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Hypertension Flashcards

1
Q

What is blood pressure like in the population?

A
  • Vary widely

- Show normal distribution

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2
Q

What is hypertension?

A

Risk of complications increasing progressively with higher values
Cut off = arbitary

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3
Q

What is isolated systolic hypertension?

A

Isolated elevation in systolic pressure alone with normal diastolic pressure

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4
Q

What value is isolated systolic hypertension equal to and above?

A

140mmHg

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5
Q

What population is isolated systolic hypertension common in?

A

Elderly

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6
Q

What is isolated systolic hypertension a problem with? (3)

A
  • Increased stiffness
  • Reduced compliance
  • In large elastic blood vessels e.g aorta
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7
Q

What is white coat hypertension?

A

Rise in blood pressure while examined by physician e.g flight/fight response

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8
Q

What are the types of hypertension? (4)

A
  • Primary essential hypertension
  • Secondary hypertension
  • Isolated systolic hypertension
  • White coat hypertension
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9
Q

What is primary essential hypertension? (3)

A
  • No known cause identified
  • Most common
  • Causes organ damage
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10
Q

What is the threshold for primary essential hypertension?

A

More than or equal to 140/90 mmHg

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11
Q

What is secondary hypertension? (2)

A
  • Uncommon

- Pathology: defined underlying cause

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12
Q

When is hypertension normally discovered? (2)

A

Majority asymptomatic : discovered in

  • Routine physical examination
  • Complication e.g MRI
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13
Q

What are the “classic” symptoms of hypertension? When do they normally occur? (3)

A
  • Headache
  • Nosebleeds
    = severe hypertension
  • Normally only sign is high recorded BP
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14
Q

What are the damages that occur to the heart that occur as a result of primary hypertension? (2)

A
  • Left ventricular hypertrophy: congestive cardiac failure (CCF)
  • Accelerated coronary ahterosclerosis : ischaemia + infarction
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15
Q

What occurs in myocytes cause hypertrophy? (2)

A
  • Enlarged myocytes

- NOT more myocytes

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16
Q

What are the organs damaged as a result of primary hypertension? (4)

A
  • Heart
  • Brain
  • Aorta/peripheral vasculature
  • Kidney
  • Retina
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17
Q

What are the damages that happen to the brain due to primary hypertension? (3)

A
  • Microaneurysms rupturing to cause haemorrhagic strokes (CVE/CVA)
  • Cerebral infarct: atherosclerotic plaques in internal carotid arteries
  • Lacunae (cavaties) occulusion of small penetrating branches = multiple tiny infarcts
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18
Q

What is the treatment for an ischaemic stroke? (4)

A
  • Specialised scanning cenre
  • Drug administred to dissolve clot (thrombolysis)
  • Catheter in and suck out blood clot
  • 12 hour window
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19
Q

What are the 3 ways the peripheral vasculature and aorta is damaged by primary hypertension? (3)

A
  • Peripheral vascular disease
  • AAA (+6cm diameter: rupture and death risk)
  • Aortic dissection
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20
Q

How is the kidney damaged by primary hypertension? And what should be assessed to check this? (4)

A
  • Nephrosclerosis (scarring)
  • Can progress to proteinuria - leaking protein into urine
  • Chronic renal failure
  • Urine test
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21
Q

How should damage due to primary hypertension be checked in the retina?

A

Visualed with an ophalmoscope through pupil to back of eye

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22
Q

What do changes in the retina caused by primary hypertension depend on? (2)

A
  • Hypertension severity

- Hypertension duration

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23
Q

What area of the retina is used for fine detail examination?

24
Q

What are the signs of hypertension in the retina? (5)

A
  • Flame haemorrage
  • Papilloedema
  • Hard exudates: small white/yellow deposits in outer layers of retina deep to vessels
  • Cotton wool spot
  • Optic disc disappears (=SEVERE)
25
What should be done on seeing signs of hypertension in the retina? (2)
- Measure BP | - Refer to hospital for high BP
26
What are the signs of secondary hypertension? (6)
- Young age onset (less than 20) - Abrupt not progressive - Accelerated hypertension - Underlying pathology - Sporadic (no history in 1st degree relatives) - Refractory to drug treatment
27
What value is acclerated hypertension?
>180/110 mmHg
28
What are the categories of causes for secondary hypertension? (5)
- Renal - Mechanical - Endorcrine - Drugs - Pre-eclamptic toxaemia
29
What are the renal causes of secondary hypertension? (2)
- Chronic renal failure | - Renal artery stenosis
30
What is a mechanical cause of secondary hypertension? (2)
Coarctation of the aorta - congenital aorta narrowing
31
List endocrine causes of secondary hypertension (5)
- Conn's syndrome (primary hyperaldoesteronism) - Cushing's syndrome - Phaechromocytoma - Acromegaly - Thyrotoxicosis
32
What common type of drug used causes secondary hypertension?
Oral contraceptives
33
How does renal artery stenosis cause secondary hypertension? (4)
- Stenosis in one renal artery: not enough blood flow - Activation of renin-angiotensin-aldosterone system (pumps out renin) - Angiotensin: fluid retention: increased TPR: increased BP - Aldosterone: potassium excretion by kidney
34
When should renal artery stenosis be suspected as a cause of hypertension patients? (2)
Abrupt onset hypertension plus - Hypokalaemia - Abdominal bruit (whooshing through stenoised artery)
35
What is coarctation of the aorta as a cause of secondary hypertension? (2)
- Congenital narrowing of aorta | - Distal to left subclavian artery origin
36
What are the signs of coarctation of aorta as a cause of secondary hypertension? (3)
- BP more in arms than leg - Weak/absent femoral pulses - Notched rib appearance of upper ribs on chest x ray
37
Why does coarctation of aorta as a cause of secondary hypertension cause a notched appearance of upper ribs?
Shunting of bood through enlarged internal mammary arteries (rather than aorta)
38
What is Conn's syndrome as a cause of secondary hypertension? (3)
- Adrenal tumour (adenoma) secretes excess aldosterone - Fluid retention - Hypokalemia
39
What is Cushing's syndrome as a cause of secondary hypertension? And what are the main symptoms? (4)
Excess glucocorticoid secretion - Moon face - Central obesity - Hirsutism - Promixal muscle wasting
40
What is phaechromocytoma? (3)
- Rare catecholamine secreting tumour of adrenal medulla - Sudden bursts of (nora)adrenaline - Stimulates cardiac b1 adrenoreceptors
41
What are the symptoms of phaechromocytoma? (6)
- Anxiety - Sweating - Palpitations - Hypertension - Headache - Swelling
42
What is pre-clamptic toxaemia of pregnancy as a cause of secondary hypertension? (3)
- Placental ischaemia = release of agents causing: - Endothelial dysunction - Vasoconstriction
43
What are the symptoms of pre-clamptic toxaemia of pregnancy? (2)
- Eclampsia (high BP fits) | - Maternal death
44
What should be monitored throughout pregnancy and why?
Blood pressure - check for pre-eclamptic toxaemia of pregnancy
45
What does hyperthyroidism e.g Grave's disease cause of secondary hypertension?
- Excess production of thyroid hormones - Calcium release - Increase in blood volume and cardiac output
46
What is the pathophysiology of hypertension? (5)
- Imbalance between CO and TPR - Early: Increased CO and normal TPR - Disease progression: LVH - Compromises diastolic filling and reduces CO - Long term: blood vessel changes=increased TPR
47
What causes long term elevated TPR in hypertension to do with blood vessels? (4)
- Prolonged vasoconstriction and high BP - Resistance - Tunica media hypertrophy to withstand - Narrowing of artery lumen
48
What are the other causes for elevated TPR in hypertension other than blood vessels? (2)
- Rarefraction: vessel number/unit volume reduction | - Baroreceptor reflex reset at higher set point
49
What is accelerated (malignant) hypertension?
Emergency BP requiring admission to hospital
50
What are the signs of acclerated (malignant) hypertension? (2)
- More than 180/110 mmHg | - + papilloedema/retinal haemorrhage
51
When do patients die if aaccelerated (malignant) hypertension is left untreated?
6-12 months
52
What is the pathological cause of acclerated (malignant) hypertension?
Fibrinoid necrosis of arterioles
53
What are the long term effects of acclerated (malignant) hypertension on the brain?
Impaired function of brain: hypertensive encephalopathy
54
What is the treatment of acclerated (malignant) hypertension? (2)
- IV medication | - Reduce TPR/CO
55
What blood/urine tests should be done to check for secondary causes of hypertension? And for what conditions? (8)
- Plasma creatinine + GFR + protein urinalysis : renal disease - Plasma potassium (hypokalaemia) + plasma renin:aldosterone ratio: Conn's (primary aldosteronism) - Urinary catecholamines: phaechromocytoma - Hyperglycaemia + 24hr urinary cortisol secretion + dexamethasone supression test: Cushing's
56
What imaging tests should be done to check for secondary causes of hypertension? And for what conditions? (3)
- Renal USS: renal disease - Renal duplex ultrasonography: renal artery stenosis - CT/MRI abdo pelvis: phaeochromocytoma

Cardiology (18 decks)

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