Hypertension and ACHD Flashcards
What is the first line treatment for hypertension?
This has 5 components.
Lifestyle changes
- Salt restriction (5-6dg/day)
- Reduce alcohol intake
- Reduce weight (BMI 25)
- Regular exercise
- Smoking cessation
List the 5 types of drugs used to treat hypertension.
- Thiazide diuretics
- Beta blockers
- Calcium channel blockers
- ACE inhibitors
- Angiotensin receptor blockers
Which 4 drugs can be used to treat hypertension with atrial fibrillation?
- ARB
- ACE inhibitors
- Beta blockers
- Non-dihydropiridine CCB
Which 3 drugs should be used to treat hypertension in pregnancy?
- Methyldopa
- Beta blockers
- CCB
Which drug CANNOT be used to treat hypertension in heart failure?
Calcium channel blockers (will make heart failure worse)
Which drug CANNOT be used to treat hypertension in peripheral vascular disease?
Beta blockers (they decrease peripheral circulation)
How would you treat an acute hypertensive crisis?
Labetalol (IV) Sodium nitroprusside (IV)
What is primary/essential hypertension?
Hypertension with an unknown cause
List 4 causes of secondary hypertension.
Renal/renovascular disease
Endocrine disease
Coarctation of the aorta
Iatrogenic
List 5 examples of endocrine causes of secondary hypertension.
Phaeochromocytoma Cushing's syndrome Conn's syndrome Acromegaly Hypothyroidism
List 2 examples of drugs which might cause secondary hypertension.
Hormonal/oral contraception
NSAIDs
List 7 complications of hypertension.
Cerebrovascular disease (stroke) Left ventricular hypertrophy Heart failure CAD (MI) Peripheral vascular disease Nephrosclerosis Renal vascular disease
Outline the 3 grades of hypertension.
Grade 1:
Systolic: 140-159
Diastolic: 90-99
Grade 2:
Systolic: 160-179
Diastolic: 100-109
Grade 3:
Systolic: 180+
Diastolic: 110+
What are the 5 types of congenital heart defects that might be seen in adults?
Atrial septal defect (ASD) Coarctation of aorta Tetralogy of Fallot Transposition of great arteries Fontan circulation
List 4 types of atrial septal defect.
How common is each one?
Secundum (75%)
Primum (15%)
Sinus venosus (10%)
Cor sinus (rare)
What is a sinus venosus?
Atrial septal defect
Extra, small chamber before right atrium
Describe the signs and symptoms of atrial septal defects. Consider:
a) Asymptomatic ASD (4)
b) Symptomatic ASD (3)
ASYMPTOMATIC: Systolic ejection murmur Abnormal ECG Abnormal CXR Incidental finding on echo
SYMPTOMATIC:
Dyspnoea
Stroke/embolism
Atrial fibrillation
Describe the treatment of atrial septal defects. (2)
PERCUTANEOUS CLOSURE
- Only for secundum
- Stent used to close defect
SURGICAL CLOSURE
-Good prognosis if closure done before 25 yo
Define coarctation of the aorta.
Congenital narrowing of a section of the aorta
Describe the features of coarctation of aorta. (4)
May be long narrowing
May be discrete ridge of narrowing
May be before/after ductus arteriosus
May be before/after left subclavian artery
Describe the clinical features of coarctation of the aorta. (6)
List 3 consequences of coarctation.
CLINICAL FEATURES: Hypertension Heart murmur (continuous or systolic) Ejection click of mitral valve Radio-femoral delay Radial-radial delay Rib notching on CXR
CONSEQUENCES:
Aortic aneurysm
Congestive heart failure
Premature CAD
Describe the treatment of coarctation of the aorta. (3)
Patch aortoplasty
Balloon angioplasty
Bypass tube around narrowing
List the 4 defining features of tetralogy of Fallot.
Pulmonary stenosis
Enlargement of right ventricle
Ventricular septal defect
Origin of aorta lies over septal defect
Describe the treatment of tetralogy of Fallot. (2)
Systemic-pulmonary shunt
Complete repair
List 3 different surgical methods of creating a systemic-pulmonary shunt in tetralogy of Fallot.
Blalock-Taussig procedure
Waterston procedure
Potts procedure
Briefly describe the process of a complete repair of tetralogy of Fallot. (4)
- Prior systemic-pulmonary shunt removed
- Patch over ventricular septal defect
- Resection of pulmonary obstruction
- Transannular patch around the pulmonary valve annulus
List 4 consequences of tetralogy of Fallot.
Increased risk of sudden death
Broad QRS complex
Atrial arrhythmias
Pulmonary insufficiency
Define “transposition of the great arteries”.
congenital abnormality of the heart in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle
Incompatible with life unless there is also a septal defect that permits the mixing of blood between the pulmonary and systemic circulations
List 2 types of transposition of the great arteries.
D-type transposition (PA from the LV, aorta from the RV)
L-type transpositions (PA arises from LV and aorta from RV, BUT ventricles are switched around which “corrects” the transposition)
Describe treatment of D-type great artery transposition. (4)
Prostaglandins (in newborns)
Balloon atrial septostomy
Atrial switch (Mustard procedure)
Arterial switch
Describe complications of great artery transposition. Consider:
a) D-type transposition (5)
b) L-type transposition (4)
D-TYPE TRANSPOSITION Arrhythmias Sudden cardiac death Tricuspid valve regurgitation Right ventricular failure Baffle obstruction
L-TYPE TRANSPOSITION Progressive heart failure Arrhythmias Sudden cardiac death Severe tricuspid regurgitation
Define a surgical Fontan circulation.
Surgery correcting congenital abnormality so that there is:
- only 1 ventricle
- all other blood vessels go directly to the lungs
List 4 indications for Fontan circulation surgery.
Tricuspid atresia
Double inlet left ventricle
Hypoplastic left heart
Some variations of double outlet right ventricle
List 5 complications of a Fontan procedure.
Arrhythmias Heart failure RA enlargement Thrombosis Polycytaemia
