15 Flashcards
(72 cards)
1
Q
vascular endothelium main function
A
maintain vascular tone, controlling tissue blood flow and inflammatory responses and maintaining blood fluidity
2
Q
what are the 4 main types of CVD
A
- coronary heart disease (angina)
- aortic disease
- peripheral arterial disease
- strokes and TIA
3
Q
how many people suffer from CVD
A
422 million
4
Q
cost of CVD
A
300 B dollar
5
Q
goal of treatment
A
return to normal physiological ranges
6
Q
is high BP a disease
A
no
7
Q
how many people worldwide have high BP
A
1 in 3 worldwide have high BP
8
Q
how many of those w high BP are unaware
A
half
9
Q
hyperT is risk factor for
A
stroke and HR
10
Q
number one cause of death worldwide
A
CVD
11
Q
optimal systolic BP
systole
A
120
less than 80
12
Q
risks of CVD increases with
A
medical history
13
Q
optimal pressure
A
less 120
AND
less 80
14
Q
normal pressure
A
120-129
AND
80-84
15
Q
high normal
A
130-139
AND OR
85-89
16
Q
grade 1 hypertension
A
140-159
AND OR
90-99
17
Q
grade 2 hypertension
A
160-179
AND OR
100-109
18
Q
grade 3 hypertension
A
over or equal 180
AND OR
over 110
19
Q
lifestyle changes to help with HyperT
A
less salt
no smoking
20
Q
what will drug choice depend on
A
race
age
severity
21
Q
how would you treat high normal BP
A
lifestyle advice
consider drugs in high risk like Hx
22
Q
how would you treat grade 1 BP
A
lifestyle advice
immediate drug treatment in high risk patients or all patients if BP not controlled with lifestyle changes after 3-6 months
23
Q
how would you treat grade 2 BP
A
lifestyle advice
immediate drug treatment
AIM for BP control within 3 months
24
Q
how would you treat grade 3 BP
A
lifestyle advice
immediate drug treatment
AIM for BP control within 3 months
25
firstline drug for patients age under 55
Angiotensin converting enzyme inhibitor ACE
| young Rafa aces
26
firstline drug for patients age over 55 or black or African or carribean family
ca chanel blockers
| carribean calcium...
27
does age or race affect drug choice more
race
28
if drug doesn't help what happens
combination of drugs
29
second line
A and C
30
third line
A and C and thiozide diuretic (D)
31
fourth line
A C D and further diuretic or alpha and beta blockers
32
processes that regulate BP
rening angiotensin aldosterone system (RAAS)
baroreceptor reflex (actue changes)
33
how long does it take after you take steroids to see effects? why?
hours bc its affect is on gene expression
34
what factors activate the RAAS system
1. Sympathetic nerve activation (via β1-adrenoceptors)
2. Renal artery hypotension (e.g. systemic hypotension or renal artery stenosis)
3. ↓sodium delivery to the distal tubules of the kidney
35
explain the RAAS system
1. Activation of JG cells = cleaves prorenin to renin
2. Renin converts Angiotensinogen (liver) into angiotensin I
3. Angiotensin converting enzyme (ACE; Lungs & kidneys) converts Angiotensin I to Angiotensin II
4. Angiotensin binds to Angiotensin II Type I & type II receptors
5. Proximal tubule: Angiotensin II = ↑Na+ reabsorption = ↑blood flow bc water follows=
↑BP
6. Adrenal cortex: Angiotensin II: ↑aldosterone= ↑Na+ reabsorption (at distal
tubule) = ↑blood flow=↑BP
7. Systemic arterioles: Angiotensin II binds to GPCR = arteriolar vasoconstriction=↑BP
8. Brain: Angiotensin II stimulates release of antidiuretic
hormone (ADH). ↑ ADH = ↑Na+ reabsorption
36
affect of angiotensin II on systemic material
binds GPCR and leads to arteriole vasoconstriction and so increase in BP
37
angiotensin and the brain
angiotensin II acts on hypothalamus (pituitary??) makes you thirsty so increase blood volume
38
Brazilian pit viper nemo,
ACE inhibitor
39
mechanism of ACE inhibitor
Inhibit Angiotensin II (potent vasoconstrictor)
= vasodilation of small resistance arteries,
↓SVR & ↓BP
40
where do diuretics act
nephron
41
long term effect of antidiuretic
reduce vascular resistance
42
where do loop diuretics act
loop of hence
43
where do thiazides act
distal convoluted tubule
| ti amo de loi (distal)
44
mode of action of loop direuctics
Loop diuretics inhibit the luminal Na/K/2Cl co-transporter in the thick ascending limb of the loop of Henle
Increased delivery of Na to the distal tubule enhances K secretion into the urine
45
which leads to more vasodilation, loop diuretics or thiazide
thiazide
46
problems of diuretics
loss of K (hypokalaemia metabolic alkalosis)
loss of Ca
47
name of a thiazide often used
indapamide
48
thiazide mode of action
vasodilator by reducing systemic vascular resistance
decrease intravascular volume
sodium and water loss
reduce CO
49
calcium channel blockers mode of action
block ca entry to vascular smooth muscle
| so reduce contraction --> vasodilator
50
what are the two types of calcium channels blockers
dihydropyridine (amlopidine)
vasodilation mainly
reduce systemic vascular resistance
non dihydropyridine (diltiazem)
reduce HR
negative ionotropes andchronotrops so may worsen heart failure
51
angina
blockage of coronary artery
52
diagnostic tool for determining wether to give drugs for prevention of angina
cholesterol plus que 200mg dL then you give preventative drugs
53
first line preventative therapy of angina
```
lipid lowering (statins)
lower BP
lifestyle changes
```
54
what are statins
lipid lowering drugs
55
common drugs to manage angina
```
nitrates (vasodilator)
calcium blockers (vasodilator AND cardiac depressants)
beta blockers (cardiac depressants)
```
56
is nitrate short or long response
quick short
57
mode of action of nitrates
nitroglycerine converted to NO which is a major physiological molecule that leads to vasodilation.
NO activates GTP tp cGMP which leads to realxation of coronary arteries or veins
58
mode of action of beta blockers
antagonist of b1 receptor
| reduce HR and BP and myocardial oxygen demand
59
Heart failure symptoms
Symptoms (e.g. breathlessness, ankle swelling and fatigue)
60
heart failure sings
signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema bilateral ankle deem heart murmur)
61
cause of Heart failure
Structural and/or functional cardiac abnormality, resulting in a ↓ cardiac output +/- ↑ intracardiac pressures at rest/stress
62
ejection fraction
measurement of the percentage of blood leaving your heart each time it contracts
about of blood pumped out/amount of blood in chamber
63
normal ejection fraction
50-70%
64
below ejection fraction
heart failure
65
chemical to diagnose heart failure
naturiuretic peptides
66
drugs used in heart failure
positive inotropic drugs
vasodilators
miscellaneous drugs for chronic failure
67
mrEF
| pEF:
mrEF: mid-range ejection fraction
pEF: Preserved ejection fraction
68
Heart Failure with preserved/mid-range ejection fraction recommendations
diuretics for congested patients to relieve symptoms
| screen for comorbidities
69
Heart Failure with reduced ejection fraction
Ace and beta blockers plus MRA if still symptomatic
70
problem of giving non dihydropyridine (diltiazem)
can worsen heart failure because it acts as a negative inotrop
71
invasive treatment of angina
angioplasty and stent
72
heart failure dx tool
natriuretic peptides and echocardiogram
