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BDS2 BAMS Cardiovascular > Hypertension, heart failure & cardiac arrhythmias > Flashcards

Hypertension, heart failure & cardiac arrhythmias Flashcards

1
Q

what is hypertension

A

raised blood pressure

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2
Q

what is normal BP

A

120/80

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3
Q

what is hypertension defined as

A

systolic >140

diastolic >90

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4
Q

what is the systolic pressure for isolated systolic hypertension

A

> 160

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5
Q

how is BP measured

A

It is taken as 3 separate measurements taken while sitting

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6
Q

what are the risk factors that determine hypertension

A 
Age
Race
Obesity
Alcohol
Family history
Pregnancy 
Stress
Drugs
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7
Q

how does age affect hypertension

A

o As you get older your blood pressure rises and this is because the blood vessels get less elastic. The aorta is meant to accommodate the increase in pressure. The diastolic pressure rises a bit and so does the pulse pressure
o Despite this you should still have a blood pressure lower than the thresholds

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8
Q

what are drugs that can lead to hypertension

A

o Non-steroidal
o Corticosteroids
o Oral contraceptives
o Sympathomimetics

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9
Q

what diseases can hypertension put you more at risk at

A
  • Cerebrovascular accident
  • Coronary heart disease
  • Congestive heart disease
  • Congestive heart failure
  • Accelerated hypertension
  • Renal damage
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10
Q

why does treating hypertension not decrease risk of coronary heart disease by much

A

as it is not actually the high blood pressure that is causing the CHD but rather it is just making the atherosclerosis that is present worse however treating it is still better than not treating it.

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11
Q

what are the two different types of stroke

A

embolic

ischemic

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12
Q

what can hypertension lead to

A

accelerated atherosclerosis

renal failure

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13
Q

what can accelerated atherosclerosis lead to

A
  • Myocardial infarction
  • Stroke
  • Peripheral vascular disease
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14
Q

what is essential hypertension

A

no common trigger found

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15
Q

what are rare triggers for hypertension

A

renal artery stenosis

endocrine tumors

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16
Q

what is renal artery stenosis

A

This is when the renal artery is narrowed and there is a decrease in blood flow. This is sensed by the kidneys and it does something about it.

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17
Q

why does renal artery stenosis make Bp worse

A

o It senses that the blood pressure has fallen so makes ways to make the blood pressure better by constricting via the angiotensin system
o Therefore the blood pressure problem is made worse

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18
Q

why are renal arteries common for atherosclerosis

A

o Common place for atherosclerosis is where there is junctions as there is abnormal curving of blood. The renal arteries come off the aorta at right angles making this a common place for atherosclerosis.

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19
Q

what are the endocrine tumors that can lead to HT

A

phaeochromocytoma
conn’s syndrome
cushing’s syndrome

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20
Q

what is Phaeochromocytoma

A

 Tumour of the adrenal gland that produces adrenalin

 Adrenal gland sits on the kidney

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21
Q

what is conn’s syndrome

A

too much aldosterone

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22
Q

what is cushings syndrome

A

cortisol

 Causes retention of salt and water

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23
Q

what are signs and symptoms of hypertension

A

There are usually none
maybe headaches
transient ischemic attacks

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24
Q

when may you get a headache because of hypertension

A

malignant hypertension

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25
Q

wha are TIAs

A

These are ‘mini strokes’ and there is a full neurological return in 24 hours. TIA is a warning of high blood pressure. Underlying cause is often a buildup of atherosclerosis in an artery.

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26
Q

what are indications for further investigations of HT

A
  • Young patient
  • Resistant hypertension
  • Accelerated hypertension
  • ‘unusual’ history
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27
Q

what are investigations for HT

A

urinalysis
serum biochemistry (electrolytes, urea, creatine)
serum lipids
ecg
renal ultrasound, renal angiography, hormone estimations

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28
Q

what does urinalysis test

A

o Renal function/renal disease

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29
Q

what does serum biochemistry test

A

o The solution of plasma should have certain levels of chemicals
o Exclude renal/endocrine causes

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30
Q

what does serum lipid test

A

o Is the atherosclerosis high?

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31
Q

what does ECG test for

A

o Cardiac problem

o Done occasionally

32
Q

why is single daily dose done for Tx

A

compliance

33
Q

what are drug options for HT

A

thiazide diuretcis
beta blocker
calcium channel antagonist
ace inhibitor

34
Q

describe thiazide diuretics

A

o High chance of getting gout

o Often used for older patients

35
Q

describe beta blockers

A

o Can make COPD/asthma worse because it blocks recpetors in the lungs that are involved with those
o Reduces cardiac output but does not treat the vasoconstriction
o Younger patients

36
Q

what is heart failure

A

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

37
Q

what are the two types of heart failure

A

high output failure

low output failure

38
Q

what is high output failure

A

o When demands of the tissues increase and the heart cannot cope with the demands
o For example anaemia, lack of RBC to pump fast enough and may reach a point where the heart cannot pump quick enough to meet the demands
o Thyrotoxicosis can lead to heart failure
o Uncommon

39
Q

what is low output failure

A

o Cardiac defect e.g MI, valve disease

o Body’s demands remain the same but the heart’s ability to pump gets less

40
Q

why is left heart failure more common

A

works under higher pressure

41
Q

what is left heart failure

A

o Left ventricle doesn’t pump efficiently
o Prevents body from getting oxygen-rich blood
o Blood backs up into lungs instead

42
Q

what is right heart failure

A

can happen for example in an MI but is less common

often follows LHF

43
Q

why is the compensation for heart failure make it worse

A

body is expecting that this drop in blood pressure is due to a haemorrhage so to compensate it brings the blood volume back up and increases fluid levels in the system. The fluid has nowhere to go and builds up in the lungs.

44
Q

what is the etiology of low output failure

A 
heart muscle disease
pressur overload
volume overload
arrhythmias 
drugs
45
Q

what heart muscle diseases can lead to LOF

A

o MI, myocarditis

o Diabetes, obesity

46
Q

how can a pressure overload lead to LOF

A 
o	Hypertension (more force required) 
o	Aortic stenosis
47
Q

how can volume overload lead to LOF

A

o Mitral incompetence

o Aortic incompetence

48
Q

how can arrhythmias lead to LOF

A

o Atrial fibrillation

o Heart block

49
Q

how can drugs lead to LOF

A

o Beta blockers – it is used to manage heart attacks but when you combine it with heart muscle disease it will result in heart failure
o Corticosteroids
o Anticancer drugs

50
Q

what are the symptoms and signs of HF

A

depends on the side that is mainly affected

51
Q

what are the symptoms and sigs of LHF

A
  • Dyspnea
  • Tachycardia
  • Low blood pressure
  • Low volume pulse

LUNG AND SYSTOLIC EVENTS

52
Q

why is there dyspnea in LHF

A

difficulty breathing because venous pressure will be building up on the ‘input’ side so it will be building up in the lungs and will result in pulmonary oedema. Causes a difficulty in breathing

53
Q

what are the symptoms and signs of RHF

A
  • Swollen ankles
  • Ascites
  • Raised JVP
  • Tender enlarged liver
  • Poor GI absorption
54
Q

why is there a enlarged liver in RHF

A

o Due to venous blood feedback through the liver causing an increase in pressure

55
Q

what is the treatment of acute HF

A

emergency hospital management where we provide oxygen, morphine, frusemide

56
Q

what is the treatment for chronic HF

A

community based. We improve the myocardial function and reduce ‘compensation’ effects (diuretics can get rid of the liquid). Where possible we treat the cause e.g if a valve is not working

57
Q

when treating underlying cause of HF what may we be treating

A
  • Hypertension - educe it
  • Valve disease – fix any valve problems
  • Heart arryhtmias
  • Atrial fibrillation
  • Anaemia
  • Thyroid disease
58
Q

what are the drug therapies we use for chronic heart failure

A
  • Diuretics
  • ACE inhibitor
  • Nitrates
  • Inotropes – digoxin.
59
Q

what do diuretics do

A

increase salt and water loss

60
Q

what do ACE inhibitors do

A

reduce salt/water retention

61
Q

what do nitrates do

A

reduce venous filling pressure and so reduces oedema in the lungs

62
Q

what do inotropes do

A

Positively inotropic. Increases the force of contraction. We use drugs to make the heart work more efficiently

63
Q

what drug do we not give to patients with chronic HF

A

Stop negative inotropes – Beta blockers! As they make it worse

64
Q

what are the different cardiac arrhythmia

A

tachy arrhythmias - FAST

brady arrhythmias - SLOW

65
Q

describe tachy arrhythmias

A

o Most common
o Fast heart rate means reduced blood flow to the heart making you more at risk of heart failure
o Atrial fibrillation
o Ventricular tachycardia

66
Q

describe brady arrhythmias

A 
o	Heart block
o	Can be due to a blockage in AV node
o	Drug induced (beta blocker, digoxin) 
	Digoxin blocks AV node
o	Can be an issue if you want to stand up
67
Q

what are cardiac pacemakers used for

A

Used to treat bradyarrhythmia’s

Keeps heart rate at a minimum level

68
Q

what is there a risk of with pacemakers

A

Theoretical risk of electrical interference – some electro scaling devices may be a problem

69
Q

what is a sinus rhythm

A

Slow conduction of the rhythm near the atria (P wave)
Rapid conduction to the muscle (QRS) – the width depends on how good the conduction is and the height is to do with the muscle
P wave = atrial depolarization
QRS = ventricular depolarization
T wave = ventricular repolarization

70
Q

what is ventricular fibrillation

A

It is unstable heart electrical activity
There is no cardiac output
Death follows

71
Q

what can VF be due to

A
  • Heart attack
  • Electrocution
  • Long QT syndrome – can be made worse by some medications
  • Wolf-parkinson-white syndrome
72
Q

how is VF treated

A

Treated with defibrillation, for high risk patients a defibrillator may be implanted

73
Q

what is asystole

A

lack of electrical activity

74
Q

why is asystole not a flat line

A

there is no electrical activity in the heart there is some in the body. It is a wandering line instead of a flat one.

75
Q

what is atrial fibrillation

A 
Looks normal but there is no P wave 
Irregular heartbeat
Distance between QRS complexes varies
Common 
Risk of emboli so chronic oral anticoagulation is recommended for most AF therapy – these patients more at risk of bleeding
76
Q

what is the cardiac rhythm for a HA

A

ST segment elevation then depression *NOT SURE

BDS2 BAMS Cardiovascular (6 decks)

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