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Human Disease > Hypertension and Stroke > Flashcards

Hypertension and Stroke Flashcards

1
Q

What does normal blood pressure depend on?

A

Balance of cardiac output and peripheral resistance

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2
Q

What physiological mechanisms are involved in maintaining blood pressure?

A

Renin angiotensin aldosterone system
Autonomic nervous system
Also : genetics plays a role

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3
Q

What happens when low BP, blood volume and sodium plasma levels are detected?

A

Renin released
Renin converts angiotensinogen to angiotensin 1
ACE converts angiotensin 1 to angiotensin 2
Angiotensin 2 causes vasoconstriction and increased aldosterone

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4
Q

What are most cases of hypertension due to?

A

“essential hypertension” - problem with peripheral resistance, exact mechanism unknown - prolonged smooth muscle contraction

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5
Q

What would persistently high BP cause?

A

Stroke
Heart disease
Renal disease
Visual failure

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6
Q

What increases the risk of developing high BP?

A 
Family history
Afro - Caribbean
Obese
Diabetes
Alcohol
Smoking
Sedentary life
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7
Q

What value is high BP?

A

Over 140/90 mmHg

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8
Q

How do we test BP?

A

Sphygmomanometer
Serial clinic readings
Ambulatory BP
Home testing

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9
Q

How is BP managed?

A 
Lifestyle changes
Weight loss
Smoking cessation
Reduce alcohol
Exercise
Diet
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10
Q

What drugs act on the RAAS?

A

Calcium blockers and diuretics stimulate renin
Beta blockers inhibit renin
ACE inhibitors inhibit ACE
Angiotensin 2 receptor antagonists (AIIRA) inhibit vasoconstriction in the arteries and inhibit aldosterone release from adrenal gland

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11
Q

What is the biggest modifiable risk for a stroke?

A

Hypertension

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12
Q

What is the burden of strokes?

A

Leading cause of hospital mortality
Second leading cause of death
Major cause of acquired disability
110,000 strokes per year - 1/3 will die, 1/3 will be disabled and 1/3 make a full recovery

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13
Q

What is a stroke?

A

A sudden onset of focal neurological symptoms related to the disruption of the vascular supply to a particular area of the brain, leading to tissue death
Infarction - 80%
Haemorrhage - 20%
Pattern of signs and symptoms is attributable to one part of the brain and a particular vascular supply

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14
Q

Name 6 transient focal neurological events?

A 
Partial seizure
Transient global amnesia
Demyelination
Hypoglycaemia
Peripheral nerve compression
Migraine
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15
Q

What is a TIA?

A

Transient ischaemic attack (Differs from stroke only in duration)
Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia
Symptoms last less than an hour
Requires urgent attention

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16
Q

What % of strokes are preceded by a TIA?

A

23%

17
Q

What should happen following a TIA?

A

Assessment within one week, and within 72 hrs if high risk

18
Q

What is the ABCD2 score?

A 
Predicts risk of stroke at 2 days
A = age
B = BP
C = clinical - weakness / speech
D = duration
D = diabetes
19
Q

What do the results of ABCD2 mean?

A

0 - 3 low risk
4 - 5 mod risk
6-7 high risk
Anything over 4 should be treated as if they’ve had a stroke

20
Q

What is the Bamford clasification of strokes?

A

TACS - total anterior circulation stroke
PACS - partial anterior circulation stroke
LACS - lacunar stroke
POCS - Posterior circulation stroke

21
Q

What comprises a TACS?

A

Extensive middle cerebral artery infarction
All of:
Contralateral hemiparesis
Contralateral homonymous hemianopia
Cortical higher function loss - dysphagia (dominant hemisphere), visuospatial (non dominant hemisphere)

22
Q

What comprises a PACS?

A

Branch of the middle cerebral artery

Any 2 of the 3 components of TACS

23
Q

What is lacunar syndrome?

A

Tiny deep infarcts, usually silent
Unsually internal capsule or pontine
Some symptoms - clumsy hands

24
Q

What comprises POCS?

A 
Ipsilateral cranial nerve defects
Motor or sensory
Disorder of conjunctive eye movement
Cerebellar dysfunction 
Contralateral homonymous hemianopia
25
Q

How can a stroke be treated?

A

PRIMARY PREVENTION - modify risk factors
ACUTE TREATMENT - thrombolysis as long as not due to haemmorhage!!
SECONDARY PREVENTION - lifestyle measures, thromboprophylaxis - anticoags , antiplatelets
REHABILITATION - restores neurological functionality

26
Q

What is a stroke unit?

A 
Multidisciplinary team
Expertise in rehabilitation
Regular in service training for staff
Involvement of carers in patient care
Observations
Advice
27
Q

What occurs on a stroke unit?

A 
Swallow assessment
Pressure sore prevention
Hydration and nutrition
BP management
Active glucose monitoring
Antipyretic treatment
28
Q

What is a carotid endarterectomy?

A

Surgical removal of the fatty deposits that have built up in the carotid

29
Q

What are the laws for driving after a stroke?

A

No driving for 1 month

Don’t have to notify DVLA in first month after stroke/TIA

30
Q

Why is it good to keep BP high following a stroke?

A

Keep it raised for 2 weeks to maintain brain perfusion

Human Disease (54 decks)

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