Hypertension and heart failure Flashcards
What is hypertension?
- High/raised blood pressure
What are the systolic and diastolic figures considered to be hypertension?
- Systolic >140mmHg (>160mmHg in isolated systolic hypertension)
- Diastolic > 90mmHg
How could you tell if a patient has hypertension?
- Take 3 measurements over separate sittings
What are the possible risk factors for hypertension? (8 points)
- Age
- Race
- Obesity
- Alcohol
- Family history
- Pregnancy
- Stress
- Drugs (non steroidal, corticosteroids, oral contraceptives, sympathomimetics)
Hypertension can cause accelerated atherosclerosis, What can this lead to? (3 points)
- Myocardial infarction
- Stroke
- Peripheral vascular disease
Can hypertension contribute to renal failure?
Yes
What is essential hypertension?
- Means we have no idea why it happens it just occurs (in vast majority of patients you cannot find the disease that causes the hypertension)
- Has no identifiable cause
What are the common triggers for hypertension?
NONE usually found (essential hypertension)
What are the rare triggers for hypertension? (5 points)
- Renal artery stenosis
- Endocrine tumours:
- Phaeochromocytoma (adrenaline)
- Conn’s syndrome (aldosterone)
- Cushing’s syndrome (cortisol)
What are the signs and symptoms of hypertension?
- Usually NONE
- May get headaches (more likely in malignant hypertension)
- May get transient ischaemic attacks ‘mini strokes’ (Full neurological return in 24hrs) (this occurs due to platelets coming off and blocking vessels - quickly removed so don’t cause any permanent damage)
What are 4 examples of indications for further investigation of a person with hypertension?
- Young patient
- Resistant hypertension
- Accelerated hypertension
- ‘unusual history’
What is resistant hypertension?
Where blood pressure remains high despite efforts to lower it
What is a phaeochromocytoma?
- A tumour of the adrenal gland which produces an over secretion or adrenaline and nor-adrenaline
What is Cushing’s syndrome?
- An over production of cortisol
- Retain salt and water
What investigations can be done to test for renal artery stenosis? (5 points)
- Urinalysis (to test renal function)
- Serum biochemistry (electrolytes, urea & creatine)
- Serum lipids
- ECG
- Occasionally - renal ultrasound, renal angiography, hormone estimations
What is the aim of treating hypertension?
Aim to get BP to <120/90mmHg
(if can’t get it down to this want to at least have it in the ballpark
One treatment of hypertension is to modify risk factors. What are examples of these risk factors? (3 points)
- Exercise
- Diet
- Weight loss
One possible treatment of hypertension is single daily drug use. Give examples of 4 of these drugs and the possible side effects of these?
- Thiazide diuretic (gout)
- Beta blocker (COPD & asthma)
- Calcium channel antagonist
- ACE inhibitor (PVD)
What is heart failure?
- When the ability of the heart to produce a cardiac output necessary in the body for bodily functions is compromised
Are high output heart failures common or rare?
- Rare
Give 2 examples of high output failure heart failures?
- Anaemia
- Thyrotoxitosis
Give an example of low output hear failures?
- Cardiac defect e.g. MI, valve disease
the ability of the heart tp pump gets less
What are 3 alternative terms for heart failure?
- Left heart failure
- Right heart failure
- Congestive heart failure
A possible cause of low output hear failure is heart muscle disease. Give 2 examples of these and 2 examples of what may cause this?
- MI and myocarditis
- (diabetes, obesity)
A possible cause of low output heart failure is pressure overload. Give 2 examples of these ?
- Hypertension
- Aortic stenosis
A possible cause of low output heart failure is volume overload. Give 2 examples of these?
- Mitral incompetence
- Aortic incompetence
A possible cause of low output heart failure is arrythmias. Give 2 examples of these?
- Atrial fibrillation
- Heart block
A possible cause of low output heart failure is drugs. Give 3 examples of these?
- Beta blocker
- Corticosteroids
- Anticancer drugs
The signs and symptoms of heart failure are different depending on the side affected. What are the signs and symptoms of left side heart failure? (4 points)
- lungs & systolic effects
- Dyspnoea
- Tachycardia
- Low BP
- Low vol. pulse
The signs and symptoms of heart failure are different depending on the side affected. What are the signs and symptoms of right side heart failure? (5 points)
- Venous pressure elevated
- Swollen ankles
- Ascites
- Raised JVP
- Tender enlarged liver
- Poor GI absorption
What is ascites?
The accumulation of fluid in the peritoneal cavity, causing abdominal swelling
What are a lot of common signs and symptoms of heart failure? (8 points)
- Shotness of breath
- Swelling of legs and feet
- Chronic lack of energy
- Difficulty sleeping at night due to breathing problems
- Swollen or tender abdomen with loss of apatite
- Cough with frothy sputum
- Increased urination at night
- Confusion and/or impaired memory
What is a common type of peripheral swelling that can be a sign of heart failure?
- Pitting oedema
What is the treatment of acute heart failure? (3 points)
- Emergency hospital management
- Oxygen
- Morphine
- Frusemide (diuretic - to pee out excess fluid)
What is the treatment of chronic heart failure? (3 points)
- Community based
- Improved myocardial function
- Reduce ‘compensation effects’
- Where possible treat the cause
What are compensation effects in relation to heart failure?
- In cardiology, the maintenance of an adequate blood flow without distressing symptoms, accomplished by such cardiac and circulatory adjustments as tachycardia, cardiac hypertrophy and increase of blood volume by sodium and water retention
When treating the underlying cause of heart failure what are things that may need to be treated? (5 points)
- Hypertension
- Valve disease
- Heart arrhythmias (AF)
- Anaemia
- Thyroid disease
Drug therapy can be a treatment of chronic heart failure. Give examples of some drugs? (5 points)
- Diuretics = increase and water loss
- ACE inhibitors = reduce salt/water retention
- Nitrates = reduce the venous filling pressure
- Inotropes = digoxin
- STOP negative inotropes = beta blockers
What are inotropes?
Substances that are used to alter the energy of muscle contractions. These substances can be negatively inotropic or positively inotropic. Negatively inotropic agents decrease the energy of muscle contractions, and positively inotropic agents increase the energy of muscle contractions
What are 2 examples of tachy arrhythmias (FAST)?
- Atrial fibrillation
- Ventricular fibrillation
What are 2 examples of brady arrhythmias (SLOW)?
- Heart block
- Drug induced (beta-blocker, digoxin)
What are cardiac pacemakers used for?
- Used to keep HR from dropping too low
- Used to treat BRADYARRHYTHMIA’s
What will cardiac pacemakers keep the heart rate at?
- Keeps HR at a minimum level
What possible things in the dental/medical environment could affect cardiac pacemakers?
- Electrical fields - MRI, electrosurgery/diathermy
- Dental equipment THEORETICAL risk only
- Pulp tests okay - Avoid INDUCTION scalers
Which cardiac atthythmias should yo be able to recognise? (3 points)
- Sinus rhythm
- Asystole
- Ventricular fibrillation
(Know about AF and MI)
What does the P wave in the sinus rhythm suggest?
- Atrial depolarisation
What does the QRS complex in sinus rhythm suggest?
- Ventricular depolarisation
What does the T wave in sinus rhythm suggest?
- Ventricular repolarisation
What are examples of unstable heart electrical activity that can cause VF? (4 points)
- Heart attack
- Electrocution
- Long QT syndrome
- Wolf-Parkinson-white syndrome
What is the treatment or VF?
- Defibrillation
implanted defibrillators used in risk cases
What will you see in a sinus rhythm of someone having a heart attack?
- ST segment elevation (suggests the patient is having an MI)
