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BDS2 BAMS > Hypertension, Heart Failure and Cardiac Arrhythmias > Flashcards

Hypertension, Heart Failure and Cardiac Arrhythmias Flashcards

1
Q

what is hypertension

A

raised blood pressure

Systolic >140mm Hg
( > 160mm Hg in isolated systolic hypertension )
Diastolic > 90mm Hg
- Normal BP is 120/80

3 separate resting measurement and average

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2
Q

normal BP

A

120/80

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3
Q

is blood pressure constant

A

not a constant,
varies from person to person,
defined parameters where you would like the patient to lie

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4
Q

8 risk factors for hypertension

A

age

race

obesity

alcohol

family history

pregnancy

stress

drugs

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5
Q

how is age a risk factor for hypertension

A

Tends to rise with age as blood vessels get less elastic

Pulse pressure becomes higher, so systolic pressure rises (diastolic a little)

Age alone should not put you at risk – combination of factors

Risk factors change throughout life too

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6
Q

4 drugs that can increase risk of hypertension

A

Non steroidal
Corticosteroids
Oral contraceptives
Sympathomimetics

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7
Q

2 outcomes of hypertension

A

accelerated atherosclerosis
- can lead to Myocardial Infarction; Stroke; Peripheral Vascular disease

renal failure

risk of CV problems is proportional to BP
- treatment of HBP can reduce risk (except for coronary heart disease; atherosclerosis stays after treatment)

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8
Q

3 main influences on hypertension

A

environment
(inactivity, stress, obesity, tobacco, age, salt, alcohol)

gene/environment interactions

genes

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9
Q

common triggers for hypertension

A

none

this is essential hypertension
- can’t find source

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10
Q

essential hypertension

A

no triggers found

common

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11
Q

2 rare triggers for hypertension

A

renal artery stenosis

endocrine tumours

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12
Q

renal artery stenosis and how that can cause hypertension

A

Kidney helps alter BP

Kidney is maldiffused due to blockage (damaged vessels – narrow, weaken or harden)
- Thinks BP has dropped due to HBP lowering flow through in kidney, so then tries to retain salt and water = worsen HBP = worse kidney problems

Renal arteries of aorta at right angles – common area for atherosclerosis – can cause narrowing of artery so less blood flow in

can be congenital issue

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13
Q

3 endocrine tumours that can cause hypertension

A

Phaeochromocytoma (Adrenaline)

  • Tumour of adrenal gland
  • Adrenal gland sits on top of kidney

Crohn’s Syndrome (aldosterone)

Cushing’s Syndrome (cortisol)
- Tumour causing excess cortisol – so retaining too much salt and water

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14
Q

signs and symptoms of hypertension

A

Usually NONE

May get headache
- More common in ‘malignant hypertension’

May get Transient Ischaemic Attacks
- TIA’s are ‘mini strokes’ due to atherosclerosis caused by HBP – can be warning of HBP
Full neurological return in 24hrs

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15
Q

4 indications for further investigation

A

young patient

resistant hypertension

accelerated hypertension

‘unusual history’

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16
Q

5 investigations for hypertension

A

Urinalysis
- Biochemistry can be upset due to changes in absorption

Serum Biochemistry
- (electrolytes, urea & creatinine)

Serum Lipids

ECG
- occasionally

renal ultrasound, renal angiography, hormone estimations
- (need indication to do them)

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17
Q

aim of treatment for hypertension

A

BP < 120/90 mm Hg (aim for 140/90 otherwise no benefit of medicine)

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18
Q

treatments for hypertension

A

Modify risk factors

Single daily drug dose (higher compliance)

  • thiazide diuretic
  • beta blocker ; lower heart rate and cardiac output but may not help vasoconstrictors – poor evidence but still use
  • Calcium Channel antagonist
  • ACE inhibitor
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19
Q

4 single daily drugs used to treat hypertension

A
  • thiazide diuretic
  • beta blocker ; lower heart rate and cardiac output but may not help vasoconstrictors – poor evidence but still use
  • Calcium Channel antagonist
  • ACE inhibitor
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20
Q

side effect of thiazide diuretic

A

gout

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21
Q

side effect of beta blocker

A

COPD and asthma

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22
Q

side effect of ACE inhibitor

A

PVD

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23
Q

what drugs should be used in younger hypertension patients

A

Lower risk with beta blocker and ACE inhibitor for younger

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24
Q

what drugs should be used in older hypertension patients

A

thiazide diuretic and calcium channel blockers (less chance of being affected by long term side effects)

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25
Q

what is heart failure

A

ability of heart to make a CO necessary for its function is compromised
- cannot meet oxygen demands of tissues

imbalance between body needs and ability of heart to delliver

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26
Q

2 types of heart failure

A

high output failure

low output failure

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27
Q

2 causes of high output heart failure

A

anaemia
- less RBC, can no longer HR to meet oxygen demand

thyrotoxicosis

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28
Q

what type of heart failure is commonest

A

low output failure

body’s demand is roughly the same but unable to pump as effectively

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29
Q

causes of low output heart failure

A

cardiac defect e.g. MI, valve disease

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30
Q

left heart failure

A

More chance of failure due to increase pressure and workload

31
Q

right heart failure

A

can happen in isolation (MI or issue with lungs meaning harder to pump)

32
Q

congestive heart failure

A

high pressure in lungs knock on left side as more to pump which then means right has to work more to pump into the lungs
- both sides effected

33
Q

does left or right heart failure happen in isolation usually

A

no

34
Q

how can ventricle failure lead to heart disease

A 
failure of ventricle, 
CO fall, 
BP fall, 
increase in blood vessel constriction, 
increase aldosterone – inc in BP and inc in constriction,

reduce CO causing circle to go round again as lower BP

cycle gets worse and worse and worse – repeated cycles lead to heart failure

brain assumes loss of BP is haemorrhage – increase fluid levels and platelets in body but pump failure is the issue – builds up pressure – leads to pulmonary oedema and oedema swelling

35
Q

what is a simplified way to explain the commonest cause of heart failure

A

pump stops pumping around system – commonest issue

- certain areas easier to deliver oxygen over others

36
Q

aetiology of low output failure (5)

A

Heart Muscle disease

  • MI, Myocarditis
  • (diabetes, obesity)

Pressure Overload

  • Hypertension – more through = more likely to fail
  • aortic stenosis

Volume Overload

  • mitral incompetence
  • Aortic incompetence

Arrythmias

  • Atrial fibrillation
  • Heart Block

Drugs

  • beta blockers - used to manage heart attacks, less likely to have arrhythmia (combine with cardiac muscle issue leads to heart failure)
  • corticosteroids
  • anticancer drugs
37
Q

heart muscle diseases lead to low output failure

A

MI, mycarditis

diabetes, obesity

38
Q

how does pressure overload lead to low output failure

A

Hypertension – more through = more likely to fail

aortic stenosis

39
Q

how does volume overload lead to low output failure

A

mitral incompetence

Aortic incompetence

40
Q

how does arrhythmia lead to low output failure

A
  • Atrial fibrillation

- Heart Block

41
Q

what 3 drugs can lead to low output failure

A

beta blockers

corticosteroids

anticancer drugs

42
Q

how can beta blockers lead to low output failure

A

sed to manage heart attacks,

less likely to have arrhythmia (combine with cardiac muscle issue leads to heart failure)

43
Q

flagpost symptoms of heart failure

A

shortness of breath

swelling of feet and legs

chronic lack of energy

difficulty sleeping at night due to breathing problems

swollen or tender abdomen with loss of appetite (ascites)
- due to right side failure and venous pooling

cough with frothy sputum

increased urination at night

confusion and/or impaired memory

44
Q

how can heart failure cause difficulty sleeping at night

A

breathing problems

usually sleep propped up – lie down get breathless (left failure causing pulmonary oedema

45
Q

how do the symptoms and signs of heart failure change

A

depend upon ‘side’ mainly affected

46
Q

left heart failure symptoms and signs

A

dyspnoea,

tachycardia,

low BP,

low vol. Pulse,

pulmonary oedmea

(venous pressure building up on left side - lungs & systolic effects, fluid in lungs)

47
Q

right heart failure symptoms and signs

A

swollen ankles (both affected) - pitting oedema

ascites,

raised JVP,

tender enlarged liver,

poor GI absorption

(venous pressure elevated)

48
Q

ascites

A

abnormal buildup of fluid in the abdomen

swollen or tender abdomen with loss of appetite
- due to right side failure and venous pooling

49
Q

JVP

A

vertical distance between the highest point at which pulsation of the jugular vein can be seen and the sternal angle.

50
Q

what can impact the signs and symptoms of heart failure

A

how the patient is positioned

51
Q

acute treatment of heart failure

A

emergency hospital management

Oxygen, morphine, frusemide (diuretic)

52
Q

chronic treatment of heart failure

A

community based (most of the time)

  • improve myocardial function
  • reduce ‘compensation’ effects
  • where possible treat the cause
53
Q

appearance acute heart failure on an X-ray

A

white area is fluid - larger than in health (less air in lungs)

Heart width bigger – muscle problem, more flabby, poor contraction

54
Q

4 underlying causes of heart failure you may treat

A

hypertension

valve disease

heart arrhythmias (atrial fibrillation)

thyroid disease

55
Q

4 drug therapies for chronic heart failure

A

Diuretics - increase salt and water loss

ACE inhibitor - reduce salt/water retention, and reduce some compensation (hypertension)

Nitrates - reduce venous filling pressure

Inotropes - digoxin

  • work to make the heart more efficient
  • STOP negative inotropes - beta blockers! (make it worse)
56
Q

tachy arrhythmias are

A

FAST
commonest, 160-170 not 60-70,

  • can only move blood into coronary arteries during diastole so issue as increase HR the amount of diastole time shortens – reduces coronary artery flow, more likely to have MI
57
Q

2 types of tachy arrhythmias

A

atrial fibrillation

ventricular tachycardia

58
Q

brady arrhythmia are

A

SLOW less common,
rhythm maintained by pacemaker,
basal heart rate is 30bpm without – cannot stand

59
Q

2 types of brady arrhythmia

A
  • heart block

- drug induced (beta blocker, digoxin)

60
Q

cardiac pacemakers

A

Electronic boxes used to treat BRADYARRHYTHMIAs

Keep heart rate at a minimum level. Beats at a set rate.

61
Q

risk with cardiac pacemakers

A

theoretical risk of electrical interference (as looking for very small electrical heart signals)

  • electrical fields - MRI, electrosurgery/diathermy
  • dental equipment THEORETICAL risk only (some electrical scalers)
  • Pulp Testers OK - avoid INDUCTION scalers
62
Q

how an cardiac pacemaker works

A

Wire to see if heartbeat, and a wire to make cardiac muscle beat if no beat
- Sit and do nothing if happy level of beats, will kick in if HR drops e.g. due to blockage

Wire up through subclavian into superior vena cava and into right ventricle – sensing how often ventricle contracting compares against programme normal

63
Q

when are cardiac pacemakers used

A

to treat bradyarrhythmias

- kick in if HR drops

64
Q

sinus rhytm

A

PQRST wave

P wave – atrial depolarisation

QRS complex – Ventricular depolarisation

  • Narrow signals move quickly
  • Size of spike on size of muscle
  • Width of spike depends on conduction

T wave – Ventricular repolarisation

65
Q

ventricular fibrillation appearance on graph

A

Big broad irregular spikes – different bits conducting at different times

66
Q

ventricular fibrillation is

A

Unstable heart electrical activity

  • Heart attack
  • Electrocution
  • Long QT syndrome (can be worsened by medicines)
  • Wolf-Parkinson-White syndrome

No cardiac output
- Death follows!

Treat with ‘Defibrillation’
- Implanted defibrillators used in risk cases

67
Q

consequence of ventricular fibrilllation

A

No cardiac output
- Death follows!

Treat with ‘Defibrillation’
- Implanted defibrillators used in risk cases

68
Q

asystole is

A

Lack of any electrical activity

Wandering line
- Not flat line (not plugged in correctly)

69
Q

atrial fibrillation appearance on graph

A

Appears normal but no P wave

- Regularity of heartbeat gone
QRS is irregularly spaced

70
Q

asystole appearance on graph

A

Wandering line

- Not flat line (not plugged in correctly)

71
Q

atrial fibrillation is

A

Irregularly irregular heartbeat
- Regularity of heartbeat gone (QRS is irregularly spaced)

Common – managed with anticoagulants
As can develop blood clots in atria and lead to stroke

72
Q

how is atrial fibrillation managed

A

managed with anticoagulants

- As can develop blood clots in atria and lead to stroke

73
Q

graph of heart attack

A

ST elevation

BDS2 BAMS (54 decks)

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