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Cardiology > 1: HTN > Flashcards

1: HTN Flashcards

1
Q

What defines HTN

A
  1. Persistent clinical BP reading of >140/90

2. Ambulatory BP reading of >135/85

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2
Q

What are the types of HTN

A
  • Essential (primary)
  • secondary
  • white coat
  • malignant
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3
Q

What % of HTN is essential

A

95%

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4
Q

What % of HTN is secondary

A

5

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5
Q

Define white coat HTN

A

Clinical BP reading of >140/90. But an ambulatory BP reading of <135/85

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6
Q

Define essential HTN

A

HTN of unknown cause

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7
Q

What are the 3 aetiological categories of secondary HTN

A

Renal
Endocrine
Other

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8
Q

What % of renal HTN is due to intrinisic renal disease

A

75

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9
Q

What are the 5 types of intrinsic renal disease

A 
Chronic pyelonephritis
Systemic sclerosis
Polyarteritis nodosa
Adult polycystic kidney disease 
Glomerulonephritis
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10
Q

What % of renal HTN is vascular

A

25

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11
Q

What is the main cause of renovascular HTN

A

Renal artery stenosis

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12
Q

What are the 5 endocrine causes of HTN

A
  • Cushing’s disease
  • Pheochromocytoma
  • Conn’s syndrome
  • CAH
  • Acromegaly
  • Liddle’s syndrome
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13
Q

What are 2 other causes of HTN

A

Medications

Co-arctation of the aorta

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14
Q

What medications can cause HTN

A 
Glucocorticoids
MAOIs 
COCP
NSAIDs
Cocaine + Amphetamines
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15
Q

What is malignant HTN

A

Sudden increase in BP leading to vascular damage

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16
Q

What BP defines malignant HTN

A

180/120

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17
Q

What is the pathological hallmark of malignant HTN

A

fibrinoid necrosis

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18
Q

What are 3 non-modifiable risk factors for HTN

A

Age
FHx
Ethnicity

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19
Q

What are the modifiable risk factors for HTN

A 
Obesity
Diabetes
Smoking
Excess alcohol intake
Excess caffeine intake 
High sodium diet 
Physical inactivity 
Psychological stress
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20
Q

How does HTN present clinically

A

Asymptomatic. Unless malignant

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21
Q

How can HTN present

A

Headache, visual disturbances, seizures

22
Q

What is first-line Ix for HTN

A

Clinical BP reading - in both arms

23
Q

If BP is high at the first measurement what should be done

A

Take a second measurement during the consultation

24
Q

If someone has a clinical reading >140/90mmHg what should be done

25
If someone has an ABPM of <135/85 what should be done
Nothing - they are normotensive
26
If someone has an ABPM of >135/85 what stage of HTN do they have
Stage I
27
If someone has an ABPM of >135/85 what should be done
If they are <80y AND have one of the following they should be treated 1. Diabetes 2. 10y cardiovascular risk of >20% 3. Evidence of end-organ damage 4. Renal disease 5. Established cardiovascular disease
28
If someone has a BP of >150/95 what should be done
Treat, regardless of age and co-morbidities
29
If someone has malignant HTN what is first line
Sodium nitroprusside
30
If an individual has HTN and signs of papilloedema or retinal haemorrhage - what should be done
Refer to specalist same day
31
What is stage I HTN
Clinical BP: >140/90 | ABPM: >135/85
32
What is stage II HTN
Clinical BP: > 160/100 | ABPM: >150/95
33
What is stage III HTN
>180/110
34
What is the justification for other Ix in HTN
To look for evidence of end-organ damage
35
What other investigations may be done in HTN and why
``` Opthalmoscopy - retinal haemorrhage U+E - renal damage Urinanalysis - renal damage ECG- IHD of LVH HbA1c - CV risk Lipids - CV risk ```
36
What is the lifestyle advice for someone with HTN
- Limit salt intake <6g/d - Reduce caffeine - Physical activity - Reduce alcohol - More fruit + veg - Weight loss
37
If someone is <55 and NOT afro-carribean what should they be given first-line for HTN
ACEi
38
If someone is >55 or Afro-Carribean what is first line for HTN
Calcium channel blocker
39
What is second line for HTN
ACEi + Calcium channel blocker
40
What is third line for HTN
ACEi + Calcium channel blocker + Thiazide diuretic
41
If someones K+ is <4.5 what is given 4th line
Spirinolactone
42
If someones K+ is >4.5 what is given 4th line
Increase dose of thiazide
43
If individual does not respond to 4th line what should be done
Refer to specialist
44
What are 4 complications of HTN
1. HTN retinopathy 2. Stroke 3. CVS disease - HF, IHD 4. HTN nephrosclerosis
45
What is grade I HTN retinopathy
Tortous arteries with thick shiny walls
46
What is grade 2 HTN retinopathy
AV nicking
47
What is grade 3 HTN retinopathy
Flame haemorrhage and cotton wool spots
48
What is grade 4 HTN retinopathy
Papilloedema
49
How will HTN nephropathy present
microalbuminuria
50
How may HTN nephropathy present later
Nephrosclerosis and proteinuria

Cardiology (13 decks)

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