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5. Cardiology > Hypertension and ACHD > Flashcards

Hypertension and ACHD Flashcards

1
Q

What is the first line treatment for hypertension?

This has 5 components.

A

Lifestyle changes

  1. Salt restriction (5-6dg/day)
  2. Reduce alcohol intake
  3. Reduce weight (BMI 25)
  4. Regular exercise
  5. Smoking cessation
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2
Q

List the 5 types of drugs used to treat hypertension.

A
  1. Thiazide diuretics
  2. Beta blockers
  3. Calcium channel blockers
  4. ACE inhibitors
  5. Angiotensin receptor blockers
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3
Q

Which 4 drugs can be used to treat hypertension with atrial fibrillation?

A
  1. ARB
  2. ACE inhibitors
  3. Beta blockers
  4. Non-dihydropiridine CCB
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4
Q

Which 3 drugs should be used to treat hypertension in pregnancy?

A
  1. Methyldopa
  2. Beta blockers
  3. CCB
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5
Q

Which drug CANNOT be used to treat hypertension in heart failure?

A

Calcium channel blockers (will make heart failure worse)

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6
Q

Which drug CANNOT be used to treat hypertension in peripheral vascular disease?

A

Beta blockers (they decrease peripheral circulation)

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7
Q

How would you treat an acute hypertensive crisis?

A 
Labetalol (IV)
Sodium nitroprusside (IV)
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8
Q

What is primary/essential hypertension?

A

Hypertension with an unknown cause

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9
Q

List 4 causes of secondary hypertension.

A

Renal/renovascular disease
Endocrine disease
Coarctation of the aorta
Iatrogenic

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10
Q

List 5 examples of endocrine causes of secondary hypertension.

A 
Phaeochromocytoma
Cushing's syndrome
Conn's syndrome
Acromegaly
Hypothyroidism
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11
Q

List 2 examples of drugs which might cause secondary hypertension.

A

Hormonal/oral contraception

NSAIDs

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12
Q

List 7 complications of hypertension.

A 
Cerebrovascular disease (stroke)
Left ventricular hypertrophy
Heart failure
CAD (MI)
Peripheral vascular disease
Nephrosclerosis
Renal vascular disease
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13
Q

Outline the 3 grades of hypertension.

A

Grade 1:
Systolic: 140-159
Diastolic: 90-99

Grade 2:
Systolic: 160-179
Diastolic: 100-109

Grade 3:
Systolic: 180+
Diastolic: 110+

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14
Q

What are the 5 types of congenital heart defects that might be seen in adults?

A 
Atrial septal defect (ASD)
Coarctation of aorta
Tetralogy of Fallot
Transposition of great arteries
Fontan circulation
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15
Q

List 4 types of atrial septal defect.

How common is each one?

A

Secundum (75%)
Primum (15%)
Sinus venosus (10%)
Cor sinus (rare)

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16
Q

What is a sinus venosus?

A

Atrial septal defect

Extra, small chamber before right atrium

17
Q

Describe the signs and symptoms of atrial septal defects. Consider:

a) Asymptomatic ASD (4)
b) Symptomatic ASD (3)

A 
ASYMPTOMATIC:
Systolic ejection murmur
Abnormal ECG
Abnormal CXR
Incidental finding on echo

SYMPTOMATIC:
Dyspnoea
Stroke/embolism
Atrial fibrillation

18
Q

Describe the treatment of atrial septal defects. (2)

A

PERCUTANEOUS CLOSURE

  • Only for secundum
  • Stent used to close defect

SURGICAL CLOSURE
-Good prognosis if closure done before 25 yo

19
Q

Define coarctation of the aorta.

A

Congenital narrowing of a section of the aorta

20
Q

Describe the features of coarctation of aorta. (4)

A

May be long narrowing
May be discrete ridge of narrowing
May be before/after ductus arteriosus
May be before/after left subclavian artery

21
Q

Describe the clinical features of coarctation of the aorta. (6)

List 3 consequences of coarctation.

A 
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

22
Q

Describe the treatment of coarctation of the aorta. (3)

A

Patch aortoplasty
Balloon angioplasty
Bypass tube around narrowing

23
Q

List the 4 defining features of tetralogy of Fallot.

A

Pulmonary stenosis
Enlargement of right ventricle
Ventricular septal defect
Origin of aorta lies over septal defect

24
Q

Describe the treatment of tetralogy of Fallot. (2)

A

Systemic-pulmonary shunt

Complete repair

25
Q

List 3 different surgical methods of creating a systemic-pulmonary shunt in tetralogy of Fallot.

A

Blalock-Taussig procedure
Waterston procedure
Potts procedure

26
Q

Briefly describe the process of a complete repair of tetralogy of Fallot. (4)

A
  1. Prior systemic-pulmonary shunt removed
  2. Patch over ventricular septal defect
  3. Resection of pulmonary obstruction
  4. Transannular patch around the pulmonary valve annulus
27
Q

List 4 consequences of tetralogy of Fallot.

A

Increased risk of sudden death
Broad QRS complex
Atrial arrhythmias
Pulmonary insufficiency

28
Q

Define “transposition of the great arteries”.

A

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

29
Q

List 2 types of transposition of the great arteries.

A

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)

30
Q

Describe treatment of D-type great artery transposition. (4)

A

Prostaglandins (in newborns)
Balloon atrial septostomy
Atrial switch (Mustard procedure)
Arterial switch

31
Q

Describe complications of great artery transposition. Consider:

a) D-type transposition (5)
b) L-type transposition (4)

A 
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
32
Q

Define a surgical Fontan circulation.

A

Surgery correcting congenital abnormality so that there is:

  • only 1 ventricle
  • all other blood vessels go directly to the lungs
33
Q

List 4 indications for Fontan circulation surgery.

A

Tricuspid atresia
Double inlet left ventricle
Hypoplastic left heart
Some variations of double outlet right ventricle

34
Q

List 5 complications of a Fontan procedure.

A 
Arrhythmias
Heart failure
RA enlargement
Thrombosis
Polycytaemia

5. Cardiology (9 decks)

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