MEERAN HTN

Question 1

Describe the sounds heard when S3 is present

Answer 1

Lub- de- dub

Ken-tuck-yyy

Question 2

What does S3 indicate? When does this occur?

Answer 2

Rapid ventricular filling

Dilated ventricle e.g. HF, Athletes (increase in vol)

Question 3

Describe the sounds heard when S4 is present

Answer 3

Le- Lub- Dub

Ten- nesss- seee

Question 4

What does S4 indicate? When does this occur?

Answer 4

Turbulent flow from atria contracting against non compliant, thickened ventricle
= Stiff or hypertrophic ventricle
Hypertensive patients (Tall R on ECG)

Question 5

List 3 signs that may be found in a hypertensive patient?

Answer 5

LV hypertrophy (Heave)
S4 heart sound
Hypertensive retinopathy

Question 6

List 4 non modifiable cardiovascular risk factors

Answer 6

Male
Age
Ethnic background (Asian/ Afro-carribean)
FH

Question 7

List 6 modifiable cardiovascular risk factors

Answer 7

Smoking
HTN
Obesity
Sedentary lifestyle 
Diabetes
High cholesterol

Question 8

What does presence of hypertensive retinopathy indicate?

Answer 8

HTN has been present for a long time

Question 9

List 6 causes of HTN

Answer 9

Phaeochromocytoma
Cushings
Conns
Acromegaly
Renal Artery Stenosis
Co-arctation of the aorta

Question 10

Which 2 diseases should not really be tested for unless visible clinical features are seen on examination?

Answer 10

Cushings

Acromegaly

Question 11

How does RAS cause hypertension?

Answer 11

Low pressure reaching JGA means renin is high
Causes production of more A1, more A2 + more aldosterone
Constricts efferent arteriole to maintain GFR
Keep on peeing
High aldosterone which increases BP, but pressure does not get through stenotic vessel, pressure remains low, thus renin stays high

Question 12

What condition would cause hypertension with high aldosterone and low renin?

Answer 12

Conn’s tumour

high aldosterone suppresses renin

Question 13

What condition would cause hypertension with high urine catecholamines?

Answer 13

Phaeochromocytoma

Question 14

How do phaeos differ from conns tumours?

Answer 14

Phaeos:
Pulsatile blasts of adrenaline cause episodic HTN
Large on imaging
Conns:
Constant release of aldosterone causes constant HTN
Small on imaging

Question 15

What drugs are used first line in phaeochromocytomas? Which drugs are given afterwards?

Answer 15

Alpha blockers to prevent vasoconstriction

B blockers secondary, as B2 receptors cause a bit of peripheral vasodilation thus blocking them can increase BP