Hypertension + HOCM Flashcards
What is the most common secondary cause of hypertension?
Renal disease e.g. renal artery stenosis
What are 2 other secondary causes of hypertension?
1) Endocrine disease e.g. thyroid dysfunction
2) Aortic coarctation
How do you diagnose hypertension?
High BP on two occasions - BP + ABPM/HBPM
What are the side effects of ACE inhibitors?
1) Dry cough
2) Angioedema
3) Hyperkalaemia
When are ACE inhibitors contraindicated?
1) Renovascular disease
2) Aortic stenosis
3) Pregnancy & breastfeeding
When can ACE inhibitors increase the risk of hypotension?
If patient is on high-dose diuretic therapy e.g. > 80mg furosemide a day
What is the side effect of calcium channel blockers?
Peripheral oedema e.g. ankle
What are the side effects of diuretics?
1) Excessive urine output
2) Hyponatraemia
3) Hypokalaemia
4) Hypercalcaemia
What are side effects of ARBs?
Hypotension and hyperkalaemia
What does HOCM stand for?
Hypertrophic obstructive cardiomyopathy
What is HOCM?
LV outflow tract obstruction from asymmetric septal hypertrophy (LVH)
What is HOCM the leading cause of?
Sudden cardiac death in the young
What causes HOCM?
- Genetic - autosomal dominant
- 50% are sporadic - 70% of these have mutations in genes
- Ask about FH of sudden death
When does HOCM present?
Any age
What are the symptoms of HOCM?
- Sudden death (VF)
- Palpitations (arrhythmias - AF/VT)
- Angina
- Dyspnoea
- Syncope
- Congestive cardiac failure symptoms
What are the signs of HOCM?
- Jerky pulse
- Ejection systolic murmur
- a wave in JVP
- Double-apex beat
- Systolic (apical) thrill at lower left sternal edge
What does HOCM (LVH) lead to due to LV outflow tract obstruction?
- HF
- Arrhythmias (AF/VT)
- Ischaemia (ACS)
What would you see on an ECG of someone with HOCM?
- LVH
- T wave inversion
- Deep Q waves
How do you diagnose HOCM?
Echo
What would you see on echo in HOCM?
Asymmetrical septal hypertrophy (LVH)
What other investigations can you do in someone with HOCM?
- MRI
- Cardiac catheterisation
- Electrophysiological (WPW)
- Exercise test ± Holter monitor
How do you manage HOCM symptomatically?
- Beta blocker/CCB (verapamil) to reduce ventricular contractility (ACS)
- Amiodarone for arrhythmias (AF, VT)
- Anticoagulation (for paroxysmal AF or systemic emboli)
- Consider ICD
How do you treat HOCM with severe symptoms?
Septal myomectomy
What are poor prognostic factors for HOCM?
- Age < 14 years or syncope at presentation
- FH of HOCM/sudden death
