ILA 1 - HF & HTN Flashcards
secondary causes of HTN
glomerulonephritis, polycystic kidneys, Cushing’s, phaeochromocytoma, pregnancy, steroids, OCP
Stage 1 HTN
clinic BP greater than 140/90 and ABPM average greater than 135/85
Stage 2 HTN
clinic BP greater than 160/100 and ABPM average greater than 150/95
Severe HTN
clinic BP greater than 180 over 110
Accelerated HTN
severe HTN with visible end organ damage
Who to treat for HTN
Any stage 2. Stage 1 if under 80 and have end organ damage, CVD, renal disease, DM, QRisk2 score over 20%
QRisk2 score
10 year risk of having a CV event. Incoperates age, sex, smoking, DM, AF, CKD, blood pressure, cholesterol/HDL ratio.
Microvascular effects of HTN
retinopathy, nephropathy, neuropathy.
Microvascular effects of HTN
Atherosclerosis, stroke, MI, peripheral vascular disease
HTN treatment 1st pharmacological step
If under 55 ACE inhibitor e.g. ramipril or angiotensin 2 receptor blocker e.g. losartan. If over 55 or afro-carribean give CCB e.g. nifedipine.
Patient group where ACEi won’t work
Those with renal artery stenosis will see BP increase on ACEi
HTN 2nd line pharmacological treatment
ACEi + CCB or if afro-cab ARB + CCB
HTN 3rd line pharmacological treatment
add thiazide-like diuretic e.g. indapamide
4th line HTN pharmacology treatment
potassium sparing diuretic (if baseline K+ levels good), alpha or beta blocker. If poor K+ levels increase thiazide like diuretic dose.
Investigations in HTN patient and findings
ECG: left ventricular hypertrophy causing big T waves or post MI. Urinalysis: protein. Echovardiogram: LV hypertrophy. Bloods: U&E, creatinine, fasting glucose, cholesterol.
Target BP for HTN patients
less than 140/90 if under 80yrs. Less than 150/90 if over 80yrs. If diabetic less than 130/80.
Systolic V diastolic heart failure
systolic = unable for ventricles to maintain cardiac output needed. causes = cardiomyopathy, MI, IHD. diastolic= unable to relax and fill with required volume, have preserved ejection fraction. Causes = constrictive pericarditis, HTN, tamponade.
Left V right ventricular heart failure
Left = dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea (ask about pillows and night time sleeping as fluid moves when lying horizontal), cough. Right = peripheral oedema, nausea, raised JVP, hepatomegaly, ascites.
CXR of left HF
Alveolar oedema, Kerley B Lines (interstitial oedema), cardiomegaly, dilated prominent upper lobe vessels, pleural effusions.
HF causes
CAD with MI history, nephrotic syndrome, alcohol, anaemia (high output), thyroid disease, NSAIDs exacerbate.
Criteria for Congestive HF
Framingham Criteria. 2 major or 1major and 2 minor symptoms
Major symptoms in Framingham Criteria for HF
Paroxysmal nocturnal dyspnoea, crepitations, cardiomegaly, S3 gallop, increased central venous pressure, weight loss, neck vein distension, acute pulmonary oedema, hepatojugular reflex.
Minor symptoms for Framingham Criteria fro HF
bilateral ankle oedema, dyspnoea, tachycardia, decrease VC, nocturnal cough, hepatomegaly, pleural effusion,
Investigating/Diagnosis of HF
Natriuretic peptide (BNP or NTproBNP). ECG. Doppler 2D echocardiogram. CXR.
