W24 - Hypertension Flashcards
What are 4 key cardiovascular disease
Hpertension
Ischaemic heart disease
Heart failure
Arrhythmia
what is hypertension
high blood pressure
when clinic blood pressure is > 140/90 mmHg for people ages under 80
Bp up to 150/90 if those over 80
what are the three stages of hypertension
> 140/90 stage 1 hypertension
160/100 stage 2 hypertension
180 or DBP >110 mmHg severe hypertension
why should we even bother with hypertension treatment what can it cause
stroke blindness heart attack heart faillure kidney failure
who should be offered lifestyle advise
offer lifestyle advice in anyone under 80 stage 1 hypertension who has at least one of the following
target organ damage established cardiovascular disease renal disease diabetes high cardiovascular risk under 40 years old
when should we consider treatment
anyone with stage 2 or severe (urgent)
what can be given to treat hypertension
ACE inhibitor (Diabetes)
Angiotensin Receptor Blocker (Diabetes)
Calcium channel blocker
Thiazide like diuretic
Outline treatment plan for hypertension non diabetic
Calcium channel blocker combined with lifestyle advice
calcium channel blocker + Ace inhibitor, Angiotensin Receptor blocker or thiazide like diuretic
Ace inhib + calcium channel blocker + thiazide like diuretic
confirm resistant hypertension, confirm elevated BP
consider seeking expert advicE
ADD low dose pironolactone if blood potassium <4.5
Alpha blocker or beta blocker >4.5
Outline treatment plan for hypertension diabetic
Ace inhibitor or ARB
CCB
Thiazide like duiretic
confirm resistant hypertension, confirm elevated BP
consider seeking expert advicE
ADD low dose pironolactone if blood potassium <4.5
Alpha blocker or beta blocker >4.5
What monitoring should be taken into account for ACE/ARB
urea and creatinine
what monitoring should be looked at for calcium channel blocker
heart rate
ankle oedemea
what monitoring should be looked at for thiazide like diuretics
urea and creatinine
electrolytes
uric acid if at risk of suspect gout
what might drug drug interactions cause
increase or decrease effects of the antihypertensive drug
what might an example of drug disease interaction be
some drugs may increase or reduce BP
what is an example of Co morbidity
pre existing or new condition may increase
what is coronary heart disease
umbrella term covering a range of conditions all caused by atherosclerosis
angina
non st segment myocardial infarction
st segment myocardial infarction
What are cardiac symptoms of CHD
central or band like pressure or pain
sub-sternal pain
radiation to jaw arm or back
fast pulse
may be relieved by GTN/rest
what are respiratory symptoms of CHD
fast respiratory rate
persistant localised pain
pain worsens on breathing deeply or coughing
knife like
what are GI symptoms of CHD
epigastric burning pain
often after food or at night
relieved by antacid
difficulty swallowing
tenderness
what are infection symptoms of CHD
High temperature
Previous viral illness
Fast pulse
infected sputum
what are some mental health symptoms of CHD
stressed
anxious
not radiating
fast pulse
palpitation
fast respiratory rate
relieved by breathing techniques and distractions
what might a patient with MI have
Patients having an MI often look grey in colour, sweaty, feel dizzy, short of breath, feel or be sick, pain may be felt in the back or radiating down the left arm or jaw.
diabetics not always feel the severity of pain but are especially high risk.
what are the locations of pain for myocardial infarction (Heart attack)
left arm radiation
irradiation in the back
What is ACS
acute coronary syndrome ACS is unpredictable and not relieved by GTN and is classed as an emergency
how can ACS and stable angina be differentiated
relieved by GTN
What is CHD - Stable Angina
Stable atherosclerotic plaque
predictable onset - usually on exertion
Offer short acting nitrate
what counselling can be given for CHD - stable angina
use immediately upon symptoms or before any planned exercise
sit or lie down before using as causes vasodilation so can drop BP
hold spray upright, spray 1 or 2 sprays under tongue
close mouth
repeat dose after 5 minutes if pain not subsided
How can we treat stable angina
Licensed beta blocker or licensed calcium channel blocker
switch or combine
long acting nitrate
Nicorandil
Ivabradine
Ranolzaine
Consideration of aspirin
use depending upon individual risks / benefits
consideration of Ace inhibitors
use in those with diabetes
use for hyperetension in line with guidance
consideration of statins
recommend use
intensity dose dependant upon patient
risk/ preference
what should all patient presenting Mi go through
risk stratification.
why should mi presenters go through risk stratification
allow future planning by clinicians, patients and their family. helps guide clinicians advice and action and to prioritise high risk patients.
what techniques are used to diagnose ACS
ECG
- St segment elevation = stemi
- NSTEMI seen as other markers of ischaemia
- No changes seen in UA
Troponin
- 2 tests taken 3 hours apart
- if increase >10 then +ve
Percutaneous coronary intervention
- visualisation of coronary blood vessels is the only way to confirm diagnosis
what can we use to treat acute coronary syndrome
GTN (Glyceryl trinatrate)
Morphine/ Diamorphine
Aspirin/Ticagrelor/CLopidogrel/Prasugrel
Statin/beta blocker/ace inhibitor
what secondary exists for CHD
aspirin + second antiplatelet medication
atorvastatin
ace inhibitor
beta blocker
GTN spray
what monitoring parameter exist for CHD
BP and HR
Blood sugars
GI effects
Signs of bleeding or bruising
Platelets
Hyper sensitivity reactions
Cholesterol
U and Es
Pain
Liver Transaminase enzymes
what are side effects of aspirin + antiplatelets
GI upset
Bleeding
Wheeze
Thrombocytopenia
what is Thrombocytopenia
shortage of platelets in your blood
what are the side effects of beta blockers
fatigue
cold extremities
bronchoconstriction
hypotension
impotence
bradycardia
mask hypoglycaemia
sleep disturbances
what are the side effects of statin
muscle cramp
Deranged LFT
hyperglycaemia
abdominal pain
headache
rarely rhabodymolysis
what are the side effects of GTN
headache
flushing
dizziness / hypotension
CHD drug drug interactions
ADRs usually as an additive effect of multiple cardiac meds
e.g. hypotension due to use of bisoprolol and ramipril
CHD drug disease interaction
broncho constriction from beta blockers usually only in asthma
COmorbidity
anxiety, depression , anaemia , COPD
