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Cardiovascular Year 1 > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is primary/essential hypertension?

A

Means that the hypertension has developed on its own and does not have a secondary cause

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2
Q

What are the secondary causes of hypertension?

A

Renal disease
Obesity
Pregnancy Induced hypertension/preclampsia
Endocrine conditions

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3
Q

What is the most common secondary cause of hypertension?

A

Renal disease especially renal artery stenosis

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4
Q

What are the figures for stage 1 hypertension?

A

Clinic BP >= 140/90 mmHg

ABPM/HBPM BP >= 135/85 mmHg

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5
Q

What are the figures for stage 2 hypertension?

A

Clinic BP >= 160/100 mmHg

ABPM/HBPM BP >= 150/95 mmHg

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6
Q

What are the figures for stage 3 hypertension?

A

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

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7
Q

What lifestyle factors can be done to manage hypertension?

A 
Low salt diet
Caffeine intake reduced
Stop smoking, 
Drink less alcohol
Eat a balanced diet 
Exercise more
Lose weight
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8
Q

When should stage 1 hypertension be treated?

A

Treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater

Consider drug treatment in addition to lifestyle advice for adults aged under 60 and an estimated 10-year risk below 10%. ‘.

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9
Q

When should stage 2 hypertension be treated?

A

Offer drug treatment regardless of age

For patients < 40 years consider specialist referral to exclude secondary causes.

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10
Q

What is the first line treatment for stage 1 hypertension?

A

Patients < 55-years-old or T2D: ACE inhibitor or a Angiotensin receptor blocker (ACE-i or ARB)

Patients >= 55-years-old or black African or African–Caribbean origin: Calcium channel blocker

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11
Q

Give examples of ACE inhibitors

A

ramipril

lisinopril

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12
Q

Give examples of calcium channel blockers

A

amlodipine

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13
Q

ACE inhibtors can cause a troublesome cough due to build-up of bradykinin usually broken down by ACE; What drug is substituted for ACE if this side effect is present?

A

Angiotensin receptor blocker

Candesartan/losartan

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14
Q

What is the 2nd line treatment for hypertension?

A

If already taking an ACE-i or ARB add a Calcium channel blocker or a thiazide-like Diuretic

If already taking a Calcium channel blocker add an ACE-i or ARB or a thiazide-like Diuretic

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15
Q

What drug is used in preference to ACEi in patients of black African or African–Caribbean origin requiring 2nd line management of hypertension?

A

If they require a second agent consider an ARB in preference to an ACE inhibitor

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16
Q

Give examples of thiazide diuretics

A

Indapamide or bendrofluthiazide

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17
Q

What is the 3rd line treatment for hypertension?

A

Add a third drug to make:

a. if already taking an (A + C) then add a D
b. if already (A + D) then add a C

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18
Q

What is the 4th line treatment for hypertension?

A

If potassium < 4.5 mmol/l add low-dose spironolactone (aldosterone antagonist)

If potassium > 4.5 mmol/l add an alpha blocker or beta-blocker (e.g carvedilol)

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19
Q

Whats an alpha blocker used in hypertension?

A

Doxazosin

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20
Q

What is a beta blocker used in hypertension?

A

Carvedilol

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21
Q

Give an example of an aldosterone antagonist

A

Spironolactone

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22
Q

What are the blood pressure targets for patients <80 years old?

A

Clinic - 140/90 mmHg

HBPM/ABPM - 135/85 mmHg

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23
Q

What are the blood pressure targets for patients >80 years old?

A

Clinic - 150/90 mmHg

HBPM/ABPM - 145/85 mmHg

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24
Q

What is Acute coronary syndrome?

A

The term (ACS) encompasses a range of conditions including unstable angina, NSTEMI and STEMI that are due to a sudden reduction of blood flow to the heart.

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25
Q

Why is anti-platelet medications such as aspirin & clopidogrel the mainstay of treatment in Acute coronary syndrome?

A

When a thrombus forms in a fast-flowing artery it is made up mostly of platelets, that is why anti-platelet drugs are used to break up the thrombus.

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26
Q

What arteries supply the heart?

A

The right and left coronary arteries.

The Left Coronary Artery becomes the Circumflex and Left Anterior Descending (LAD).

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27
Q

The left coronary artery bifurcates into two separate arteries that supply the heart; what are they?

A

The Left Coronary Artery becomes the Circumflex and Left Anterior Descending (LAD).

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28
Q

What area of the heart does the Right Coronary Artery (RCA) supply?

A

a. Right atrium
b. Right ventricle
c. Inferior aspect of left ventricle
d. Posterior septal area

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29
Q

What area of the heart does the Circumflex artery supply?

A

a. Left atrium

b. Posterior aspect of left ventricle

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30
Q

What area of the heart does the Left anterior descending artery supply?

A

a. Anterior aspect of left ventricle

b. Anterior aspect of septum

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31
Q

What are the 3 types of Acute Coronary Syndromes?

A

ST-elevation myocardial infarction (STEMI)
non-ST-elevation myocardial infarction (NSTEMI)
Unstable angina

32
Q

How is acute coronary syndromes diagnosed?

A

ECG

33
Q

What is the category for diagnosis of STEMI?

A

If there is ST elevation or new left bundle branch block the diagnosis is STEMI.

If there is no ST elevation then perform troponin blood tests:

If there are raised troponin levels and/or other ECG changes (ST depression or T wave inversion or pathological Q waves) the diagnosis is NSTEMI

34
Q

What is the category for diagnosis of NSTEMI?

A

If there is no ST elevation then perform troponin blood tests:

If there are raised troponin levels and/or other ECG changes (ST depression or T wave inversion or pathological Q waves) the diagnosis is NSTEMI

35
Q

What ECG changes are seen in NSTEMI?

A

ST depression or T wave inversion or pathological Q waves

36
Q

What are troponins?

A

Proteins found in cardiac muscle.

A rise in troponin is consistent with myocardial ischaemia as the proteins are released from the ischaemic muscle.

37
Q

If troponins are negative with normal ECG in suspected ACS, what is the likely diagnosis (after STEMI/NSTEMI has been excluded?

A

If troponin levels are normal and the ECG does not show pathological changes the diagnosis is either unstable angina or another cause such as musculoskeletal chest pain.

38
Q

What is different about a posterior MI?

A

ST depression not elevation on a 12-lead ECG

39
Q

What is the management of all patients with ACS?

A

Aspirin 300mg
Oxygen should only be given oxygen < 94% saturation
Morphine should only be given for severe pain

40
Q

What is the first line treatment for STEMI?

A

Offered if within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes (2 hours) of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI)

Fibrinolysis if over 120 mins or delay in PCI

41
Q

What is PCI?

A

Putting a catheter into the patient’s brachial or femoral artery, feeding that up to the coronary arteries under x ray guidance and injecting contrast to identify the area of blockage.

This can then be treated using balloons to widen the gap or devices to remove or aspirate the blockage. Usually a stent is put in to keep the artery open.

42
Q

What is fibrinolysis?

A

Involves injecting a fibrinolytic medication (they break down fibrin) that rapidly dissolves clots. There is a significant risk of bleeding which can make it dangerous.

43
Q

Give examples of fibrinolytic agents?

A

Streptokinase, alteplase and Tenecteplase.

44
Q

What two other antiplatelet treatments (dual antiplatelet therapy) are given prior to PCI in STEMI?

A

Termed ‘dual antiplatelet therapy’, i.e. aspirin + another drug

  • if the patient is not taking an oral anticoagulant such as warfarin: prasugrel is given (anti-platelet drug)
  • if taking an oral anticoagulant: clopidogrel (anti-platelet drug) is given
45
Q

What anti platelet drug (alongside aspirin) is given to patients already taking oral anticoagulants?

A

If taking an oral anticoagulant: clopidogrel (anti-platelet drug) is given

46
Q

What anti platelet drug (alongside aspirin) is given to patients NOT already taking oral anticoagulants (such as warfarin)?

A

If the patient is not taking an oral anticoagulant such as warfarin: prasugrel is given (anti-platelet drug)

47
Q

What is the management of NSTEMI?

A

B – Beta-blockers unless contraindicated
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative if higher bleeding risk)
M – Morphine titrated to control pain
A – Anticoagulant: Fondaparinux in all patients who are not having angiography immediately (unless high bleeding risk)
if immediate angiography is planned or a patient’s creatinine is > 265 µmol/L then unfractionated heparin should be given
N – Nitrates
Give oxygen if <95%.

48
Q

When are beta blocker use contrindicated?

A

Asthma, Type 1 diabetics maybe?

49
Q

What anticougulant drug is given in NSTEMI for patients who are NOT having the angiography immediately?

A

Fondaparinux in all patients who are not having angiography immediately (unless high bleeding risk)

50
Q

What anticougulant drug is given in NSTEMI for patients who are having an immediate angiography or who have creatinine is > 265 µmol/L?

A

Unfractionated heparin should be given

51
Q

When can Fondaparinux NOT be used as an anticoagulant in NSTEMI?

A

High bleeding risk or if getting an PCI immediately or creatinine over 265

52
Q

What is the GRACE score used for in NSTEMI?

A

Scoring system gives a 6-month risk of death or repeat MI after having an NSTEMI

53
Q

If the GRACE score is moderate/high following an NSTEMI; what is done?

A

Patient is considered for early PCI (within 4 days of admission) to treat underlying coronary artery disease.

54
Q

Prior to PCI in a NSTEMI, what further antiplatelet (‘dual antiplatelet therapy’, ) is given alongside aspirin if patient is NOT already taking an anticoagulant?

A

prasugrel or ticagrelor

55
Q

Prior to PCI in a NSTEMI, what further antiplatelet (‘dual antiplatelet therapy’, ) is given alongside aspirin if patient is ALREADY taking an anticoagulant?

A

Clopidogrel

56
Q

Prior to PCI in a NSTEMI, what further antiplatelet (‘dual antiplatelet therapy’, ) is given alongside aspirin if patient is at risk of bleeding?

A

Clopidogrel

57
Q

Prior to PCI in a NSTEMI, what further antiplatelet (‘dual antiplatelet therapy’, ) is given alongside aspirin if patient is NOT at risk of bleeding?

A

Ticagrelor/prasugrel

58
Q

Cardiogenic shock is a risk for development following an MI; what is it?

A

A serious condition that occurs when your heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs. Ejection fraction is decreased.

59
Q

Cardiac arrest is at risk for development following an MI; why does this happen?

A

Most commonly occurs due to patients developing ventricular fibrillation and is the most common cause of death following a MI.

60
Q

What is the most common tachyarrhythmia to occur as a complication of MI?

A

Ventricular fibrillation

61
Q

What is the most common bradyarrhythmia following an MI?

A

Atrioventricular block

62
Q

Left ventricular aneurysm is a complication that occurs following MI, what can be done as management?

A

This is typically associated with persistent ST elevation and left ventricular failure.

Patients are therefore anti coagulated.

63
Q

Left ventricular aneurysm increases the risk of what condition?

A

Stroke risk is increased

64
Q

What is an aneurysm?

A

An outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall.

65
Q

What are the features of Left ventricular free wall rupture as a complication following an MI?

A

Occurs around 1-2 weeks afterwards.
Patient presents with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds).

66
Q

What is the management of Left ventricular free wall rupture?

A

Urgent pericardiocentesis and thoracotomy are required.

67
Q

What are the features of Ventricular septal defect as a complication following an MI?

A

Rupture of the interventricular septum usually occurs in the first week

Presents as acute heart failure associated with a pan-systolic murmur

68
Q

What murmur is seen following an ventricular septal defect?

A

pan-systolic murmur

69
Q

What is Ventricular septal defect?

A

Rupture of the interventricular septum usually occurs in the first week after an MI

70
Q

What is the management of Ventricular septal defects?

A

Urgent surgical correction is needed

71
Q

What murmur commonly occurs as a complication following an MI?

A

Acute mitral regurgitation

72
Q

What are the secondary prevention measures following an MI?

A

Dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
Beta-blocker
Statin

73
Q

What antiplatelet drugs are available to be given alongside aspirin following an MI (secondary prevention)?

A

Add prasugrel or ticagrelor to aspirin if patient has had PCI

Add ticagrelor to aspirin if patient was medically managed (no PCI)

74
Q

Dual anti platelet therapy is given to patients following an MI, when should the second drug be stopped if the patient’s MI was managed with PCI?

A

Stop ticagrelor/prasugrel after 12 months

75
Q

Dual anti platelet therapy is given to patients following an MI, when should the second drug be stopped if the patient’s MI was managed without PCI?

A

Stop ticagrelor after 12 months if patient was medically managed (no PCI)

Cardiovascular Year 1 (19 decks)

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