Hypertension, heart failure & cardiac arrhythmias Flashcards
what is hypertension
raised blood pressure
what is normal BP
120/80
what is hypertension defined as
systolic >140
diastolic >90
what is the systolic pressure for isolated systolic hypertension
> 160
how is BP measured
It is taken as 3 separate measurements taken while sitting
what are the risk factors that determine hypertension
Age Race Obesity Alcohol Family history Pregnancy Stress Drugs
how does age affect hypertension
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
what are drugs that can lead to hypertension
o Non-steroidal
o Corticosteroids
o Oral contraceptives
o Sympathomimetics
what diseases can hypertension put you more at risk at
- Cerebrovascular accident
- Coronary heart disease
- Congestive heart disease
- Congestive heart failure
- Accelerated hypertension
- Renal damage
why does treating hypertension not decrease risk of coronary heart disease by much
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.
what are the two different types of stroke
embolic
ischemic
what can hypertension lead to
accelerated atherosclerosis
renal failure
what can accelerated atherosclerosis lead to
- Myocardial infarction
- Stroke
- Peripheral vascular disease
what is essential hypertension
no common trigger found
what are rare triggers for hypertension
renal artery stenosis
endocrine tumors
what is renal artery stenosis
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.
why does renal artery stenosis make Bp worse
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
why are renal arteries common for atherosclerosis
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.
what are the endocrine tumors that can lead to HT
phaeochromocytoma
conn’s syndrome
cushing’s syndrome
what is Phaeochromocytoma
Tumour of the adrenal gland that produces adrenalin
Adrenal gland sits on the kidney
what is conn’s syndrome
too much aldosterone
what is cushings syndrome
cortisol
Causes retention of salt and water
what are signs and symptoms of hypertension
There are usually none
maybe headaches
transient ischemic attacks
when may you get a headache because of hypertension
malignant hypertension
wha are TIAs
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.
what are indications for further investigations of HT
- Young patient
- Resistant hypertension
- Accelerated hypertension
- ‘unusual’ history
what are investigations for HT
urinalysis
serum biochemistry (electrolytes, urea, creatine)
serum lipids
ecg
renal ultrasound, renal angiography, hormone estimations
what does urinalysis test
o Renal function/renal disease
what does serum biochemistry test
o The solution of plasma should have certain levels of chemicals
o Exclude renal/endocrine causes
what does serum lipid test
o Is the atherosclerosis high?
what does ECG test for
o Cardiac problem
o Done occasionally
why is single daily dose done for Tx
compliance
what are drug options for HT
thiazide diuretcis
beta blocker
calcium channel antagonist
ace inhibitor
describe thiazide diuretics
o High chance of getting gout
o Often used for older patients
describe beta blockers
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
what is heart failure
output of the heart is incapable of meeting the demands of the tissues
what are the two types of heart failure
high output failure
low output failure
what is high output failure
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
what is low output failure
o Cardiac defect e.g MI, valve disease
o Body’s demands remain the same but the heart’s ability to pump gets less
why is left heart failure more common
works under higher pressure
what is left heart failure
o Left ventricle doesn’t pump efficiently
o Prevents body from getting oxygen-rich blood
o Blood backs up into lungs instead
what is right heart failure
can happen for example in an MI but is less common
often follows LHF
why is the compensation for heart failure make it worse
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.
what is the etiology of low output failure
heart muscle disease pressur overload volume overload arrhythmias drugs
what heart muscle diseases can lead to LOF
o MI, myocarditis
o Diabetes, obesity
how can a pressure overload lead to LOF
o Hypertension (more force required) o Aortic stenosis
how can volume overload lead to LOF
o Mitral incompetence
o Aortic incompetence
how can arrhythmias lead to LOF
o Atrial fibrillation
o Heart block
how can drugs lead to LOF
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
what are the symptoms and signs of HF
depends on the side that is mainly affected
what are the symptoms and sigs of LHF
- Dyspnea
- Tachycardia
- Low blood pressure
- Low volume pulse
LUNG AND SYSTOLIC EVENTS
why is there dyspnea in LHF
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
what are the symptoms and signs of RHF
- Swollen ankles
- Ascites
- Raised JVP
- Tender enlarged liver
- Poor GI absorption
why is there a enlarged liver in RHF
o Due to venous blood feedback through the liver causing an increase in pressure
what is the treatment of acute HF
emergency hospital management where we provide oxygen, morphine, frusemide
what is the treatment for chronic HF
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
when treating underlying cause of HF what may we be treating
- Hypertension - educe it
- Valve disease – fix any valve problems
- Heart arryhtmias
- Atrial fibrillation
- Anaemia
- Thyroid disease
what are the drug therapies we use for chronic heart failure
- Diuretics
- ACE inhibitor
- Nitrates
- Inotropes – digoxin.
what do diuretics do
increase salt and water loss
what do ACE inhibitors do
reduce salt/water retention
what do nitrates do
reduce venous filling pressure and so reduces oedema in the lungs
what do inotropes do
Positively inotropic. Increases the force of contraction. We use drugs to make the heart work more efficiently
what drug do we not give to patients with chronic HF
Stop negative inotropes – Beta blockers! As they make it worse
what are the different cardiac arrhythmia
tachy arrhythmias - FAST
brady arrhythmias - SLOW
describe tachy arrhythmias
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
describe brady arrhythmias
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
what are cardiac pacemakers used for
Used to treat bradyarrhythmia’s
Keeps heart rate at a minimum level
what is there a risk of with pacemakers
Theoretical risk of electrical interference – some electro scaling devices may be a problem
what is a sinus rhythm
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
what is ventricular fibrillation
It is unstable heart electrical activity
There is no cardiac output
Death follows
what can VF be due to
- Heart attack
- Electrocution
- Long QT syndrome – can be made worse by some medications
- Wolf-parkinson-white syndrome
how is VF treated
Treated with defibrillation, for high risk patients a defibrillator may be implanted
what is asystole
lack of electrical activity
why is asystole not a flat line
there is no electrical activity in the heart there is some in the body. It is a wandering line instead of a flat one.
what is atrial fibrillation
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
what is the cardiac rhythm for a HA
ST segment elevation then depression *NOT SURE
