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TCD Vascular > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the NHS Health Check?

A

A free check-up of overall health offered every 5 years to those aged 40 to 74 that do not have a pre-existing health condition; done to determine whether they’re at higher risk of getting certain conditions, and how to reduce their risk of these.

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2
Q

What is the overarching aim of the NHS Health Check system?

A

To identify whether there is any evidence of cardiovascular disease, and to identify areas that can be targeted with medical or lifestyle interventions, to reduce overall risk of cardiovascular events.

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3
Q

What is the UK Chief Medical Officers guidance for physical activity? (2)

A

At least 150 minutes moderate intensity activity per week.
OR
At least 75 minutes vigorous intensity activity per week.

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4
Q

What happens next if blood pressure measured in a clinic is 140/90 or higher? (2)

A

-Take second measurement - if this is substantially different, take a third. The lowest of these is the ‘clinic BP’.
-If clinic BP between 140/90 and 180/120, offer ambulatory BP monitoring (ABPM) (or home BP monitoring if ABPM unsuitable/intolerable) to confirm hypertension diagnosis.

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5
Q

What does a urine albumin to creatinine ratio (ACR) tell us?

A

Whether excess protein is getting into the urine through the kidney; this would indicate the kidneys have become leaky and damaged (potentially due to hypertension).

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6
Q

Why can longstanding hypertension cause the left side of heart to become hypertrophied?

A

Longstanding hypertension leads to an increase in peripheral vascular resistance; this increases afterload, meaning the heart must work harder to maintain cardiac output. This causes the left side of heart to become hypertrophied as it remodels to increase its ability to pump blood.

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7
Q

How can the rate of a regular ECG rhythm be calculated?

A

Divide 300/number of large squares between two QRS complexes.

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8
Q

What is a QTc interval?

A

A corrected QT interval (or QTc) for a given heart rate. Normal QTc interval is ≤0.44 sec in males and ≤0.46 sec in females.

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9
Q

What is the QT interval of an ECG?

A

The start of the QRS complex to the end of the T wave; this represents the time taken to depolarize and repolarize the ventricular myocardium. [The QT interval varies greatly with heart rate.]

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10
Q

How much time does one small square on a standard calibration ECG represent?

A

0.04 seconds

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11
Q

How much time does one large square on a standard calibration ECG represent?

A

0.2 seconds

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12
Q

How narrow should a normal QRS complex be?

A

≤0.10 sec, which is not more than 2.5 small squares.

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13
Q

How is hypertension defined (in European guidelines)?

A

Blood pressure greater than or equal to 140/90mmHg.

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14
Q

What is secondary hypertension?

A

Hypertension resulting from an underlying, often reversible, cause.

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15
Q

What is primary (essential) hypertension?

A

Hypertension resulting from genetics and/or lifestyle, with no other underlying cause.

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16
Q

What are four common causes of secondary hypertension?

A

-Renovascular disease
-Hyperthyroidism
-Primary hyperaldosteronism
-Cushing’s Syndrome

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17
Q

What is hypertensive urgency?

A

A type of hypertensive crisis in which blood pressure is equal to or greater than 180/120, but there is no evidence of organ damage and may be no symptoms at all.

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18
Q

What is a hypertensive emergency?

A

A type of hypertensive crisis in which there is hypertension with the presence of end organ damage.

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19
Q

What is the first line pharmacological treatment for hypertension in a patient aged under 55, or a patient with diabetes? (2)

A

ACE inhibitor or angiotensin receptor blocker (ARB).

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20
Q

What is the first line pharmacological treatment for hypertension in a patient aged over 55, or a patient with African American background? (1)

A

Calcium channel blocker.

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21
Q

What is the second line pharmacological treatment for hypertension? (2)

A

Addition of either an ACEi/ARB or calcium channel blocker, depending on what the patient is already taking.

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22
Q

What is the third line pharmacological treatment for hypertension? (1)

A

Addition of a thiazide diuretic (and reconsider investigations for secondary hypertension at this point)

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23
Q

What is the fourth line pharmacological treatment for hypertension? (2)

A

Addition of lose dose spironolactone, or an alpha/beta blocker if potassium levels are already high.

24
Q

What are the main goals of managing a hypertensive emergency? (3)

A

-Reduce BP by around 25% within the first hour.
-Lower BP further to below 160/110 in the first 2-6 hours.
-Reach normal BP within next 24-48 hours.

[In some cases, such as aortic dissection, more aggressive reduction rate may be needed.]

25
Q

What is labetalol?

A

A beta-blocker often used as a first line agent in hypertensive emergency.

26
Q

Which ECG leads are ‘inferior’ leads? (3)

A

II, III and aVF

27
Q

Which ECG leads are ‘lateral’ leads? (4)

A

I, aVL, V5 and V6

28
Q

Which ECG leads are ‘septal’ leads? (2)

A

V1 and V2

29
Q

Which ECG leads are ‘anterior’ leads? (2)

A

V3 and V4

30
Q

Which artery supplies the septal and anterior regions of the heart?

A

Left anterior descending artery

31
Q

Which artery supplies the inferior region of the heart?

A

Right coronary artery

32
Q

Which artery supplies the lateral region of the heart?

A

Left circumflex artery

33
Q

What QRISK3 threshold does NICE use to determine whether statins should be prescribed?

A

NICE uses a threshold QRISK3 score of >10% for primary prevention of CVD with lipid lowering medications.

34
Q

What is important to monitor in a patient newly commenced on an ACE inhibitor, and why? (2)

A

U&Es/renal profile, to:
-monitor for potassium levels (hyperkalaemia is a known side-effect of ACE inhibitors)
-check for increases in serum creatinine (slight rise is normal when ACEi started but increases of >30% or decrease in eGFR of > 25% would prompt discontinuation and investigation for renal artery stenosis).

35
Q

What is refractory hypertension?

A

The inability to achieve blood pressure control (by office or ambulatory blood pressure monitoring) despite maximum tolerated doses of at least five antihypertensive medications, including a diuretic.

36
Q

What ECG changes are indicative of left ventricle hypertrophy? (3)

A

-Increased voltages in precordial leads
-Non-specific ST-segment and T-wave abnormalities
-Deep, narrow Q-waves are common.

[P-mitrale (wide and notched P wave) reflects left atrial dilatation.]

37
Q

Name three drugs that may precipitate a hypertensive emergency.

A

-Amphetamines
-Cocaine
-Monoamine oxidase inhibitors (MAOI)

38
Q

How should hypertensive emergencies be managed? (2)

A

-Inpatient IV antihypertensive medication and admission for close monitoring
-After suitable period (often 8 to 24 hours) of BP control at target in intensive care unit, oral medications usually given, and initial IV therapy is tapered and discontinued.

39
Q

When is it recommended to look for secondary hypertension causes as a priority? (5)

A

In cases of hypertension involving:
-Patient under 30 with no family history hypertension or obesity
-Accelerated hypertension
-Severe or resistant hypertension
-Acute rise in BP
-Proven age of onset before puberty

40
Q

What is the most common cause of secondary hypertension in young adults?

A

Primary hyperaldosteronism

41
Q

What blood test results indicate primary hyperaldosteronism? (2)

A

High aldosterone levels and low renin levels (suggests high aldosterone production and intact negative feedback loop).

42
Q

What is primary hyperaldosteronism?

A

Increased levels of aldosterone due to an adrenal cause of aldosterone secretion; either a benign adenoma of adrenal gland, or bilaterally enlarged glands.

43
Q

What is secondary hyperaldosteronism?

A

Increased levels of aldosterone due to a cause outside of the renal glands, resulting in excessive stimulation of the RAAS pathway, with high renin levels triggering high aldosterone production.

44
Q

What are three causes of secondary hyperaldosteronism?

A

-Reduced blood flow to the kidneys (i.e renal artery stenosis, fibromuscular dysplasia)
-Reduced cardiac output (i.e congestive cardiac failure)
-Reduced circulating volume (i.e cirrhosis with ascites)

45
Q

Why can hypokalaemia occur in hyperaldosteronism?

A

Aldosterone acts on the nephrons to increase sodium reabsorption; potassium is lost into the urine in exchange for sodium to maintain electrical neutrality.

46
Q

How is bilateral adrenal hyperplasia managed? (2)

A

-Giving a mineralocorticoid receptor antagonist (such as spironolactone), to block effect of high aldosterone levels and therefore reduce salt retention and water retention, reducing circulating volume.
-Salt restriction should also be encouraged to all patients with hyperaldosteronism.

47
Q

What is a good general rule for PO2 ranges of a patient on a Venturi oxygen mask?

A

Expect ‘healthy’ PO2 range to be no less than 10KPa below the FiO2

[For example, if FiO2 is 35%, PO2 should be no lower than 25kPa.]

48
Q

Via what mechanism can ACE inhibitors cause sudden onset pulmonary oedema?

A

ACE inhibitors deactivate the RAAS which inhibits constriction of the efferent arteriole; filtration pressure across the glomerulus is not maintained and results in acute renal impairment.

49
Q

What is calcium gluconate?

A

A calcium salt given in hypocalcaemia, hyperkalaemia and other conditions associated with calcium imbalance, to stabilise the myocardium to prevent arrhythmias occurring.

50
Q

When should calcium gluconate be given in hyperkalaemia? (2)

A

-With a potassium of 6-6.4 if there is evidence of ECG changes
-If a potassium level is >6.5, regardless of ECG findings.

51
Q

What is standard treatment for the management of hyperkalaemia? (2)

A

An insulin-dextrose infusion to drive potassium into cells, along with salbutamol.

52
Q

What is HELLP Syndrome?

A

A life-threatening pregnancy complication characterized by the triad of:
-Hemolysis
-Elevated Liver enzymes
-Low Platelet count

53
Q

What is the blood pressure target of a patient who presents with acute Intracranial Haemorrhage and systolic BP (SBP) between 150 and 220 mmHg?

A

Reduce BP to 140 mmHg within the first one hour of presentation.

54
Q

What is the blood pressure target of a patient who presents with acute Intracranial Haemorrhage and systolic BP (SBP) >220 mmHg? (2)

A

-BP should be rapidly lowered to <220 mmHg.
-Thereafter, BP should be gradually reduced (over a period of hours) to a target range of 140 to 160 mmHg.

55
Q

What blood test results are indicative of primary hyperparathyroidism? (4)

A

-Raised serum calcium
-Low serum phosphate
-Raised ALP
-Raised PTH

56
Q

What is the drug of choice in managing concurrent hypertensive emergency and cardiac ischaemia?

A

IV nitroglycerin

57
Q

What is IV nitroglycerin?

A

A nitrate used to treat acute coronary syndromes, hypertensive emergency and acute congestive heart failure exacerbations by causing vasodilation.

TCD Vascular (2 decks)

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