Hypertension, diseases of aorta, arteries, veins and lymphatics Flashcards
how deadly is hypertension and why?
biggest killer in the world
because of the risk of cardiovascular disease and end-organ damage
what are the causes of hypertension?
no single cause
polifactorial and poligenic
what are the risks associated with hypertension?
heart failure CVA (stroke, MI) kidney failure vascular disease eye disease (retinopathy)
what are some of the risk factors for hypertension?
smoking diabetes age gender (male) obesity pregnancy alcoholism genetics/family history race hypercholesterolaemia environment salt intake stress
which family link is more likely to develop hypertension?
siblings and identical twins
which ethnicity is more likely to develop hypertension?
afrocaribbeans
what is defined as hypertension?
BP higher than 140/90
what types of hypertension are there, what is their prevalence?
primary hypertension (90%) secondary hypertension (10%)
what are the causes of primary hypertension?
often idiopathic
what are the causes of secondary hypertension?
kidney disease
pregnancy
endocrine disease
what is a potential cause for primary hypertension?
increased arteriolar resistance
what is the main target of treatment for hypertension?
the RAAS system
what is the approach to hypertension?
stepped approach
use low doses of multiple drugs
what are common drugs given for hypertension?
ACEi/ARB CCB thiazide diuretics methyldopa (pregnancy) nifedipine (pregnancy)
what treatments are given to pregnant women for hypertension/preeclampsia?
methyldopa
nifedipine
beta blocker
hydralazine
which subgroups should ACEi not be given to and why?
Older patients - because of kidney damage risk
Afrocaribbeans - because of angioedema risk
Pregnant women - because of teratogenicity
what treatment should be given first line to people over 55 and afrocaribbeans for hypertension?
Calcium channel blocker or thiazide diuretic
what are less commonly used drugs in hypertension?
doxazosin
methyldopa
hydralazine
what investigations should be done for hypertension?
Ambulatory BP meter
calculate risk (with online calculator)
ECG/kidney function tests (assess end-organ damage)
look for underlying treatable causes of HTN
what are the main non-pharmacological treatments for hypertension?
weight loss
smoking cessation
salt intake reduction
what are common risk factors for aortic aneurysms?
atherosclerosis hypertension smoking high cholesterol connective tissue diseases
what are the common types of aortic aneurysms?
saccular aneurysm
fusiform aneurysm
false (dissecting) aneurysm
what are some infectious/inflammatory diseases which cause aortic disease?
takayasu’s arteritis
syphilis
what are the imaging investigations carried out to diagnose aortic aneurysms?
Echocardiogram
CXR
MRI
what is the medical and surgical treatment for aneurysms?
medical - antihypertensives
surgical if severe/emergency
what type of aneurysm is seen most commonly by cardiologists?
dissecting aneurysm
how is a dissecting aneurysm diagnosed with imaging?
CXR
echocardiogram
CT scan
what are some signs/symptoms of aortic aneurysms?
- often asymptomatic
- hoarseness/dysphagia if compressing L Recurrent laryngeal nerve
- heart failure/aortic regurgitation
- shortness of breath
what are some signs/symptoms of dissecting aneurysms?
- sharp pain between shoulder blades/chest pain
- collapse
- cardiogenic shock
- pulmonary oedema
- hypertension/hypotension
what are the different types of aortic coarctation and the incidence of some of them?
- ductal
- pre-ductal (turner’s syndrome)
- post-ductal (most common in adults)
what are some of the signs of aortic coarctation?
hypertension upper limbs
low pulse/cold lower limbs
before subclavian artery:
radial-radial delay
right radio-femoral delay
after subclavian artery:
no radial-radial delay
right and left radio-femoral delay
how is aortic coarctation diagnosed with imaging?
echocardiogram
CT scan
MRI scan
what is the treatment of takayasu’s arteritis?
steroids
surgery if severe
what are the complications of cardiac syphilis?
risk of aneurysm
risk of aortic regurgitation
what are the cardiac risks associated with bicuspid aortic valve disorders?
abnormal aorta
risk of aneurysm/dissection
risk of aortic regurgitation
what are the imaging investigations used to diagnose bicuspid aortic valve?
echocardiogram
CXR
MRI
what are some symptoms in children and adults with aortic coarctation?
children - normally severe, heart failure
adults - hypertension
what are the most common congenital aortic abnormalities due to?
Marfan’s syndrome
aortic coarctation
bicuspid aortic valve
what are common causes of peripheral artery disease?
atherosclerosis
thromboembolism
what are two common types of peripheral artery disease?
chronic limb ischaemia
acute limb ischaemia
what are the risk factors for chronic limb ischaemia?
same risks as the ones for atherosclerosis
what are possible signs of chronic limb ischaemia?
pallor pain faint/no pulse ulceration gangrene if severe prominent collateral circulation
what are possible tests to diagnose chronic limb ischaemia?
history and examination ECG, FBC, U&E Ankle Brachial Index Buerger's test Doppler ultrasound CTA/MRA angiogram
what treatment options are there for chronic limb ischaemia?
same as ischemic heart disease: antiplatelets blood pressure medication statins smoking cessation exercise diabetic control surgery - embolectomy, angioplasty/bypass
what is the classification used to diagnose critical limb ischaemia?
fontaine classification
what is acute limb ischaemia?
complete occlusion of artery supplying part of the leg
what are the signs of acute limb ischaemia?
6 P's perishingly cold pain pallor paresthesia paralysis pulseless
what is the management of acute limb ischaemia?
analgesia, heparin
urgent surgery - embolectomy or angioplasty, amputation
what is the main treatment of diabetic foot disease?
prevention, foot care
diabetic control
revascularisation
amputation
what causes varicose veins?
regurgitation from saphenofemoral junction or saphenopoplitear junction –> increased pressure –> blood backs up the great/small saphenous vein
what are possible signs/symptoms of varicose veins?
obvious enlarged superficial veins itching burning heaviness phlebitis bleeding ulcerating swelling pain
what are the tests that can be done to diagnose varicose veins?
tap test
doppler test
how can varicose veins be classified and treated?
CEAP classification only treat if symptomatic or severe CEAP heat treatment (ablation) deep treatment (slerotherapy) stripping the vein
what is chronic venous insufficiency?
inability of veins to move blood back up to the heart
what symptoms can chronic venous insufficiency show?
oedema
eczema
ulceration
hypopigmentation
how can chronic venous insufficiency be managed?
compression stockings
what is lymphoedema and what can it be caused by?
obstruction of lymphatic drainage
primary or secondary
caused by obliteration of the lymph vessels or hyperplasia/congestion of lymph vessels
how is lymphoedema commonly treated?
drainage and elevation
what are the possible functional and anatomical imaging techniques used to visualise blood vessels?
xray catheter angiograms (xray + contrast) CT MRI ultrasound functional MRI nuclear imaging
which patients should not go through catheter angiograms?
people with renal disease
people with allergies to contrast
what can be used as contrast apart from iodinated contrast?
carbon dioxide
