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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
Q

What different replacement valves can you get

A

metal

porcine

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26
Q

Main differences between metal and porcine valves

A

Metal:

  • last longer
  • on anticoagulants

Porcine:

  • shorter life span
  • not on anticoagulants
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27
Q

What are the most common valves to be replaced

A

left ones

Aortic and mitric

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28
Q

what is a very common reason for valve replacement

A

narrowed valve (stenosis)

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29
Q

what are two ways to develop heart failure

A

congenital or acquired

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30
Q

What is endocarditis

A

infection of the inner lining of the heart, most commonly affecting the valves

31
Q

What happens to the lining of the heart during endocarditis

A

surface abnormalities, bacteria colonise on lining of heart walls and valves

32
Q

how is endocarditis relevant to dentistry

A

dental work is one of the major causes of endocaridits

33
Q

Are pacemakers used for slow or fast hearts or both?

A

slow (brady…)

34
Q

what is a normal heart rate, what is a brady heart rate and what is a tacky heart rate

A 
normal = 60-100
brady = less than 60
tacky = more than 100
35
Q

What are theorectical risks to patients on pacemakers in the dental surgery

A

scaler and electrosurgery machienes (extremly rare)

36
Q

What are signs of heart failure

A
  • breathlessness
  • swollen ankles
  • can’t lie back/ need lots of pillows to sleep
  • medication of beta agonist e.g. didroxin
37
Q

What things would you need to consider before giving a patient with heart failure/ endocarditis LA?

A

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
Q

What are the priorities of oral care for patients with valve disease

A
  • 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
Q

What do you need to discuss with patients who have a high endocarditis risk

A
  • 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
Q

How could patients be made aware of dental issues with pacemakers

A

patients will have info given to them with the pacemaker

41
Q

What is the role of ‘patient choice’ in the provision of antibiotic prophyslaxis

A
  • 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
Q

How do you treat acute heart failure

A

emergency hospital management:

  • oxygen
  • morphine, frusemide
43
Q

How do you treat chronic heart failure

A

community based:

  • improve myocardial function
  • reduce compensation effects
  • where possible treat the cause
44
Q

What are hc workers aiming to achieve when treating heart failure

A

Treat any underlying cause

  • hypertension
  • valve disease
  • heart arrhythmias e.g. atrial fibrillation
  • anaemia
  • thyroid disease
45
Q

What drug therapy is there for chronic heart failure

A
  • diuretics
  • ACE inhibitor
  • nitrates
  • inotropes
46
Q

how do diuretices help in chronic heart failure

A

increase salt and water loss

47
Q

how do ACE inhibitors help in chronic heart failure

A

reduce salt/water retention

48
Q

how do nitrates help in chronic heart failure

A

reduce venous filling pressure

49
Q

how do inotropes help in chronic heart failure? an example of one?

A

makes heart more efficient

Example: digoxin

50
Q

What drugs should you stop when treating chronic heart failure

A

negative inotropes

= beta blockers

51
Q

what is a tachy arrhythmia

A

fast heart rate

52
Q

what is a brady arrhythmia

A

slow heart rate

53
Q

What can cause a tachy arrhythmia

A
  • atrial fibrillation

- ventricular fibrillation

54
Q

What can cause a brady arrhythmia

A
  • heart block

- drug induced (beta blocker, digoxin)

55
Q

What a normal heart rate

A

around 160-170

56
Q

how does a tachy arrhythmia contribute to reduced cardiac blood flow

A

can only move blood into coronary arteries during diastole

as you increase hr the time spent in diastole gets shorter

57
Q

When is a slow hr a problem

A

when you want to stand up

58
Q

what kinds of heart conditions are treated with a pacemaker

A

bradyarrhythmias

59
Q

what do cardiac pacemakers do

A

keep the heart rate at a minimum level

60
Q

what is the risk of dental patients with pacemakers

A

theoretical risk of electrical interference

61
Q

In cardiac arrhythmias what should we be able to identify

A
  • sinus rhythm
  • asystole
  • ventricular fibrillation
62
Q

what is a sinus rhythm

A

a normal heart beat

63
Q

describe the ‘labelled’ elements of a sinus rhythm

A

P wave - atrial depolarisation

QRS complex - ventricular depolarisation

T wave - ventricular repolarisation

64
Q

What does the height of a sinus rhythm vary by

A

the size of the muscle

65
Q

what does the width of a sinus rhythm vary by

A

conduction

66
Q

What is the heart rate, rhthym, P wave and QRS complex like of a sinus rhythm

A

heart rate = 60-100bpm
rhythm = regular
P wave = before each QRS, identical
QRS - <0.12 seconds

(looks like your classic heart beat)

67
Q

What is the heart rate, rhthym, P wave and QRS complex like of a ventricular fibrillation

A

heart rate = 300-600bpm
rhythm = extremely irregular
P wave = absent
QRS = fibrillatory baseline

(looks like a squiggly line)

68
Q

What is ventricular fibrillation caused by

A

Unstable heart electrical activity:

  • heart attack
  • electrocution
  • long QT syndrome
  • wolf-parkinson-white syndrome
69
Q

how do you treat ventricular fibrillation

A

defibrillation

70
Q

What is the heart rate, rhthym, P wave and QRS complex like of a ventricular fibrillation

A

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
Q

What is the heart rate, rhthym, P wave and QRS complex like of a atrial fibrillation

A

heat rate = 350-650bpm
rhythm = irregular
P wave = fibrillatory (fine to course)
QRS = <0.12seconds

72
Q

How is atrial fibrillation managed

A

with anticoagulants (can lead to blood clots in atria which can move and get stuck elsewhere)

73
Q

what segment alters in a heart attack

A

ST segment elevation

BDS2 BAMS Cardiovascular medicine (5 decks)

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