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YEAR 2: CSI > Hypertension > Flashcards

Hypertension Flashcards

1
Q

What is the NHS health check?

A

A free check-up of your overall health and identifies any risk factors you might have for health problems.

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2
Q

What specific health problems does it calculate the risk for?

A
  • heart disease, diabetes, stroke (cardiovascular risk)
  • kidney disease
  • dementia
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3
Q

What happens at an NHS health check?

A
  1. History
  2. Measurement of height + weight
  3. BP reading
  4. Blood test
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4
Q

What are the effects of hypertension on the brain?

A
  • Transient Ischaemic Attack

- Stroke

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5
Q

What causes a TIA?

A

An embolus that briefly blocks blood supply causing a mini-stroke which lasts for less than 24hrs.

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6
Q

What are the 2 main types of stroke?

A
  • Haemorrhagic: damage to blood vessels leading to rupturing of an artery
  • Ischaemic: reduction in blood supply to brain due to clot etc.
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7
Q

What are the effects of hypertension on the eyes?

A
  • Hypertensive retinopathy

- Optic neuropathy

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8
Q

What is hypertensive retinopathy?

A

Damage to the blood vessels feeding the retina due to the hypertension.

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9
Q

What are the signs of retinopathy?

A
  • microaneurysms

- ‘cotton wool’ spots

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10
Q

What is optic neuropathy?

A

Blurring of the disc margin due to damage to the optic nerve caused by a lack of blood supply to it.

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11
Q

What are the signs of optic neuropathy?

A
  • angiogenesis of new vessels across the optic disc (leading to blurring)
  • disc becomes paler
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12
Q

What are the effects of hypertension on the heart?

A
  • hypertrophy

- coronary heart disease

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13
Q

Why does hypertrophy occur?

A

There is increased vascular resistance so the heart tries to adapt by growing muscle. This is inefficient and can progress into heart failure.

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14
Q

What primarily causes coronary heart disease?

A

atherosclerosis in the coronary vessels

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15
Q

What are the effects of hypertension on the kidneys?

A
  • Glomerulosclerosis

- Kidney failure

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16
Q

What is Glomerulosclerosis?

A

Narrowing and hardening of the the blood vessels that make up the glomerulus.

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17
Q

How does high BP cause aneurysms?

A
  1. Hypertension stretches the blood vessels.
  2. This makes the walls weaker and more friable.
  3. This increases risk of aneurysms.
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18
Q

How is hypertension managed in a GP setting?

A
  1. Recheck BP
  2. 24hr ambulatory BP monitoring
  3. Give lifestyle advice
  4. Recheck BP
  5. Start medications
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19
Q

What is 24hr ambulatory BP monitoring?

A

BP monitoring done at home

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20
Q

Why is 24hr ambulatory BP monitoring carried out?

A

It mitigates white coat hypertension (patients naturally feel more stressed when seeing a doctor)

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21
Q

What kind of lifestyle advice may be given?

A
  • reduce obesity
  • encourage aerobic exercise -> this will increase blood flow to muscles, skin and kidneys
  • restrict salt intake
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22
Q

According to NICE guidelines, what should all people with hypertension be offered?

A
  • test for proteinuria with urine sample
  • blood test for HbA1c, eGFR, cholesterol
  • fundoscopy for retinopathy (use light to look into eye)
  • 12 lead ECG
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23
Q

What does the P wave denote?

A

Positive deflection caused by atria depolarisation

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24
Q

What does the Q wave denote?

A

Small negative deflection as the electrical signal move through (horizontally) the slow myocytes in interventricular septum.

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25
Q

What does the R wave denote?

A

Positive deflection caused by depolarisation in the apices of the ventricles.

26
Q

What causes the S wave?

A

Negative deflection caused by depolarisation of the rest of the ventricles (which is in opposite direction to Lead II).

27
Q

What causes the T wave?

A

Ventricles repolarise (the ventricular cells’ MP need to become negative again) and so even though the wave is travelling away from Lead II, it is a positive deflection. It is slower and more spread out

28
Q

What is the PR interval?

A

Time between the beginning of atrial depolarisation and ventricular depolarisation. Delay at AV node with no depolarisation occurring to allow atria to fully contract (flat line) ~3/4 small boxes.

29
Q

What is the QT interval?

A

It represents ventricular systole.

30
Q

What does the QT interval depend on?

A

HR -> if rate increases, the QT interval decreases -> Corrected QT interval

31
Q

What are the main nodes in the RA?

A
  • Sino atrial node
  • Atrioventricular node -> conduction velocity decreases as the cells have smaller diameters and slower ion channels. This causes a delay in ventricular filling
32
Q

What is the main node in the LA?

A

Bachmann’s bundle (receives signals from RA)

33
Q

What are the fibres in the interventricular septum called?

A

Bundle of His -> purkinje fibres

34
Q

Why is the R wave peak bigger than the P wave?

A

There is a lot of muscle and electrical activity in the ventricles, over a short period of time.

35
Q

Why is the T wave smaller than the R wave?

A

The electrical signal for repolarisation is more spread out -> it occurs over a longer period of time.

36
Q

What are the leads of an ECG?

A
  • x4 Limb leads (which make up leads I,II,III, AVL, AVR, AVF)
  • x6 chest/ precordial leads (V1-V6)
37
Q

What are the inferior leads?

A

II, III, AVF

38
Q

Which coronary artery are the inferior leads associated with?

A

Right coronary artery

39
Q

What are the lateral leads?

A

I, AVL, V5, V6

40
Q

Which coronary artery are the lateral leads associated with?

A

Left circumflex artery

41
Q

What are the septal leads?

A

V1, V2

42
Q

Which coronary artery are the septal leads associated with?

A

Left anterior descending artery

43
Q

What are the anterior leads?

A

V3, V4

44
Q

Which coronary artery are the anterior leads associated with?

A

Left anterior descending artery

45
Q

What is an ectopic pacemaker?

A

Nodes that can act as the pacemaker if the SA node fails. This includes…

  • bachmann’s bundle
  • AVN cells
  • pacemaker cells in purkinje fibres
46
Q

How do you describe ECGs?

A
  1. Check patient details
  2. Check calibration of ECG (position of patient)
  3. Rate
  4. Rhythm (distance between the peaks)
  5. Cardiac axis
  6. Look at individual waves and any elevations/depressions
47
Q

What does a higher-than-average QRS complex suggest?

A

Greater muscle mass -> Left ventricular hypertrophy, prolonged hypertension

48
Q

What causes inversion of T waves?

A

Cardiomyopathy (hypertrophy) causing abnormal depolarisation

49
Q

How can you differentiate between MI and Left ventricular hypertrophy?

A
  • look for biomarkers of MI (i.e. troponin)
  • clinical history + symptoms
  • concerning ST elevation
50
Q

What can cause slight ST elevation in people not suffering from MI?

A

Inappropriate repolarisation

51
Q

Are the effects of significant hypertension (pathological hypertrophy) reversible?

A

No -> their baseline ECG will look abnormal for the rest of their lives so it is important to always refer to their baseline ECG before making comments on new ECGs.

52
Q

What roles does the sympathetic NS play in hypertrophy?

A
  1. RAS activation; further vasoconstriction

2. Insulin, growth factor, lipid release

53
Q

What are the first line anti-hypertensives for those aged 55 or over?

A

Calcium channel blockers e.g. amlodopine

54
Q

What are the first line anti-hypertensives for those from african-caribbean backgrounds?

A

Calcium channel blockers e.g. amlodopine

55
Q

What is the recommended dosage for amlodopine?

A

5mg once daily -> 10mg

56
Q

If this doesn’t work, what is the second line?

A

CCB + ACEi/ ARB/ Thiazide diuretics

57
Q

What are the first line anti-hypertensives for those with diabetes/ <55yrs / non african-carribean origin?

A

ACEi/ ARB

58
Q

If this doesn’t work, what is the second line?

A

ACEi/ ARB + CCB/Thiazide diuretics

59
Q

Why are CCB first line for african-carribean patients?

A
  1. they have increased salt sensitivity (BP rises more easily in response to high salt)
  2. This leads to reduced renin responsiveness (ACEi are less effective initially).
60
Q

How do CCB work?

A
  1. They block L type calcium channels on vascular smooth muscle.
61
Q

What are the effects of blocking the calcium channels?

A
  1. ⬇️ amount of calcium entering smooth muscle cells
  2. ⬇️ activity of myosin -> less cross-bridging
  3. ⬇️ contraction of smooth muscle (vasodilation)
  4. ⬇️ peripheral resistance
62
Q

Why can BP remain high even after taking medication?

A
  • lack of adherence due to side effects/ lack of proper education/ life
  • secondary causes which maintain high BP
  • drug interactions reducing efficiency
  • dose may not be high enough
  • white coat syndrome
  • ethnicity

YEAR 2: CSI (8 decks)

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