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BDS2 - cardiovascular medicine > hypertension, heart failure and cardiac arrhythmias > Flashcards

hypertension, heart failure and cardiac arrhythmias Flashcards

1
Q

what is hypertension

A

high blood pressure

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2
Q

what is a major cause of hypertension

A

genes

- ties in slightly with gender and race

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3
Q

what are the genes/environmetn interactions that can affect hypertension

A

race and gender

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4
Q

what causes can you not do much about to reduce chance of hypertension

A
  • genes

- race and gender

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5
Q

what things can patients do to help reduce their risk of hypertension

A
  • environmental factors
  • in vast majority of patients this is all that needs changed
  • inactivity
  • stress
  • obesity
  • age
  • salt
  • alcohol
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6
Q

what is normal blood pressure

A

120/80

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7
Q

when do you call it hypertension

A
  • once blood pressure reaches a certain threshold
  • not just a one off measurement = do test 3 times
  • hypertension when systolic = >140mmHg
  • hypertension when diastolic = >90mmHg
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8
Q

why is age a risk factor in hypertension

A
  • as you age you bp rises
  • the elasticity in you blood vessels decreases so pump pressure is higher
  • but by itself age should not put you at risk
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9
Q

what drugs can make you more at risk of hypertension

A
  • some drugs can make hypertension more predictable
  • non steroidal
  • corticosteroids
  • oral contraceptives
  • sympathomimetics
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10
Q

what is the outcome of hypertension

A
  • at risk of a lot of CV diseases if you have high blood pressure
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11
Q

what happens in cerebrovascular accident (CVA) if treat hypertension

A

reduces risk massively

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12
Q

what happens in cardiovascular disease (CVD) if treat hypertension

A

doesn’t make much of a difference

- problem is hbp causes atherosclerosis and this still remains after treating hbp

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13
Q

what happens to congestive heart failure if treat hypertension

A

decreases a lot

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14
Q

what happens to renal damage if treat hypertension

A

decreases

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15
Q

what happens to atherosclerosis if treat hypertension

A
  • accelerated
  • causes
    = myocardial infarction
    = stroke (bleed or atherosclerosis in carotid artery stroke)
    = peripheral vascular disease
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16
Q

what is a bleed stroke

A

vessel popped from too much pressure

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17
Q

what can fail due to hypertension

A

renal system - get renal failure

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18
Q

what are the causes of hypertension

A
  • genes
  • genetic/environment = race, gender
  • environments = inactivity, stress, obesity, tobacco, age, salt and alcohol
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19
Q

what are common triggers for hypertension

A
  • none usually found

- have essential hypertension

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20
Q

what is essential hypertension

A
  • have no idea why it happens

- for a patient you can’t find the cause for disease

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21
Q

what are rare triggers for hypertension

A
  • renal artery stenosis

- endocrine tumours

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22
Q

what is renal artery stenosis

A
  • kidney arteries narrowed and blood flow reduced, kidney thinks bp has fallen and takes measures to try and improve bp = this compensation by the kidney makes it worse as it will make bp higher
  • more likely in younger people as older people hypertension is more to do with inactivity
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23
Q

what are some examples of endocrine tumours

A
  • pheochromocytoma = adrenaline
  • Crohn’s syndrome = aldosterone
  • Cushing’s syndrome = cortisol
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24
Q

what are the signs and symptoms of hypertension

A
  • usually none
  • may get headaches = more common in malignant hypertension
  • may get transient ischaemic attacks (TIA’s)
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25
Q

what are TIA’s

A
  • mini strokes
  • clot comes off and clocks vessel to the brain
  • full neurological return in 24 hours = clot cleared like a normal clot
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26
Q

what are some indications for further investigations

A
  • occurs in young patients
  • resistant hypertension
  • accelerated hypertension
  • ‘unusual’ history
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27
Q

what is pheochromocytoma

A

tumour of adrenal gland that produces adrenaline

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28
Q

what is Cushing’s syndrome

A
  • too much cortisol
  • absorb too much salt and water
  • characteristics = personality changes, hyperglycaemia, moon face, CNS irritability, infections, oedema, fat deposits in face and back, thin skin, bruises, osteoporosis
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29
Q

what is renal artery stenosis

A
  • one kidney is smaller as not had enough blood to grow properly
  • get atherosclerosis in aorta = common at junction and renal arteries come off of aorta so occurs here
  • causes narrowing of renal arteries so less blood to kidney so you get a small kidney and normal kidney
  • small kidney is then also working at a higher pressure
30
Q

what are the investigations for hypertension

A
  • urinalysis = look at renal function
  • serum biochemistry = electrolytes, lures and creatine; can be upset if you have a tendency to absorb more salt
  • ECG
  • occasionally = renal ultrasound, renal angiography and hormone estimations
31
Q

what does it mean if you have serum lipids

A

atherosclerosis is high

32
Q

how is hypertension treated

A
  • aim of treatment is to bring blood pressure down to 120/90
  • modify risk factors = try find reason patient can modify
  • single daily drug dose
33
Q

what is single daily drug dose

A
  • people will remember to take drug once a day more than they will to take more
  • great start
  • better compliance
  • beta blocker = doesn’t stop the fact you can have vasoconstriction of vessels, can make asthma and COPD worse
  • thiazide diuretic = can cause gout, start with this treatment for the elderly
  • calcium channel antagonist
  • ACE inhibitor = make PVD worse
34
Q

what is heart failure a consequence of

A

hypertension

35
Q

what is the role of the cardiorespiratory system

A
  • ability of heart to give cardiac output into body necessary for the oxygen demands of the tissues
36
Q

what is heart failure

A
  • imbalance of needs of body and hearts ability

- output of heart is incapable of meeting demands of the tissues

37
Q

what are diseases caused by high output failure

A
  • anaemia

- thyrotoxicosis

38
Q

what are diseases caused by low output failure

A

cardiac defect

  • MI
  • valve disease
39
Q

what is left heart failure

A
  • rare
  • more commonly has problems as under more pressure
  • means bp in lungs is raised and right side eventually too
40
Q

what is right heart failure

A
  • rare
  • less common than left
  • mainly follows left
41
Q

what is another term for heart failure

A

congestive heart failure

42
Q

what happens during systolic dysfunction

A
  • diastole (filling) = enlarged ventricles fill with blood

- systole (pumping) = ventricles pump out less than 40-50% of the blood

43
Q

what happens during diastolic dysfunction

A
  • diastole = stiff ventricles fill with less blood than normal
  • systole = ventricles pump about 60% of blood, but amount may be lower than normal
44
Q

what is the most common reason for heart failure

A
  • pump not working

- is more difficult pumping up rather than down as harder to pump against gravity

45
Q

how do you cope with blood pressure fall

A
  • increase blood vessel sympathetic tone
46
Q

what happens once you start on cycle of heart failure

A
  • just gets worse and worse
  • compensation of body to help doesn’t make it any better
  • body assumes high bp is due to a haemorrhage and all mechanism to make it work try to fix haemorrhage but that’s not the problem = this will put more fluid into pump but that makes it worse and raises bp even more
  • causes oedema in pump and peripheral tissues
  • go into spiral of heart failure
47
Q

what is caused by heart muscle disease

A
  • MI, myocarditis

- diabetes, obesity

48
Q

what is caused by pressure overload

A
  • hypertension

- aortic stenosis

49
Q

what is caused by volume overload

A
  • mitral incompetence

- aortic incompetence

50
Q

what is arrhythmias

A
  • heart not in right rhythm so won’t work
  • atrial fibrillation
  • heart block
51
Q

what drugs can cause heart failure

A
  • beta blockers
  • corticosteroids
  • anticancer drugs
52
Q

what are the symptoms and signs of heart failure

A
  • depends upon side of heart manly affected
  • left heart not working
    = lungs and systolic effects
    = venous pressure builds up in the lungs causing fluid in lungs causing pulmonary oedema and breathlessness
    = dyspnoea, tachycardia, low bp, low pulse
  • right heart not working
    = venous pressure elevated
    = venous pressure build up in peripheral tissues
    = swollen ankles, ascites, tender enlarged liver, poor GI absorption
53
Q

what are the symptoms of heart failure overall

A
  • shortness of breath
  • swelling of feet and ankles = oedema, can cause pitting if pressed upon
  • chronic lack of energy
  • difficulty sleeping at night due to breathing problems = more HF means more pillows, may even sleep upright as can’t lie flat
  • swollen or tender abdomen with loss of appetite
  • cough with frothy sputum
  • increased urination at night
  • confused and/or impaired memory
54
Q

what is the treatment of heart failure

A 
- acute = emergency hospital management 
= oxygen, morphine, frusemide 
- chronic = community based
= improve myocardial function 
= where possible treat the cause 
- treat any underlying causes = hypertension, valve disease, heart arhthymias, anaemia, hyoid disease
55
Q

what is the drug therapy in chronic heart failure

A
  • diuretics = increase salt and water loss, pee out extra fluid then get better quickly
  • ACE inhibitor = reduce salt/water retention
  • nitrates = reduce venous filling pressure
  • inotropes = digoxin
56
Q

what inotropes must you stop

A
  • negative

- these are beta blockers

57
Q

what is a big problem with patients who’ve had an MI

A
  • have a lack of muscle

- needs treated

58
Q

what is the most common problem to encounter with cardiac arrhythmias

A

fast

- these people would have a heart beat of 160/170

59
Q

what is a normal heart beat

A

60-100bpm

60
Q

what is a fast arrhythmia

A
  • tacky arrhythmia
  • atrial fibrillation
  • ventricular tachycardia
  • problem = can only pump blood into coronary arteries during diastole but as you increase HR time in diastole reduces so less O2 going to coronary arteries so heart won’t work
61
Q

what is slow arrhythmia

A
  • Brady arrhythmias
  • heart block
  • can be drug induced = beta blocker, digoxin
  • less common
  • can’t conduct from atria to ventricle so rhythm maintain by pacemaker
  • heart may only beat at 30bpm = if you stood up you wouldn’t survive
62
Q

what are pacemakers used for

A

treat Brady arrhythmias

- increases slow HR

63
Q

how do pacemakers work

A
  • 2 wires
  • 1 wire for seeing beat to check if its happening or not
  • 1 wire to go into muscle that makes heart beat
  • if HR drops then pacemakers kicks in to make HR back at set rate = keeps it at a minimum level
64
Q

what is the theoretical risk of electrical interference in pacemakers

A
  • electrical interference may cause pacemakers to stop working
  • electrical fields = MRI, electrosurgery can’t be done
  • dental equipment are theoretically risk only = pulp tests are OK but avoid electromagnetic scalers
  • can’t got through airport scanners as risk of it stopping
65
Q

how does an implanted pacemaker work

A
  • wire going up through veins = goes through subclavian to vena cava then ventricles
  • charge by putting something on skin surface and electromagnet charge it
66
Q

what do you need to recognise in cardiac arrhythmias

A
  • sinus rhythm
  • asystole
  • ventricular fibrillation
67
Q

what do you need to know about in cardiac arrhythmias

A
  • atrial fibrillation

- myocardial infarction

68
Q

what is the sinus rhythm

A
  • P wave = atrial depolarisation
  • QRS complex = ventricular depolarisation, narrow, signal moves very quickly, rapid conduction from AP node to muscle
  • T wave = ventricular repolarisation
69
Q

what is ventricular fibrillation

A
  • unstable heart electrical activity
  • heart attack, electrocution, long QT syndrome = made worse by some medicines, wolf-parkinson-white syndrome
  • big spikes that are irregular
  • different bits of muscle contracting at different times
  • treat with defibrillates = implanted defibs used in high risk cases
  • if no cardiac output then death follows
70
Q

what is asystole

A
  • wandering line, not flat line

- but no rhythm = no output, heart not working

71
Q

what is atrial fibrillation

A
  • regularity of heartbeat gone = HB may still be 60bpm but it is irregular
  • irregularly irregular heart beat
  • treated with anticoagulants
72
Q

what happens in a heart attack

A
  • very irregular PQRST

BDS2 - cardiovascular medicine (2 decks)

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