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BDS2 BAMS Cardiovascular medicine > Hypertension and heart failure > Flashcards

Hypertension and heart failure Flashcards

1
Q

Having what blood pressure means you have hypertension?

A

> 140 systolic, >90 dystolic, checked 3 times

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2
Q

what is white coat syndrome

A

White coat hypertension, more commonly known as white coat syndrome, is a phenomenon in which people exhibit a blood pressure level above the normal range, in a clinical setting, although they do not exhibit it in other settings. It is believed that the phenomenon is due to anxiety experienced during a clinic visit

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3
Q

What are the risk factors for hypertension

A
  • age
  • race
  • obesity
  • alcohol
  • family history
  • pregnancy
  • stress
  • drugs (non-steroidal, corticosteroids, OCP, sympathominmetics)
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4
Q

What are the outcomes of having hypertension

A

Accelerated atherosclerosis

  • myocardial infarction
  • stroke
  • peripheral vascular disease

Renal failure

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5
Q

What are common triggers of hypertension

A

none usually found

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6
Q

What are rare triggers of hypertension

A
  • renal artery stenosis

- endocrine tumours (e.g. phaeochromocytoma - adrenaline, Conn’s syndrome - aldosterone, Cushing’s syndrome - cortisol)

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7
Q

Signs and symptoms of hypertension?

A

usually none

  • maybe headache
  • maybe transient ischaemic attacks (‘mini strokes’- full neurological return in 24hrs)
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8
Q

What are indications for further investigation

A

young patient
resistant hypertension
accelerated hypertension
‘unusual history’

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9
Q

What is a phaemochromocytoma

A

a tumour of the adrenal gland which produces adrenaline (a potential rare cause of hypertension)

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10
Q

What is cushing’s syndrome

A

a tumour which produces too much cortisol (too much water and salt retained –> hypertension)

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11
Q

Why does renal artery stenosis make hypertension worse

A

hypertension causes renal disease which makes hypertension worse which makes renal disease worse etc (something to do with vasoconstriction causing kidneys to think there is a drop in blood vol so then replaces ‘lost’ blood vol which then puts extra pressure on heart and makes hypertension worse)

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12
Q

What investigations can you do for hypertension

A 
urinalysis
serum biochemistry
serum lipids
ECG
renal ultrasound, renal angiography, hormone estimations
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13
Q

What is the aim of treating hypertension

A

to get BP < 120/90 mmHg

modify risk factors

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14
Q

How can you treat hypertension

A

modify risk factors

single daily drug dose

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15
Q

what drugs are used to treat hypertension, what are their side effects

A 
thiazide diuretic (gout)
beta blocker (COPD/asthma)
calcium channel antagonist
ACE inhibitor (PVD)
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16
Q

What is heart failure

A

output of heart is not meeting tissues demands

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17
Q

In what 2 main ways can the heart fail

A
  • tissues aren’t getting what they need (high output failure e.g. severe anaemia)
  • heart isn’t doing enough (low output failure)
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18
Q

what is systolic dysfunction

A

ventricles are still filling but aren’t pumping enough out of them (about 60% is normal)

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19
Q

what is diastolic dysfunction

A

problems with filling the ventricles (heart is still able to pump out 60% but there is a lower volume there to pump)

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20
Q

What are signs of left sided heart failure

A

affects lungs and systolic pressure
patients breathless
high pulse rate but low blood pressure

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21
Q

what are signs of right sided heart failure

A

affects venous pressure
puffy ankles
pitting oedema
enlarged liver

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22
Q

what causes heart failure

A

lots of causes

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23
Q

What is the target of treatment for heart failure

A 
improve what they do have
reduce compensation (body increasing blood volume due to vasoconstriction but that makes heart failure worse so need to counteract with drugs)
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24
Q

what drugs are used for early heart failure and later heart failure

A

early: beta blocker
later: beta agonist (need to relax heart)

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25
What different replacement valves can you get
metal | porcine
26
Main differences between metal and porcine valves
Metal: - last longer - on anticoagulants Porcine: - shorter life span - not on anticoagulants
27
What are the most common valves to be replaced
left ones | Aortic and mitric
28
what is a very common reason for valve replacement
narrowed valve (stenosis)
29
what are two ways to develop heart failure
congenital or acquired
30
What is endocarditis
infection of the inner lining of the heart, most commonly affecting the valves
31
What happens to the lining of the heart during endocarditis
surface abnormalities, bacteria colonise on lining of heart walls and valves
32
how is endocarditis relevant to dentistry
dental work is one of the major causes of endocaridits
33
Are pacemakers used for slow or fast hearts or both?
slow (brady...)
34
what is a normal heart rate, what is a brady heart rate and what is a tacky heart rate
``` normal = 60-100 brady = less than 60 tacky = more than 100 ```
35
What are theorectical risks to patients on pacemakers in the dental surgery
scaler and electrosurgery machienes (extremly rare)
36
What are signs of heart failure
- breathlessness - swollen ankles - can't lie back/ need lots of pillows to sleep - medication of beta agonist e.g. didroxin
37
What things would you need to consider before giving a patient with heart failure/ endocarditis LA?
They will have drug absorption and metabolism issues LA isn't metabolised in liver so not a problem but the adrenaline might be balance of making patient more comfortable so less liklihood of palpatations vs effect of adrenaline
38
What are the priorities of oral care for patients with valve disease
- reducing bacteria in mouth - improve OH and denture treatment - prevent the need for dental work - get dentally fit - remove sources of infections e.g. overhangs on restorations and deep pockets
39
What do you need to discuss with patients who have a high endocarditis risk
- what it is - what their risk is of getting it depending on the treatment they are having - pros and cons of having antibacterial prophylaxis - contact cardiologist
40
How could patients be made aware of dental issues with pacemakers
patients will have info given to them with the pacemaker
41
What is the role of 'patient choice' in the provision of antibiotic prophyslaxis
- patient should have both risks and benefits - explain what they are getting done - what the consequences of ab are e.g. resistance, colitis, allergies - patient will make ultimate decision
42
How do you treat acute heart failure
emergency hospital management: - oxygen - morphine, frusemide
43
How do you treat chronic heart failure
community based: - improve myocardial function - reduce compensation effects - where possible treat the cause
44
What are hc workers aiming to achieve when treating heart failure
Treat any underlying cause - hypertension - valve disease - heart arrhythmias e.g. atrial fibrillation - anaemia - thyroid disease
45
What drug therapy is there for chronic heart failure
- diuretics - ACE inhibitor - nitrates - inotropes
46
how do diuretices help in chronic heart failure
increase salt and water loss
47
how do ACE inhibitors help in chronic heart failure
reduce salt/water retention
48
how do nitrates help in chronic heart failure
reduce venous filling pressure
49
how do inotropes help in chronic heart failure? an example of one?
makes heart more efficient Example: digoxin
50
What drugs should you stop when treating chronic heart failure
negative inotropes | = beta blockers
51
what is a tachy arrhythmia
fast heart rate
52
what is a brady arrhythmia
slow heart rate
53
What can cause a tachy arrhythmia
- atrial fibrillation | - ventricular fibrillation
54
What can cause a brady arrhythmia
- heart block | - drug induced (beta blocker, digoxin)
55
What a normal heart rate
around 160-170
56
how does a tachy arrhythmia contribute to reduced cardiac blood flow
can only move blood into coronary arteries during diastole as you increase hr the time spent in diastole gets shorter
57
When is a slow hr a problem
when you want to stand up
58
what kinds of heart conditions are treated with a pacemaker
bradyarrhythmias
59
what do cardiac pacemakers do
keep the heart rate at a minimum level
60
what is the risk of dental patients with pacemakers
theoretical risk of electrical interference
61
In cardiac arrhythmias what should we be able to identify
- sinus rhythm - asystole - ventricular fibrillation
62
what is a sinus rhythm
a normal heart beat
63
describe the 'labelled' elements of a sinus rhythm
P wave - atrial depolarisation QRS complex - ventricular depolarisation T wave - ventricular repolarisation
64
What does the height of a sinus rhythm vary by
the size of the muscle
65
what does the width of a sinus rhythm vary by
conduction
66
What is the heart rate, rhthym, P wave and QRS complex like of a sinus rhythm
heart rate = 60-100bpm rhythm = regular P wave = before each QRS, identical QRS - <0.12 seconds (looks like your classic heart beat)
67
What is the heart rate, rhthym, P wave and QRS complex like of a ventricular fibrillation
heart rate = 300-600bpm rhythm = extremely irregular P wave = absent QRS = fibrillatory baseline (looks like a squiggly line)
68
What is ventricular fibrillation caused by
Unstable heart electrical activity: - heart attack - electrocution - long QT syndrome - wolf-parkinson-white syndrome
69
how do you treat ventricular fibrillation
defibrillation
70
What is the heart rate, rhthym, P wave and QRS complex like of a ventricular fibrillation
heart rate = absent rhythm = absent P wave = absent or present QRS = absent (looks almost like a straight line as you still have a little electrical activity in body)
71
What is the heart rate, rhthym, P wave and QRS complex like of a atrial fibrillation
heat rate = 350-650bpm rhythm = irregular P wave = fibrillatory (fine to course) QRS = <0.12seconds
72
How is atrial fibrillation managed
with anticoagulants (can lead to blood clots in atria which can move and get stuck elsewhere)
73
what segment alters in a heart attack
ST segment elevation

BDS2 BAMS Cardiovascular medicine (5 decks)

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