Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVS > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What are the different types of Hypertension?

A
  • Primary or Essential
    Cause is usually unidentifiable
  • Secondary
    Identifiable cause
  • Whitecoat
    Elevated clinical BP but normal AMBP
  • Malignant
    Rapid rise in BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is AMBP?

A

Ambulatory Monitoring BP over a period of time - Non invasive test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors of hypertension?

A
  • Age
  • Family History
  • Ethnicity
  • Smoking
  • High salt diet
  • Too little K+ in diet
  • Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the differential diagnosis of hypertension?

A
  • Essential hypertension
  • Renal Artery Stenosis
  • Chronic Kidney Disease
  • Obstructive uropathy => structural or functional hinderance of normal urine flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the environmental and genetic factors leading to essential hypertension?

A

=> Environmental factors:

  • Stress
  • Diet
  • Intrauterine life

=> Genetic factors:
- Candidate genes fro angiotensinogen, renin, ANP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of secondary hypertension?

A
  • Chronic kidney Disease
  • Coarctation of aorta
  • Endocrine Disease
  • Drugs
  • Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common presentation of Malignant hypertension?

A

Malignant Hypertension is marked by increased diastolic BP and end organ damage

Headache and visual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the effects of hypertension on blood vessels?

A
  • Accelerates atherosclerosis and arteriosclerosis
  • Arteriosclerosis is the hardening if an artery or arteriole (arteriolosclerosis)

Arteriolosclerosis can be divided into:

  • Hyaline arteriosclerosis
  • Hyperplastic arteriosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hyaline arteriosclerosis?

A
  • Smooth muscle cells of media are replaced by collagen
  • Increased rigidity and lower compliance, further contributing to hypertension
  • Autoregulation curve shifts to the right, making hypotension more dangerous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is hyperplastic arteriosclerosis?

A
  • Very high systolic BP causes fibrinoid necrosis of vessel wall
  • Gives vessel ‘onion like’ appearance
  • significant reduction of blood flow leading to tissue ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main difference between atherosclerosis and arteriosclerosis?

A

Arteriosclerosis differs from atherosclerosis as there is no lipid deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the effects of hypertension on the heart?

A
  • Hypertension accelerates coronary artery atherosclerosis
  • Left ventricular hypertrophy

Left ventricular hypertrophy is a compensatory mechanism to overcome the increased pressure against the heart. Eventually the heart decompensates, leading to LV Heart Failure

=> Hypertensive Heart Disease presents as:

  • MI
  • Arrhythmias
  • Progressive Left Heart Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is Atrial Fibrillation dangerous?

A
  • Blood stasis in atria may result in thrombus, which may embolise
  • Decrease in CO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the effects of hypertension on the kidney?

A 
- Hyaline arteriosclerosis in renal arterioles may cause progressive renal ischaemia 
=> Specific results:
- Tubular atrophy
- Interstitial fibrosis
- Progressive glomerular sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the effects of hypertension on the eyes?

A
  • Flame haemorrhage
  • Papilloedema
  • Hard exudates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the effects of hypertension on the brain?

A

=> Hypertension + Atherosclerosis:
Berry Aneurysm

=> Rupture of Berry Aneurysm:
Subarachnoid Haemorrhage

=> Rupture of Charcot Bouchards Aneurysm:
Intracerebral Haemorrhage

17
Q

What are the clinical consequences of maliginant hypertension?

A
  • Hypertensive encephalopathy
  • Blurred vision
  • Acute LV Failure
  • Stroke
  • Haemolytic Anaemia + disseminated intravascular coagulation
  • Acute Renal Failure
  • Proteinuria
  • Haematuria
18
Q

What are the investigations do in someone with suspected hypertension?

A

=> AMBP

=> Fasting glucose and cholesterol levels
To quantify risk

=> ECG + Echo
To determine any end organ damage

=> U&E, Ca levels
Used to determine secondary causes
U&E - low K and high Na in Conn’s
Ca - high in hyperparathyroidism

=> Ultrasound
Small kidneys

19
Q

What is the management of hypertension?

A

Clinical BP is measured first

If BP ≥ 140/90 mmHg:
- Offer AMBP. Calculate CVS risk and look for end organ damage

If BP ≥ 180/110 mmHg (severe hypertension):

  • Consider referral and starting anti-hypertensive medication
  • Then offer AMBP. Calculate CVS risk and look for end organ damage

=> AMBP < 135/85 mmHg = NORMOTENSIVE

=> AMBP ≥ 135/85 mmHg

  • Stage 1 hypertension. Treat if < 80 years and ONE of the following (if not then give lifestyle advice + statins):
  • End organ damage
  • CVD
  • Diabetes
  • Renal disease
  • CVS risk ≥ 10%

=> AMBP ≥ 150/95 mmH
Stage 2 Hypertension, treat regardless of age

20
Q

Role of anti-hypertensive medication

A

Must be determined if patient requires mono-therapy or combination therapy

=> Mono-therapy:

  • > 55 year old OR Afro ethnicity: Ca antagonists or Thiazides
  • < 55 year old OR Diabetes: ACE Inhibitors

B Blockers less effective not usually first choice

=> Combination therapy:

  • (ACE inhibitors + Ca antagonists) or (ACEi + Thiazide Diuretic) if 2 drug combo
  • (ACE inhibitors + Ca antagonists + Thiazide) if 3 drug combo

If K ≤ 4.5 add low dose spirolactone
If K > 4.5 add alpha blocker or B blocker

IF ACE-i NOT TOLERATED, USE ARBs (eg if patient experiences cough)
ACEi used as first line treatment for diabetics regardless of age

For patients of Afro-Caribbean decent on dual therapy already on Ca antagonist, consider Ang II blocker over ACEi

21
Q

What are the 5 types of anti-hypertensive drugs

A

=> THIAZIDES
Chloratidone

=> Ca ANTAGONISTS
Nifedipine

=> B BLOCKERS
Bisoprolol

=> ARB
Candesartan

=> ACE-i
Lisinopril

22
Q

What is the management of orthostatic hypotension?

A
  • Adequate hydration and salt intake
  • Discontinuation of vasoactive drugs

=> IF symptoms still persist, then:

  • Compression garments
  • Fludrocortisone
  • Midodrine
  • Counter pressure manouvres
  • Head up tilt sleeping
23
Q

Why should Verapamil and a B blocker not be taken together?

A

Risk of complete heart block

24
Q

What are the BP targets for type 2 diabetes?

A

If end organ damage present: < 130/80 mmHg

Otherwise < 140/80

25
Q

What are the different stages of hypertension?

A

=> Stage 1 Hypertension

  • Clinical BP ≥ 140/90 mmHg
  • AMBP ≥ 135/85 mmHg

=> Stage 2 Hypertension

  • Clinical BP ≥ 160/100 mmHg
  • AMBP ≥ 150/95 mmHg

=> Severe Hypertension

  • Systolic BP ≥ 180 or Diastolic BP ≥ 110
26
Q

What are the BP targets for those with hypertension on therapy?

A

=> For those < 80

  • Clinical BP 140/90 mmHg
  • AMBP 135/85 mmHg

=> For those > 80

  • Clinical BP 150/90 mmHg
  • AMBP 145/85 mmHg
27
Q

For those with CKD and hypertension taking ACEi, what change in GFR and Creatinine is still considered acceptable before discontinuing ACEi?

A

Decrease in GFR of up to 25%

Increase in creatinine of up to 30%

28
Q

What is the biggest modifiable risk factor of intracranial haemorrhage?

A

Obesity

29
Q

What are the side effects of ACEi?

A
  • Cough
  • Angioedema
  • Hyperkalaemia
30
Q

What are the contraindications and side effects of ACEi?

A
  • Pregnancy
  • ACEi can cause renal impairment in those with renal artery stenosis
  • Aortic stenosis
31
Q

What are the contraindications of statin use?

A
  • Macrolide antibiotic

- Pregnancy

32
Q

What are the adverse effects of statins?

A
  • Myopathy
  • Liver impairment (LFTs should be checked at 3 and 12 months. If ALT rises above 3 times the upper limit, discontinue)
  • May increase intracerebral haemorrhage

CVS (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions