Week 5: hypertension, heart failure, PVD, cardiomyopathy, conduction defects

Question 1

What hormones/ substances are responsible for vasoconstriction

Answer 1

• Endothelin 1
• Angiotensin 2
• Oxidants

Question 2

What hormones/ substances are responsible for vasodilation

Answer 2

• Nitric Oxide
• Prostaglandin I2
• Endothelium-derived hyperpolarising factor

Question 3

Systolic/diastolic pressure tends to increase/decrease with age

Answer 3

SYSTOLIC: increases with age

DIASTOLIC: decreases after 60yo

Question 4

What BP level is considered stage 1 hypertension

Answer 4

Stage 1: >140/90

Question 5

What BP level is considered stage 2 hypertension

Answer 5

Stage 2: >160/100

Question 6

What BP level is considered severe hypertension

Answer 6

Systolic >180 or Diastolic >110

Question 7

From which stage of hypertension should medication be given

Answer 7

Treat stage 2 if BP remains high after 24h monitor

Treat severe hypertension immediately

Question 8

Effects of Angiotensin 2

Answer 8

1. Increases sympathetic activity
2. Na+ reabsorption & K+ secretion in renal tubules
3. Water retention in kidney tubules
4. Aldosterone secretion from adrenal cortex (which reinforces Na+ reabsorption and water retention)
5. Vasoconstriction of arteries
6. ADH secretion from posterior pituitary

Question 9

What drugs might cause hypertension

Answer 9

1. Nasal decongestants (sympathomimetic amines)
2. Oestrogen eg OCP
3. Amphetamines, cocaine
4. Corticosteroids, mineralocorticoids
5. Erythropoitin
6. Ciclosporin

Question 10

Adrenal causes of hypertension

Answer 10

1. Phaeochromocytoma (excess epinephrine)
2. Cushing’s (excess cortisol)
3. Conn’s (excess aldosterone)

Question 11

Parathyroid causes of hypertension

Answer 11

Hyperparathyroidism

Question 12

Growth hormone causes of hypertension

Answer 12

Acromegaly

Question 13

Thyroid hormone causes of hypertension

Answer 13

• Hypothyroidism (increased vascular resistance)

* Hyperthyroidism (increased metabolic rate)

Question 14

How long can a leg remain ischaemic for before it becomes un-salvage-able

Answer 14

3-6h

After this, irreversible nerve/ muscle damage

Question 15

2 main causes of acute limb ischaemia

Answer 15

1. Atrial fibrillation

2. Thrombosis on top of pre-existing atherosclerosis

Question 16

When should a carotid endarterectomy be done

Answer 16

if >70% occlusion found on carotid duplex

Question 17

What features are typical in a cardiac syncope

Answer 17

• Sudden collapse, no prodrome

* Often rapid recovery

Question 18

How do channelopathies cause cardiac arrest

Answer 18

1. Disordered ion movement in and out of myocytes

2. Eventually leads to polymorphic VT/VF (torsades de pointes)

Question 19

What kind of arrhythmia does Long QT syndrome result in

Answer 19

Polymorphic Ventricular Tachycardia (torsades de pointes

Question 20

What kind of arrhythmia does Long QT syndrome result in

Answer 20

Polymorphic Ventricular Tachycardia (torsades de pointes

Question 21

Pathophysiology of long QT syndrome

Answer 21

Channelopathy (usually potassium, but may be sodim) causing prolonged ventricular repolarisation

Question 22

What might provoke arrhythmia in long QT syndrome

Answer 22

• Exercise

- Startle reflex

Question 23

What kind of arrhythmia does Brugada syndrome result in

Answer 23

Ventricular fibrillation

Question 24

Pathophysiology of Brugada syndrome

Answer 24

Sodium channelopathy

Question 25

What might provoke arrhythmia in Brugada syndrome

Answer 25

• Fever

- Drugs which block sodium channels

Question 26

What kind of arrhythmia does Catecholinergic Polymorphic Ventricular Tachycardia result in

Answer 26

VT/VF

Question 27

Pathophysiology of Catecholinergic Polymorphic Ventricular Tachycardia

Answer 27

Problem with proteins that regulate calcium concentrations within cardiac myocytes

Question 28

What might provoke arrhythmia in Catecholinergic Polymorphic Ventricular Tachycardia

Answer 28

Pain/ stress/ adrenaline/ temper tantrum