blockers
Revascularisation: Angioplasty, CABG

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11
Q

What are the treatments for Atherothrombosis at the target?

A

Aspirin, statin, beta blockers, ACE inhibitors, exercise, smoking cessation

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12
Q

What is the pathogenesis of Atherosclerotic plaques?

A

Epithelial damage–> Cellular adhesion molecule production–> Monocytes and T lymphocytes attack to “sticky” endothelial cells–> macrophages take up oxididised LDL–> Lipid rich foam cells–> fatty streak and plaque

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13
Q

When should ambulatory blood pressure monitoring be offered to confirm hypertension and what is the procedure?

A

If clinical BP is 140/90mmHg or higher. Measure twice an hour during waking hours

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14
Q

What are the definitions of stage 1 hypertension?

A

Stage 1- clinical BP 140/90 or higher, daytime 135/85

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15
Q

What are the definitions of stage 2 hypertension?

A

clinical BP- 106/100…..daytime ABPM is 150/95

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16
Q

What are the definitions of stage 3 hypertension?

A

clinical: 180/110

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17
Q

What is the “white coat effect”?

A

High clinical pressure and variable ABPM (daytime) BP

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18
Q

What is masked hypertension?

A

Low clinical BP but increasing ambulatory BP

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19
Q

How should CV an organ risk be assessed?

A

Test urine for protein
Measure glucose, electrolytes, creatinine, glomerular filtrate rate and cholesterol
examine fundi for hypertensive retinopathy (severe)
12 lead ECG

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20
Q

What are the risk factors of end organ damage?

A

Left ventricular hypertrophy
Creatinine Raised
Albuminuria/microalbuminuria
Retinopathy

21
Q

Name some established Vascular Diseases

A

Ischaemic heart disease, cerebra-vascular disease, peripheral vascular disease, diabetes

22
Q

What is hypertensive retinopathy?

A

When there are haemorrhages and hard exudates in the retina

23
Q

For people with the “white coat effect” what is the target BP?

A

below 135/85 in aged 80yrs

24
Q

What is fibromuscular dysplasia?

A

non-atherosclerotic, non-inflammatory vascular disease that causes abnormal growth within the wall of an artery and occurs in middle aged women. May be indicated by hypertension. Treat using angioplasty

25
Q

What hypertensive drugs should be used in those <55 as first line?

A

ACE inhibitors or ARB

26
Q

What hypertensive drugs should be used in those >55 as first line?

A

Ca antagonists

27
Q

What is Spironolactone and what can it be used to treat?

A

It is a slight anti-diuretic used to treat heart failure and hypertension

28
Q

What should be advised when prescribing Spironolactone?

A

Start at low doses due to risk of renal failure and hypocalcaemia

29
Q

What drugs should be avoided if a patient has gout?

A

Thiazide diuretics

30
Q

What is a characteristic indicator of gout?

A

high plasma urate

31
Q

What are diclfenac sodium tablets used to treat?

A

Rheumatoid arthritis

32
Q

What class of drugs should you NEVER use in asthma?

A

Beta blockers

33
Q

Why should swollen ankles in men be a warning sign?

A

Men don’t tend to get swollen ankles- mainly women

34
Q

What does having an MI increase the risk of heart failure?

A

MI leaves scar tissue which leads to loss of pumping action in the ventricle meaning that cardiac output is decreased

35
Q

What is the time frame from an MI to heart failure?

A

10mins-10years

36
Q

What drug treats hypertension but not heart failure?

A

Ca antagonist

37
Q

What drug should a post MI patient immediately be put on?

A

a statin

38
Q

When are nitrates used?

A

For angina but not hypertension

39
Q

When should aspirin be used post MI?

A

When BP is down

40
Q

What can microalbumunuria indicate and what damage has been caused?

A

hypertension or diabetes. Damage to the kidneys

41
Q

Name an extra risk factor in a hypertensive patient

A

Left ventricular hypertrophy

42
Q

What can be used to treat left ventricular hypertrophy both mono therapy and another drug?

A

ACE inhibitors and addition of Ca antagonist

43
Q

What is Cushing’s Syndrome and its associated features?

A

“Moon face” due to excessive production of cortisol. A tumour (corticol adenoma) could secrete large amounts of cortisol or it could be from glucocorticoids.

44
Q

Why should a patient with hypertension be assessed?

A

To assess target organ damage, to establish the cause and assess secondary hypertension, co risk factors for atheroma

45
Q

What are the key tests in a patient with suspected hypertension?

A

Protein, blood, glucose

46
Q

What are the biochemical tests in a patient with hypertension and why?

A

Hypokalemia- low serum potassium and is very suggestive of aldersteronism
Hyperuricaemia- usually high levels of uric acid, may reflect gout in those taking diuretics
Microaluminuria- abnormal levels of albumin in urine cannot be taken in a conventional urine test

47
Q

What should you look out for in an ECG when a patient has hypertension?

A

Ventricular hypertrophy and coronary artery disease

48
Q

When should surgery be considered in the treatment of hypertension?

A
  1. Renal artery stenosis by angioplasty
  2. Endocrine causes such as adrenal tumours
  3. Coarction of the aorta

Cardiovascular (8 decks)

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