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bds2 bams > Chronic Cardiovascular Diseases > Flashcards

Chronic Cardiovascular Diseases Flashcards

1
Q

What is hypertension?

A

= raised BP

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2
Q

What are Systolic and Diastolic values for patient with hypertension?

A

= Systolic, >140mmHg
= Diastolic, >90mmHg

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3
Q

How do you diagnose high blood pressure?

A

= 3 separate measurements, sitting and rested

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4
Q

What are the risk factors for hypertension?

A

= age
race
obesity
alcohol
family history
pregnancy
stress
drugs (non steroidal, corticosteroids, oral contraceptives)

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5
Q

Which condition causes the biggest risk of hypertension?

A

A stroke= cerebrovascular accident

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6
Q

Name some of the key outcomes from Hypertension

A

= accelerated atherosclerosis
- MI
- Stroke
-Peripheral vascular disease
= renal failure (blood flowing at higher pressure and will damage the vessels which lead to the kidneys)

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7
Q

What are the common triggers of hypertension?

A

= None are usually found
=likely genetic failure of autoregulation of blood vessel wall constriction

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8
Q

Name some rare triggers for hypertension

A

= renal artery stenosis
= endocrine tumours
- phaeochromocytoma (adrenaline)
- conn’s syndrome (aldosterone)
- cushing’s syndrome (cortisol)

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9
Q

What is adrenaline ?

A

= a vasoconstrictor

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10
Q

how do aldosterone and cortisol work?

A

= increase circulating blood volume

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11
Q

what are the common signs and symptoms for hypertension?

A

= usually NONE
= may get headache
= may get transient ischaemic attacks (temporary disruption in the blood supply to part of the brain)

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12
Q

How does a phaemochromocytoma result in hypertension?

A

causes the adrenal gland to produce too much adrenaline therefore increasing a patients BP

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13
Q

How does cushing’s syndrome cause hypertension?

A

ACTH (adrenocorticotropic) tells the adrenal gland to make more cortisol

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14
Q

How does Conn’s syndrome cause hypertension?

A

= the adrenal glands make too much aldosterone

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15
Q

what some indications for further investigation (hypertension)?

A

= if the patient is young
= resistant hypertension despite adequate treatment
= accelerated hypertension
= ‘unusual’ history

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16
Q

What does cushing’s syndrome cause?

A

= salt and water retention
= leads to excess fluid within circulation

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17
Q

How can renal artery stenosis cause hypertension?

A

= narrowing of the blood flow into the kidney
= the kidneys think the BP has dropped therefore will produce aldosterone which will rapidly increase BP

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18
Q

How is renal artery stenosis treated? (medication)

A

ACE inhibitors

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19
Q

What do ACE inhibitors do in relation to renal artery stenosis?

A

Blocks angiotensin (enzyme causing arteries to narrow)
= widen the blood vessels to improve blood flow

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20
Q

What are the investigations for hypertension?

A

= urinalysis
= serum biochemistry
= serum lipids
= ECG

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21
Q

what is the ideal BP which hypertensive patients should aim for?

A

< 120/90 mmHg

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22
Q

Which risk factors should be modified when treating hypertension?

A

= weight loss
= exercise

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23
Q

Which drugs might you prescribe a patient to take once daily and why might you do this?

A

= thiazide diuretic
= beta blocker
calcium channel antagonists
ACE inhibitors

increase patient compliance

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24
Q

How often should you monitor a patient with hypertension?

A

= review at least annually when stable as the treatment will change overtime

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25
Q

What is simple definition of heart failure?

A

output of the heart is incapable of meeting the demands of the tissues

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26
Q

What is high output failure and give 2 examples

A

= demands of the system have increased beyond the capacity of the pump
= anaemia and thyrotoxicosis

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27
Q

What is low output failure and give an example

A

pump is failing and not strong enough to force liquid around the body
= cardiac defect e.g. MI, valve disease

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28
Q

What side of the heart does most of the work

A

LEFT

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29
Q

Difference between diastole and systole

A

diastole = filling
systole = pumping

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30
Q

What is the aetiology of low output failure?

A

= heart muscle disease
= pressure overload
= volume overload
= arrhythmias
= Drugs

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31
Q

Name 2 causes of heart muscle disease?

A

= MI
= Myocarditis

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32
Q

Name 2 conditions which involve pressure overload?

A

= hypertension
= aortic stenosis

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33
Q

Name 2 examples of volume overload?

A

= mitrial incompetence
= aortic incompetence

34
Q

What arythmias can cause low output failure?

A

= atrial fibrillation
= heart block

35
Q

Which drugs can cause low output failure?

A

= b blockers
= corticosteroids
= anticancer drugs

36
Q

What are the signs and symptoms of left heart failure? and what 2 things are affected

A

=lungs and systolic effects

= dyspnoea
tachycardia
low BP
low vol. pulse

37
Q

What are the signs and symptoms of right heart failure? and what is elevated

A

= venous pressure elevated

= swollen ankles
=ascites
= raised JVP
= tender enlarged liver
= poor GI absorption

38
Q

What is the difference between symptoms and signs?

A

symptoms = what the patient complains about
signs = what we find on examination

39
Q

What does JVP stand for? and where can the pulse be seen

A

Jugular venous pressure, pulse can be seen in veins on the neck

40
Q

Name the symptoms of heart failure?

A

= shortness of breath
= swelling of legs and feet
= chronic lack of energy
= difficulty sleeping at night due to breathing problems
= swollen or tender abdomen with loss of appetite
= cough with frothy sputum
= increased at night
= confusion and/or impaired memory

41
Q

Which symptom of heart failure would be important for dentist to be aware of? and why does this occur

A

SHORTNESS OF BREATH

= worse when patient lies flat
- ask how many pillows they sleep with and if they feel as if they are choking/drowning during sleep

42
Q

Common signs and symptoms of left sided heart failure?

A

=fluid in lungs
= BP in lungs increases
Cough- frothy sputum (air and fluid in lungs)

43
Q

What causes ankle swelling?

A

= fluid accumulated in peripheral tissues from right sided failure

44
Q

What is pitting oedema?

A

fluid accumulation in superficial tissues - can be squeezed out by pressure

higher the pitting is found the worse the heart failure

45
Q

What is the treatment for acute heart failure? what is administered to the patient

A

Emergency hospital management

= patient is acutely short of breath and gasping. Lungs filled with fluid (oedema)
=oxygen, morphine, frusemide

46
Q

what is the treatment for chronic heart failure?

A

= improve myocardial function
= reduce compensation effects
= where possible treat the cause

47
Q

What is frusemide and how can it be used for treatment of chronic heart failure?

A

= diuretics
= make you pass urine and relieve ankle swelling and breathlessness caused by heart failure.

48
Q

What is emergency heart failure treatment?

A

= acute heart failure presentation. Raised fluid pressure in lungs and fluid moves into lung alveoli- gas exchange is not possible. BREATHLESSNESS
= treat with high dose diuretic to remove fluid and breathing returns to normal

49
Q

What is the first line treatment for heart failure? (include examples)

A

First treat any underlying cause to see myocardial function level
= hypertension
= valve disease
=heart arrhythmias
atrial fibrillation
= anaemia
= thyroid disease

50
Q

What treatment is carried out in chronic heart failure?

A

= drug therapy
- diuretics to increase salt and water loss
- ACE inhibitor - reduce salt/water retention
- nitrates - reduce venous filling pressure
- inotropes - digoxin

51
Q

What medication should be stopped in the treatment of heart failure?

A

= stop negative inotropes- B BLOCKERS

52
Q

What is a rare treatment of heart failure?

A

= assist pump
= heart transplant

53
Q

Why must heart valves be working efficiently?

A

= to allow flow of blood out and into the heart in one direction

54
Q

Which 2 valves are under the most pressure

A

mitral and aortic valves

55
Q

What 2 groups of people are more likely to have heart valve disease?

A

=elderly
= downsyndrome

56
Q

What 4 things can cause valve disease?

A

= congenital abnormality
= MI
= Rheumatic Fever
= Dilation of the aortic root

57
Q

What is an aneurysm?

A

a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches.

58
Q

What can cause dilation of the aortic root?

A

= syphilis
= aneurysm formation

59
Q

How can a MI cause valve disease?

A

= papillary muscle rupture

60
Q

How can rheumatic fever cause valve disease?

A

= immunological reaction to streptococci

61
Q

What congenital abnormality can cause valve disease?

A

bicuspid valve

62
Q

Which of these valves can cause valve disease? and name both

A

RIGHT IMAGE

(tricuspid aortic valve, bicuspid valve)

63
Q

How many valves are there?

A

4

64
Q

Name the 2 left valves

A

= aortic
= mitral

65
Q

Name the 2 right valves

A

= pulmonary
= tricuspid

66
Q

Which type of valves most commonly fail and what is this called?

A

=left side valves
= aortic stenosis
= mitral stenosis

67
Q

What type of valves treat failure problems?

A

prosthetic valves

68
Q

What is valve stenosis?

A

narrowing of the valve opening

69
Q

How is valve disease investigated? (2)

A

= Ultrasound Scan
= doppler ultrasound scan

70
Q

What do the valves separate?

A

Ventricles from atrium

71
Q

When is best to carry out a valve replacement

A

before there is evidence of heart failure to give highest long term success

72
Q

If patients have mechanical valves, what type of medication are they usually on?

A

Anticoagulants

73
Q

What is endocarditis ?

A

infection of the inner lining of the heart

74
Q

What can reduce endocarditis infection risk?

A

= maximise oral health
= be sensitive to patient and surgeon needs
= be aware of international disagreement in this area

75
Q

Compare metal valves to tissue valves?

A

= METAL
-longer clinical life (up to 30 years)
-require warfarin anticoagulant
- consider antibiotic prophylaxis
- make a ticking noise (upsets some patients )

= TISSUE
- shorter clinical life (usually less than 10 years)
-no need for anticoagulation
- consider antibiotic prophylaxis
- silent action

76
Q

What 2 things should you remember with regards to prosthetic valves?

A

= anticoagulation
= endocarditis prevention

77
Q

3 things to ensure with regards to endocarditis prevention?

A

= remove causes of oral sepsis
= improve patient’s OHI
= improve prevention of oral disease

78
Q

What is a Tachy Arrhythmia?

A

FAST
= atrial fibrilation
= ventriculat tachycardia

79
Q

Which drug can induce bradyarryhthmia - what pulse does this commonly cause

A

Beta blocker

  • 50bpm
80
Q

What is pro-longed on an ECG for a patient with bradyarryhthmia

A

prolonged p-q interval

81
Q

How does a heart block cause a bradyarryhthmia?

A

slow/no conduction through the AV node to ventricles of impulse from SA

82
Q

How is a heart block classified (bradyarrythmia) ?

A

the length of signal delay

= 1st 2nd and 3rd degree
= 3rd degree is also termed complete heart block as no impulse passed to the ventricles

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