HTN + Endocarditis Flashcards by Thomas Eraifej

Stages of HTN

Stage 1: Clinic BP > 140/90, ABP/HBP 135/85
Stage 2: Clinic BP > 160/100, ABP/HBP 150/95
Severe: Clinic BP > 180/110
Malignant HTN

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Malignant HTN definition

BP > 200/130

+ bilateral retinal haemorrhage / papilloedema

+/- Sx

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Sx of malignant HTN

Headache

Visual disturbance

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Hypertensive emergencies

Acute renal failure

Heart failure

Encephalopathy

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HTN investigations

24h ambulatory BP

Home BP

QRISK2

Urine: haematuria, Alb:Cr ratio

Bloods: FBC, U+Es, eGFR, glucose, fasting lipids

12 lead ECG

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When to Rx HTN

Severe HTN

Stage 2 after ABP/HBP

Stage 1 if QRISK2 10 yr risk > 20%

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Mx of HTN

1) ACEi or ARB if <55yrs, Calcium channel blocker(CCB) if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + Thiazide like Diuretic
4) (resistant hypertension) Add further diuretic or a/B blocker

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Treatment of malignant HTN

Controlled reduction in BP to avoid watershed stroke
Atenolol or long acting calcium channel blocker

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Causes of HTN

Primary

Renal

Endocrine

Drugs

ICP↑

Aortic coarctation

Fluid overload

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Renal causes of HTN

Renal artery stenosis

Glomerulonephritis

Autosomal dominant polycystic kidney disease

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Endocrine causes of HTN

Hyperthyroid

Cushing’s

Phaeochromocytoma

Acromegaly

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Drugs causing HTN

Cocaine

NSAIDs

OCP

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End organ damage in HTN (CANER)

1) Cardiac - IHD, L ventricular hypertrophy, Aortic/mitral regurg
2) Aortic - Aneurysm, Dissection
3) Neuro - Stroke, Encephalopathy
4) Eyes - hypertensive retinopathy
5) Renal - Proteinuria, CKD

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Fever + new murmur

Endocarditis until proven otherwise

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RFs for infective endocarditis

Dermatitis

IV injections

Renal failure

Prosthetic valves

Dental hygiene

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Causes of endocarditis

Bacteraemia

Fungi

SLE

Malignancy

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Libman-Sacks endocarditis

SLE associated endocarditis

Bacterial causes of infective endocarditis

Strep viridans

Staph aureus

Staph epidermis

Diphtheroids

HACEK

HACEK definition

Gram negative bacteria

Rare causes of endocarditis

HACEK bacteria

Haemophilus

Actinobacillus

Cardiobacterium

Eikenella

Kingella

Fungal causes of infective endocarditis

Candida

Aspergillus

Histoplasma

Septic signs of infective endocarditis

Fever

Sweats

Weight loss

Splenomegaly

Anaemia

Hand signs of infective endocarditis

Clubbing

Splinter haemorrhages

Osler’s nodes

Janeway lesions

Cardiac signs of infective endocarditis

New / changing murmur

Vegetations

Long PR

Emboli

Immune complex deposition signs of infective endocarditis

Vasculitis Glomerulonephritis Roth spots Splinter haemorrhages

Roth spots

Boat shaped retinal haemorrhages Pale centre

Diagnosis of infective endocarditis

Duke criteria: - 2 major or - 1 major + 3 minor - 5 minor

Major Duke criteria

Positive blood cultures Endocardium involvement: - Positive echo - or new valve regurgitation

Minor Duke criteria

Fever Predisposition Vascular / immunological signs Positive blood culture (doesn't meet major criteria) Positive echo (doesn't meet major criteria)

Predisposition to infective endocarditis

Cardiac lesion IVDU

Positive blood cultures for major Duke criteria

Typical organism 2 separate cultures

Mx of infective endocarditis

Abx - liaise with microbiologists and cardiologists Surgery

When to consider surgery for infective endocarditis

Heart failure Valvular obstruction Repeated emboli Myocardial abscess Unstable infected prosthetic valve

Prevention of infective endocarditis

Good oral hygiene Risks of tattoos / piercing NOT abx

Sx of aortic dissection

Tearing chest pain +/- Radiation to back May lead to reduced brain perfusion or acute limb ischaemia

Types of thoracic aortic dissection

Type A (70%) Type B (30%)

Type A aortic dissection definition

Involves ascending aorta

Type B aortic dissection definition

Does NOT involve ascending aorta

Mx of type A aortic dissection

Crossmatch 10 units blood Surgery

Mx of type B aortic dissection

Crossmatch 10 units blood Medical Hypotensives - keep systolic BP 100-110 Surgery