CVS Disease Presentation and Hypertension

Question 1

Cause of central chest pain

Answer 1

Myocardial ischaemia

Question 2

Nature of CVS chest pain

Answer 2

Retrosternal heaving/gripping
Radiation to L arm, neck
Then specific to condition

Question 3

Chest pain provoked by exertion, relived by rest

Answer 3

Angina

Question 4

Pain at rest

Answer 4

Acute coronary syndrome

Question 5

Tearing, radiating to back

Answer 5

Aortic dissection

Question 6

Sharp, worse with movement, relived sitting forward

Answer 6

Pericarditis

Question 7

What is dyspnoea commonly caused by?

Answer 7

LV failure

Oedema of the pulmonary interstitium = lungs less compliant

Question 8

Breathless lying flat

Answer 8

Orthopnoea

Question 9

Awake from sleep gasping for breath

Answer 9

Paroxysmal nocturnal dyspnoea

Question 10

Patient presentation of palpitations

Answer 10

Awareness of heartbeat. Ask patient to tap out rate and rhythm of beat

Question 11

Palpitions: Pause, followed by a forceful beat

Answer 11

Ectopic beats

Question 12

Palpitations: Sudden, racing heartbeat

Answer 12

Paroxysmal tachycardia

Question 13

What is syncope?

Answer 13

Loss of consciousness due to inadequate blood flow to brain

Question 14

Simple fainting due to the pooling of blood

Answer 14

Vasovagal attack

Question 15

Drop in systolic BP > 20 upon standing from sitting/lying

Answer 15

Postural hypotension

Question 16

Intermittent AV block/bradycardias

Answer 16

Arrhythmias

Question 17

What is peripheral oedema

Answer 17

Salt and water retention due to renal underperfusion resulting in RAAS activation and fluid overload

Question 18

Definition of HT

Answer 18

BP ≥ 140/90 mmHg

Question 19

Categories of HT

Answer 19

Stage 1 - 140/90
Stage 2 - 160/100
Stage 3 (severe) - ≥ 180/110
Malignant - diastolic pressure > 130

Question 20

What population are at a higher risk of HT?

Answer 20

Higher rates in black African and Caribbean people

Question 21

Causes of HT

Answer 21

Low birth weight, alcohol, smoking, dyslipidaemia, stress, diet - high salt and secondary HT causes

Question 22

Secondary HT causes

Answer 22

Cushing's syndrome (excess cortisol) and Conn's syndrome (excess aldosterone) 
Phaeochromocytoma (catecholeamine-secreting tumour)
Renal disease (diabetic nephropathy, glomerulonephritis)

Question 23

Symptoms of HT

Answer 23

Asymptomatic, sweating, headaches, palps, breathlessness

Question 24

Complications of HT

Answer 24

End-organ damage:
Cerebrovascular + coronary artery disease
Retinopathy
Kidney disease

Question 25

Examples of cerebrovascular + coronary artery disease due to HT

Answer 25

Stroke, MI

Question 26

Examples of retinopathy due to HT

Answer 26

AV-nipping, exudates, haemorrhages, papilloedema

Question 27

Examples of kidney disease due to HT

Answer 27

Uraemia, proteinuria, haematuria

Question 28

HT investigations

Answer 28

Urine test (protein, blood)
Fasting lipids and glucose
Funduscopy
ECG
ABPM/HBPM must be used to diagnose hypertension

Question 29

Process of ABPM

Answer 29

2 measurements per hour over 14 hours

Question 30

Process of HBPM

Answer 30

seated, 2 measurements 1 min apart, twice daily for 4-7 days, discard 1st day result, use average to diagnose

Question 31

Treatment of HT

Answer 31

Lifestyle

1. < 55: ACEI or ARB or If 55+ or AfroCar: CCB
2. Add on: ACEI/ARB + CCB
3. Add on: Thiazide(-like) Diuretic
4. If resistant: low-dose spironolactone (25 mg once daily)1 if blood potassium level <4.5 mmol/l

Question 32

Target BP for > 80yr

Answer 32

150/90

Question 33

Target BP for > 80 yr

Answer 33

140/90

Question 34

Target BP for diabetics/renal/CV disease

Answer 34

130/85

Question 35

Who should you not give ACEI or ARBs to?

Answer 35

Child-bearing age females

Question 36

Side effect of CCB

Answer 36

Ankle swelling

Question 37

Side effect of thiazide diuretic

Answer 37

Can cause gout