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CP3 SURGERY > Vascular - HTN, Hyperlipidaemia, Aneurysm + Dissection > Flashcards

Vascular - HTN, Hyperlipidaemia, Aneurysm + Dissection Flashcards

1
Q

If the lowest BP meausrement in clinical if >140/90, what is the next step?

A

Offer ABPM to confirm diagnosis

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2
Q

How is ABPM done

A

2 measurements per hour taken, average reading used

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3
Q

Stage 1 HTN

A

Clinic BP >140/90

ABPM >135/85

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4
Q

Stage 2 HTN

A

Clinic BP >160/100

ABPM >150/95

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5
Q

Stage 3 HTN

A

SBP >180

Or DBP >110

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6
Q

What % of adults have HTN

A

20-30%

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7
Q

What % of adults have isolated systolic HTN

A

> 50% of >60s

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8
Q

What does isolated systolic HTN double the risk of

A

MI

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9
Q

What % of HTN is1’

A

95%

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10
Q

2’ causes of HTN (7)

A 
Adrenal cortical disease 
RAS
CKD
Pheochromocytoma 
CoA
Neurogenic causes - incr ICP
Pregnancy
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11
Q

Def benign HTN

A

Gradual elevation of BP over years

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12
Q

Pathology of benign HTN

A

Gradual hypertrophy of mm media in aa walls –> reduced capacity to expand + incr fragility

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13
Q

Def malignant HTN

A

rapid sustained increase in BP

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14
Q

Pathology of malignant HTN

A

intimal proliferation, reducing luminal size

–> cessation of blood flow through small vessels

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15
Q

UnTx malignant HTN 1y mortality

A

20%

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16
Q

How is malignant HTN diagnosed

A

SBP >200 or DBP ?120 + bilateral retinal haemorrhages/exudates
+/- Papilloedema

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17
Q

pathological consequences HTN - Heart

A

LVH + dilation –> eventual failure

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18
Q

Pathological consequences HTN - aorta

A

AAA

aortic dissection

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19
Q

Patholgical consquences HTN - brain

A

Intracerebral haemorrhage

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20
Q

Pathological consequences HTN - kidney

A

CKD

Glomerular destruction

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21
Q

Pathological consequences HTN - eyes

A

HTN retinopathy

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22
Q

Ix HTN to assess for 2’ causes/complications (8)

A 
Urine dip (renal damage)
ECG - LVH
Echo - LVF
RAS - Renal aa doppler 
CKD - U+E eGFR
PCC - 3x 24h urine collection - metadrenaline/normetadrenaline 
HbA1c
Lipids
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23
Q

Who do you start on Anti-HTN meds

A

all stage 2 HTN
Stage 1 HTN + <80 + 1 of:
10y CV risk >20%
Or co-morbidities

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24
Q

Target BP HTN after Mx

A

<140/90

or <150 if >80

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25
Q

Target ABPM HTN after Mx

A

<135/85

<145 if >80

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26
Q

What is 1’ hyperlipidaemic due to

A

Genetic predispositoin to abnormal lipid metabolism

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27
Q

Wha t is 2’ hyperlipidaemia due to

A

Metabolic disturbance

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28
Q

Target total cholesterol

A

<5mM

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29
Q

Target LDL

A

<3mM

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30
Q

What are high levels of HDLs protective against

A

Atheroma

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31
Q

What is the QRISK calculator

A

Collates information on RF to estimate a 10y risk of MI/stroke

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32
Q

1st line Mx hyperlipidaemia

A

lifestyle

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33
Q

When to start statins for hyperlipidaemia

A

If lifestyle mods showing no affect

34
Q

Mechanism of action statins

A

HMG CoA reductase inhibitors
Stop 1st step cholesterol synthesis
+ Incr LDL receptor expression by hepatocytes –> decr LDL levels

35
Q

When to take statins

A

At night

36
Q

Common SE statins (3)

A

Nausea
Headache
Mm pains

37
Q

Which drugs does statins interact w/

A

Cytochrome P450 pathway ones

38
Q

What should be monitored whilst on statins

A

LFTs

39
Q

Rare SE statins

A

Rhabdomyolysis

40
Q

E.g.s of fibrates (2)

A

Bezafibrate

Gemofibrozil

41
Q

Mechanism of action fibrates

A

PPAR alpha activators

–> reduced triglycerides

42
Q

What dangerous SE can fibrates in combo w/ statins cause

A

Rhabdomyolysis

43
Q

Def Atherosclerosis

A

Inflammatory process involving the intima of large and med aa in systemic circulation

44
Q

RF atherosclerosis (13)

A 
Age
Diet
M
Obesity 
DM
HTN
Hyperlipidaemia
Low birth weight 
Type A personality 
Stress 
Lack of exercise 
Smoking 
Alcohol
45
Q

Where does atheroma commonly occur

A

Aortic bifurcation
Branch points
Around ostia
Sites of haemodynamic stress

46
Q

What are Ostia

A

Funnel-shaped openings

Esepcially in abdo aorta near the kidneys

47
Q

Clinical complications of atheroma (5)

A 
Stenosis aa --> hypoperfusion 
Thrombus --> tot occlusion 
Bleeding into plaque 
Aneurysm 
Cholesterol embolism
48
Q

Mx Atheroma

A 
Antiplatelet agents (reduce risk complications) 
Modify RF
49
Q

Mx atheroma if HTN

A

ACEi = 1st line

Bblocker/CCB/Diuretic

50
Q

Mx atheroma if hyperlipidaemia

A

Statins

51
Q

Mx atheroma if diabetic

A

Lifestyle +/- metformin +/- insulin

52
Q

Def aneurysm

A

Focal dilation of an aa >150% its norm d

53
Q

Way in which an aneurysm can present

A

Mass effects - P - neuro Sx (blurred vision/headaches)
Embolic events
Haemorrhagic effects - rupture

54
Q

Causes Aneurysm (ADD IT)

A 
Atherosclerotic - aortic/popliteal 
Developmental - Berry/Marfans/Ehlers Danlos 
Dissecting - Marfans/HTN
Infection - endocarditis/syphillis 
Trauma
55
Q

Def AAA

A

Dilations of abdo aorta ?3cm

56
Q

What % of M >60 have AAA

A

5%

57
Q

What is the screening programme for AAA in the UK

A

USS offered to M at age 65

58
Q

PS - AAA rupture (4)

A

Severe continuous epigastric pain
Radiating to the back
Expansile abdominal mass
Signs of shock

59
Q

Who should AAA be suspected in?

A

Any male >50 PS w/ renal colic

60
Q

Mx AAA

A

Emergency A-E resus

–> Theatre ASAP

61
Q

Unruptured AAA Mx if <5.5cm

A

Monitor reg USS/CT

Modify RF

62
Q

What % of monitored AAA will req surgery

A

75%

63
Q

Indications AAA surgery (3)

A

If >6cm
If expanding >1cm yr
Symptomatic

64
Q

What is EVAR

A

Endovascular aneurysm repair

Uses femoral aa to access + stent aorta under fluoroscopic guidance

65
Q

Why is re-intervention sometimes needed w/ EVAR

A

Endoleaks

66
Q

What % of pt w/ AAA have a popliteal aneurysm

A

10%

67
Q

PS popliteal aneurysm

A 
Asymp 
Or complicaations: 
Acute limb ischaemia 
Chronic limb ischaemia 
DVT
68
Q

Ix popliteal aneurysm

A

USS (determine size)

Angiography (prior to surgery)

69
Q

Mx popliteal aneuyrsm

A

Femoral-distal popliteal bypass graft

70
Q

Def true aneurysm

A

All layers of aa wall are involved

71
Q

Def false aneurysm/pseudoaneurysm

A

Surrounding soft tissues = lined by thrombus from wall of aneurysm

72
Q

Cause of false aneurysm

A

trauma

73
Q

Pathology - aortic dissection

A

Tear in intima –> blood tracking into media

Aa media splits –> force channel

74
Q

Outcomes aortic dissection (3)

A

External rupture –> massive fatal haemorrhage
Internal rupture –> double-chanelled aorta
Cardiac tamponade

75
Q

2 type of aortic dissection

A

Type A - involving ascending aorta (prox LSCA)

Type B - doesn’t involve ascending aorta (distal to LSCA)

76
Q

Ix aortic dissection

A

CXR - widened mediastinum
CT - confirm diagnosis
ECG - similar to MI

77
Q

Complications aortic dissection - coronary aa

A

MI

78
Q

Complications aortic dissection - brachicephalic trunk

A

Unequal arm pulses + central neuro Sx

79
Q

Complications aortic dissection - renal aa

A

Haematuria
Anuria
AKI

80
Q

Complications aortic dissection - SMA/IMA

A

Acute mesenteric ischaemia

81
Q

Complications aortic dissection - iliac aa

A

Acute LL ischaemia

CP3 SURGERY (19 decks)

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