HTN and Valves Flashcards
Renal causes of HTN?
Renal artery stenosis, chronic glomerulonephritis, pyelonephritis, polycystic kidney diseases, renal failure
Endocrine causes of HTN?
DM, hyperthyroidism, cushings, conns, hyperPTH, phaeochromocytoma, CAH, acromegaly
Drugs, cardio and pregnancy HTN causes?
Symphamomietics, corticosteroids and contraceptives
Coarctation of the aorta, increased intravascular volume
Pre-eclampsia
What counts as stage 1 HTN?
> 135/85
Treat if > 8- and any folloiwng CORD10
CVD Target Organ damage Renal disease Diabetes 10 year CV risk 10% or greater
What is stage 2 HTN?
> 150/95
Treat everyone regardless of age`
Describe first steps of HTN management?
<55 years old or T2DM = ACEi or ARB
Then A + CCB or A + Thiazide Diuretic
> 55 and no T2DM/black carribea n CCB
Then CCB + A or Ccb + diuretic
Joint pathway = A + C + D
What is the management after A + C + D?
If K+ <4.5mmol/L add spiromolactone
if >4.5mmol/L add alpha or beta blocker
Specialist review if not controlled on 4 drugs
What lifestyle changes to reduce HTN?
Diet with low salt and fruit/veg rich.
Stop smoking
Less alcohol and exercise/lose weight
SE of HTN drugs?
ACEi = COUGH, angioedema, hyperkalaemia
ARB = hyperkalaemia
CCB = Flushing, anfle oedema, headache and gum hyperplasia
Thiazide = Hyponatraemia, hypokalaemia, dehydration and ECG changes
Spironolactone = HYPERKALAEMIA AND GYNOACOMASTIA
Beta blockers = BRONCHOSPASM AND HEART FAILURE, lethargy
Contraindicators for ACEi?
Pregnant women and check renal function 2-3 weeks after starting to not worsen renal function
What is hypertensive emergency a nd examples?
BP>180/120mmHg
Target organ damage e.g. brain, eyes, heart and kidneys
e.g. CCF or encephalopathy (headache, CNS signs, seizures and coma)
Accelerated HTN: severe increase in BP with signs or retinal haemorrhage r pappiloedema associated with target organ damage
RFS: uncontrolled HTN< CKD< RAS, renal transplant, pregnancy, phaechromocytoma
MX: IV labetolol and specilaist review. Aim to reduce MABP by no more than 25% in 1st hour and ischaemia
Phaechromocytoma sx?
HTN, headaches, palpitations, tremors
Mx: alpha blockade then beta blockade
Grades of hypertensive retinopathy?
1 = tortosity with increased reflectiveness of retinal arteries (Siver wiring)
2= 1 + arteriovenous napping
3= 2+ Flames shape haemoorhage and cotton wool exudates
4 = 3 + pappiloedema
WHat is heard in diastole?
Mid-diastolic : mitral or tricuspid stenosis
Early (regurgitation) : aortic or pulmonary regurgitation
What is heard in systole>
Pan-systolic (regurgitation): tricuspid, MITRAL and ventricular septal defect
Mid-systolic = aortic stenosis
Late-systolic = valve prolapses
When left or right heard loudest?
lEft = Expiration
rIght = Inspiration
Symptoms of Aortic stenosis?
Exertional chest pain, SYNCOPE 40%, arrhythmia or postural hypotension
Asx
Symptoms of mitral regurgitation?
Decreased exercise tolerance, lower extremitry oedema
Asx
Tricuspid regurgitation symptoms?
Palpitations, irregular heart rhythm
Exertional or Asx
Aortic regurgation symptoms?
Dyspnoea (pulmonary oedema or progressive LV dysfunction) and weakness
?fatigue orthopnoea, palpitations, Asx
Mitral stenosis symptoms>
Dyspnoea (increased LA pressure -> pulmonary congestion)
?fatigue orthopnoea, palpitations, Asx
Causes of aortic stenosis?
Degenerative age-related calcification
Bicuspid aortic valve
Williams = congenital
Signs of aortic stenosis?
Slow-rising pulse, narrow pulse pressure
Heaving palpation, no apex displacement
Absent S2 and maybe reverse splitting S2
EJECTION SYSTOLIC MURMUR radiation to carotids and apex
Sit forward and hold breath on expiration to accentuate
Mitral regurgiation causes?
Degenerative age-related calcification
LV dilatation
Rupture of chordae tendinae
PAPPILARY MUSCLE RUPTURE
Signs of mitral regurgitation?
Normal/irreegularly irregular pulse
Lateral displaced apex beat
Pan-systolic murmur louest over mitral area radiating to axilla.
Listen in left lateral position with bell for low rumblling
Causes of tricuspid regurgitation?
RV dilatation, rheumatic fever, INFECTIVE ENDOCARDITIS. carcinoid syndtome and Ebstein anomaly
Signs of tricuspid regurgiation?
Raised JVP, parasternal heave
RHF signs: pleural effusion, hepatomegaly, ascites, pitting oedema, RV heave and visible/hepatic pulsations
Pan-systolic murmur heard over tricuspid region and on inspiration for loudest
What is Ebsteins anomaly?
Abnormal attachment of tricupid valve leaflets causes it to displace downwards into the RV
Causes of aortic regurgitation?
Ascending aorti arch dissection
Connective tissue disease e.g. Marfans/ehlers-dahlos
Signs of aortic regurgitation?
Quinckes sign (hands)
Wide pulse pressure
Collapsing/water hammer/corrigans pulse
Displaced apex beat
Early diastolic murmur heard best over LSE and aortic area (severe radiates to apex)
Sit forward and hold breath on expiration
What is an austin flint murmur?
Sign of severe aortic regurgitation
LSE radiates to apex
Low pitched rumbling mid-diastoli murmur
Aortic regurgitation emponymous sings?
Quinckes
Water hammer pulse
Corrigans (visible distention and collapse of carotid arteries)
De Mussets - head bobbing with heart beat
Beckers - visible retinal artery pulsations through fundoscope
Mitral stenosis causes?
RHEUMATIC HEART DISEASE Congenital left atrial myxoma Connective tissue disorder Mucopolysaccharidosis
Signs of mitral stenosis?
Malar flush
Thready pulse or irregularly irregular AF
Tapping apex and parasternal heave on palpation
Mid-diastolic murmur = loud 1st HS with opening snap
Listen in left lateral position with bell for low rumbling murmur
