Unit 6 - Cardiovascular system 5 Flashcards

1
Q

What monitoring needs to be carried out during hypertension treatment?

A

Monitoring BP following initiation of treatment using clinic measurements
- measure standing and sitting BP in people with
- type 2 diabetes
OR
- symptoms of postural hypotension
OR
- aged 80 or over
Advise people who want to self-monitor to use HBPM
- provide training and advice
ABPM and HBPM can be used in conjunction with clinic measurements in those who suffer from “white coat” or “masked” hypertension

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2
Q

What is the target blood pressure for patients under 80 years old?

A

Clinic BP 140/90 mmHg

H/ABP 135/85 mmHg

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3
Q

What is the target blood pressure for patients over 80 years old?

A

Clinic BP 150/90 mmHg

H/ABP 145/85 mmHg

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4
Q

What are the classes of hypertension during pregnancy?

A
  • chronic/pre-existing hypertension
  • gestational hypertension
  • pre-eclampsia
  • severe pre-eclampsia
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5
Q

Which antihypertensives are contraindicated in pregnancy?

A
  • ACE inhibitors
  • ARBs
  • thiazide-like diuretics
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6
Q

Which drugs are commonly used to lower blood pressure during pregnancy?

A
  • labetalol

- nifedipine

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7
Q

What is the target blood pressure for hypertension in pregnancy?

A

135/85 mmHg

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8
Q

What is an atheroma?

A

Fatty plaque/deposit

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9
Q

What is sclerosis?

A

is the stiffening of a tissue or anatomical feature

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10
Q

What is the difference between artiosclerosis and atherosclerosis?

A

Arteriosclerosis is hardening and loss of elasticity WITHOUT the atheroma (plaque build up)

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11
Q

What is the most common cause of occlusive vascular disease leading to stenosis and ultimately ischaemia in distal tissues?

A

Atherosclerosis

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12
Q

Which vessels typically develop atherosclerosis?

A

Most often develops in larger and medium sized arteries

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13
Q

How long does it take for atherosclerosis to develop?

A

Decades

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14
Q

What are the consequences of atherosclerosis in coronary arteries?

A
Ischaemic heart disease
- angina
- stable
- unstable
Myocardial infarction
- NSTEMI
- STEMI
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15
Q

What are the consequences of atherosclerosis in cerebral arteries and carotid arteries?

A

Cerebrovascular disease

  • stroke
  • transient ischaemic attack
  • vascular dementia
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16
Q

What are the consequences of atherosclerosis in renal arteries?

A

Renovascular disease

17
Q

What are the consequences of atherosclerosis in the aorta?

A

Aortic aneurysm

18
Q

What are the consequences of atherosclerosis in the vessels leading to the arms and legs?

A
  • claudication

- peripheral gangrene

19
Q

What is the target of almost all CVD risk factors?

A

Endothelium

20
Q

What is one of the initiating factors in the development of atherosclerosis?

A

Endothelial dysfunction

21
Q

What signals endothelial dysfunction?

A

A defect in production in NO and subsequent impaired endothelium-dependent vasodilation

  • increased endothelin (ET-1)
  • increased ROS production
22
Q

What can predispose plaque build up?

A

Change in spacing of endothelial cells

23
Q

What is atherosclerosis?

A

Chronic inflammatory response of the arterial wall initiated by injury to the endothelium

24
Q

What can cause atherosclerosis?

A

An injury caused by the following risk factors

  • hypertension
  • hyperlipidaemia
  • high LDL cholesterol
  • an irritant
  • nicotine
  • certain diseases
  • diabetes
  • viral infection
25
Q

What is the progression of atheroma initiated by?

A

Response to injury/dysfunction of the intact endothelium

26
Q

What causes an inflammatory response and accumulation of leukocyte (monocyte) adhesion in the loosing endothelial junctions to form an atheroma?

A

Increased permeability and accumulation of oxidised LDL in the sub endothelial space

27
Q

What causes fatty streaks in the endothelium?

A

Monocytes differentiate into macrophages and engulf oxidised LDL by phagocytosis

  • specialised foam cells formed
  • oxidised LDL cannot be processed
  • rupture
  • fatty streak
28
Q

What is secreted by T-lymphocytes to induce smooth muscle cells to migrate from tunica media or tunica intima?

A

Cytokines

29
Q

What eventually happens to the artery when smooth muscle cells have migrated from the tunica media to the tunica intima?

A
  • the artery becomes inflamed
  • smooth muscle cells enlarge
  • hard cover formed over the affected area
  • fibrous cap forms to protect the lumen
  • atheroma becomes calcified
30
Q

Where does a coronary atheroma develop?

A

Anywhere in major epicardial coronary arteries over several decades
- typically asymptomatic

31
Q

Where do coronary atheroma develop?

A

Often form at tortuosity and bifurcations where turbulent flow of blood
- endothelial shear stress is greater

32
Q

What is collateral vessel formation stimulated by?

A

Various growth factors upregulated in response to chronic or repetitive ischaemia
- a long term beneficial structural adaptation