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Y1 Cardiovascular > Hypertension and Hyperlipidaemia > Flashcards

Hypertension and Hyperlipidaemia Flashcards

1
Q

Stage 1 Hypertension

A

clinic blood pressure is higher than 140/90 mmHg AND ambulatory BP is 135/85mmHg average

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2
Q

Stage 2 Hypertension

A

clinic BP is higher than 160/100mmHg AND ambulatory BP is 150/95mmHg or higher

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3
Q

Stage 3 hypertension

A

clinic systolic is 180mmHg or higher OR clinic diastolic is 110mmHg or higher

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4
Q

Potentially affected organs in hypertension (5)

A

Brain, Eyes, Kidneys, Heart, Arterial Tree

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5
Q

Potential effect of hypertension on the brain

A

stroke

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6
Q

Potential effect of hypertension on the eyes

A

Impaired vision

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7
Q

Potential effect of hypertension on the kidneys

A

narrowing and thickening of renal arteries leading to kidney damage

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8
Q

Potential effect of hypertension on the heart

A

MI, congestive heart failure

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9
Q

Potential effect of hypertension on the arteries

A

atherosclerosis

aortic aneurysm

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10
Q

Populations more likely to have high BP

A

African-americans

deprived areas

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11
Q

Structural changes that occur in the arteries due to hypertension

A

internal elastic lamina thickening
smooth muscle hypertrophy
fibrosis
all of these reduce the lumen and increase shear stress on the intima

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12
Q

artherosclerosis causes a(n) _______ in total peripheral resistance

A

increase

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13
Q

types of hypertension (2)

A

primary (essential) and secondary

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14
Q

Most common type of hypertension

A

primary (essential) 90-95% of cases

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15
Q

Good form of cholesterol

A

HDL

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16
Q

Bad form of cholesterol

A

LDL

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17
Q

4 major types of lipoproteins

A

HDL, LDL, VLDL, Chylomicrons

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18
Q

Lipid are soluble in water - True or false

A

false

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19
Q

What can lipids be used for? (3)

A

energy, hormones, signalling molecules

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20
Q

The hydrophobic core in lipoproteins contains?

A

esterified cholesterol and triglycerides

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21
Q

The hydrophillic coat of lipoproteins contains?

A

amphipathic cholesterol, phospholipids and one or more apoproteins

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22
Q

Cardiovascular disease is associated with which types of lipids?

A

elevated LDL, high triglycerides, low HDL

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23
Q

where does the majority of cholesterol come from?

A

from the bile, only 25% comes from the diet

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24
Q

The majority of LDL is cleared by…

A

the liver

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25
Q

Rate limiting enzyme in de novo cholesterol synthesis

A

HMG CoA reductase

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26
Q

Released cholesterol causes: (3)

A

inhibition of HMG coA reductase; down regulation of LDL receptor express; storage of cholesterol as an ester

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27
Q

Clearance of LDL is dependent upon?

A

the LDL receptor on the liver and other tissues

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28
Q

Why is LDL cholesterol bad in the arteries?

A

it migrates into the intima and produces OXLDL which causes the migration of monocytes into the endothelium and the formation of foam cells and a fatty streak.

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29
Q

Why is HDL cholesterol the good cholesterol?

A

transports excess cholesterol back to the liver where it can be cleared from the body

30
Q

Secondary dyslipidaemia is a consequence of other diseases such as…(4)

A

T2DM, hypothyroidism, alcoholism, liver disease

31
Q

Statins act via…

A

inhibiting HMG CoA reductase

32
Q

Examples of statins (2)

A

Simvastatin, atorvastatin

33
Q

Where are statins not effective?

A

in homozygous familial hypercholesteraemia

34
Q

What time of day should statins be taken?

A

at night

35
Q

Other beneficial effects of statins?

A

reduce inflammation; reverse endothelial dysfunction; decrease thrombosis; stabilise atherothrombotic plaques

36
Q

Where should statins be avoided?

A

pregnancy; rhabdomyolosis

37
Q

Where are fibrates used?

A

in high triglycerides, also produce a modest decrease in LDL

38
Q

Examples of fibrates (2)

A

benzofibrate

gemfibrozil

39
Q

where are fibrates used as first line?

A

in patients with high triglycerides

40
Q

Where are fibrates best avoided?

A

in alcoholics

41
Q

Examples of drugs that inhibit cholesterol absorption (3)

A

cholestryamine, colestipol, celsevelam

42
Q

How do drugs inhibiting cholesterol absorption act?

A

bile acid binding residues which binds cholesterol in the GI tract to prevent absorption

43
Q

How does Ezetimibe work?

A

inhibits NPC1L1 transport protein in the enterocytes reducing the absorption of cholesterol - NOT FIRST LINE

44
Q

Common causes of Atheroma

A

smoking, hypertension, hyperlipidaemia, diabetes, age, sex, genetics

45
Q

4 stages of pathogenesis of Atheroma

A
  1. Primary endothelial injury; 2. Accumulation of lipids and macrophages; 3. Migration of smooth muscle cells; 4. increase in size
46
Q

5 complications of atheroma

A

Stenosis; Thrombosis; Aneurysm formation; Arterial dissection; Embolism

47
Q

What is stenosis?

A

a narrowing of the lumenal calliper, reduced elasticity

48
Q

Stenosis may produce tissue ischamia which may be seen in the forms of?

A

angina, MI, cardiac failure, cardiac fibrosis, carotid artery disease (TIA, stroke), renal artery hypertension

49
Q

What infarctions may a thrombus cause?

A

MI, cerebral, renal, intestinal

50
Q

What is an aneurysm?

A

a abnormal and persistant dilation of an artery due to a weakness in its wall

51
Q

Commonest site of aneurysm formation

A

abdominal aorta

52
Q

Conditions associated with arterial dissection

A

atheroma and hypertension, trauma, coarction, marfans, pregnancy

53
Q

hypertension causes…

A

cardiac failure, atheroma, cerebral haemorrhage, renal failure, sudden cardiac death

54
Q

what is masked hypertension?

A

when a patient has hypertension at home, but this appears normal in the clinic

55
Q

Cardiac output is affected by (3)

A

Heart rate, contractility, blood volume

56
Q

Peripheral resistance constrictors include?

A

catecholamines, AngII

57
Q

Peripheral resistance dilators include?

A

NO, prostaglandins

58
Q

How might primary hypertension be defined?

A

hypertension with no obvious cause which is likely to be affected by genetic and lifestyle factors

59
Q

Secondary hypertension due to renal disease is salt sensitive - true or false?

A

true

60
Q

Common causes of secondary hypertension

A

renal disease, obstructive sleep apnoea, aldosteronism, reno-vascular disease

61
Q

Renal disease causes hypertension by what mechanism??

A

decreased renal blood flow leads to excessive renin secretion and thus salt and water overload

62
Q

Benign hypertension can be described as…

A

hypertension that will cause serious life threatening conditions but is often asymptomatic

63
Q

Benign hypertension can lead to…

A

LV hypertrophy, congestive heart failure, atheromas, aneurysm rupture, aortic dissection, berry aneurysms, renal disease

64
Q

Anyone diagnosed with hypertension should have which 4 tests

A

urine (protein), Bloods, fundi for hypertensive retinopathy, 12 lead ECG

65
Q

Bloods to be checked for in hypertension

A

glucose, electrolytes (ACEIs), creatinine, Glomerular Filtration rate, cholesterol and fasting lipids

66
Q

Spironolactone is given at which step in hypertension treatment?

A

step 4

67
Q

Other drugs that can be given when ACEIs, CCB and thiazide like diuretics are not successful

A

Beta blockers, Spironolacton

68
Q

Malignant hypertension is seriously life threatening - it is described as…

A

diastolic > 130/140mmHg

69
Q

malignant hypertension can result in…

A

papilloedema, acute renal failure, acute heart failure, head ache, cerebral haemorrhage, fibrinoid necrosis in arteries

70
Q

Gestational hypertension causes

A

eclampsia and an increase in maternal and foetal mortality

71
Q

pre-eclampsia is diagnosed as…

A

hypertension and proteinuria

Y1 Cardiovascular (12 decks)

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