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Year 3 Medicine Block > CARDIO: HTN > Flashcards

CARDIO: HTN Flashcards

1
Q

What is stage 1 HTN?

A

Clinical BP is 140/90 mmHg or higher.

Ambulatory BP monitor or home BP monitor averages out at 135/85 mmHg

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2
Q

What is stage 2 HTN?

A

Clinical BP is 160/100 mmHg or higher

ABPM or HBPM average is 150/95 mmHg or higher

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3
Q

What is severe HTN?

A

Clinical systolic BP is 180 mmHg or higher.

Clinical diastolic Bp is 120 mmHg or higher.

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4
Q

When should ambulatory BP readings be offered?

A

If BP is >140/90.

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5
Q

How to manage pt with severe HTN (S=>180mmHg or= 120mmHg)?

A
  • Consider treatment immediately.
  • For patients < 40 years consider specialist referral to exclude secondary causes.

No need to do ABPM or HBPM

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6
Q

Signs and symptoms of pt with HTN?

A

Asymptomatic

If severe:
* headaches
* on fundoscopy: retinal haemorrhages and papillodema
* dizzy
* nausea and vomiting
* chest pain

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7
Q

Main ddx of pt with HTN, sweating, headache, palpatations, anxiety?

A

Phaeochromocytoma

could also be MI, hyperthyroid

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8
Q

Main ddx of pt with HTN, muscle weakness and tetany?

A

Hyperaldosteronism

Hyperaldosterone leads to hypercalciuria and hypocalcemia which cause secondary hyperparathyroidism.(tetany)

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9
Q

CVS RF that may lead to HTN?

A

TIA, stroke, DM, previous renal disease, smoking, cholesterol, NSAID excess

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10
Q

Pt has HTN. What may be present in PMH?

A

Angina, CCF, palpatations, syncope, valvular heart disease

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11
Q

Pt has HTN. What should you cover in FHx?

A

FHx of HTN?
FHx of premature coronary disease
FHx of polycystic kidney disease
FHx of cardiac related death before 40 ?

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12
Q

What are secondary causes of HTN?

A 
Cushing's syndrome
Polycystic kidney disease 
Renal bruits 
Radio-femoral delay (coarctation)
Phaechromocytoma 
Hyperaldosteronism
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13
Q

What investigations would you fo for pt with HTN?

A

Urinanalysis - albumin:creatinine ratio
Urinanalysis - haematuria
Blood glucose, U+Es = creatinine and eGFR
Lipid profile - serum total cholesterol, HDL cholesterol
U+Es for secondary cause too - low potassium and high sodium = hyperaldosteronism
12 lead ECG
ECHO - if LVH, valve disease, LVSD, diastolic dysfunction

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14
Q

How to do a CVS risk assessment?

A

Use Q risk calculator

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15
Q

When should pts with stage 1 HTN (under age of 80) be offered treatment?

A
  • if they have evidence of: target organ damage
  • if they have evidence of: established CVD
  • have renal impairment
  • have DM
  • have 10 year risk >20%
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16
Q

Your pt has HTN (worked out by ABPM). Now you need to work out QRISK2 score and Investigate for end-organ damage…

What investigations to assess for end organ damage…?

A
  • Urine dip and albumin:creatinine level
  • Blood glucose, lipids and renal function
  • Fundoscopy for evidence of hypertensive retinopathy
  • ECG: look for evidence of LV hypertrophy
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17
Q

When should pts with stage 2 HTN be offered treatment?

A

Always offer if have stage 2 HTN

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18
Q

What is target BP in low-moderate risk pts with HTN?

A

<140 mmHg systolic

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19
Q

What is target BP in pts who have HTN with a background of either DM, stroke, TIA, IHD, CKD?

A

<130/80 mmHg

20
Q

Elderly pt with systolic >160mmHg should have target BP of ??

(a) if under 80
(b) if over 80

A

(a) 140-150mmHg if under 80, ideally <140mmHg

(b) 140-150mmHg

21
Q

What is target diastolic BP in:

1) all pts with HTN?
2) diabetics specifically?

A

1) <90 mmHG

2) <85mmHg

22
Q

What is target systolic BP in pt with CKD and overt proteinuria?

A

<130mmHg

23
Q

Non-pharmacological treatment for HTN?

A
  • lose weight if BMI >25 kg/m2. (for every kg lost = reduce BP by 3/2 mmHg)
  • reduce salt intake (can reduce BP by 8/5mmHg)
  • minimise alcohol intake
  • exercise
  • smoking cessation
24
Q

Initial pharmacological treatment for HTN in pt under 55?

A

ACEi or ARB

25
Q

Initial pharmacological treatment for HTN in pt 55+, or black person of African or Carribean family origin of any age?

A

CCB

26
Q

Pt is already on ACEi for HTN. It isn’t reducing BP. What to add next ?

A

ACEi + CCB

27
Q

Pt is already on CCB for HTN. It isn’t reducing BP. What to add next ?

A

CCB + ACEi

28
Q

Pt is already on ACEi and CCB for HTN which is not helping. What to consider adding next?

A

Thiazide like diuretic e.g. Indapamide

Bendroflumethiazide - not preference thiazide type diuretic. Indapamide better at reducing stroke / CVS events

29
Q

Pharmacological treatment for resistant HTN?

A

ACEi, CCB, Thiazide like diuretic + one of the following:

  • spironolactone
  • higher dose of thiazide like diuretic
  • alpha or beta blocker if the above 2 do not work.
30
Q

What is a hypertensive crisis?

A

An increase in BP which if sustained over the next few hours, will lead to irreversible end-organ damage

E.g. encephalopathy, LV failure, aortic dissection, unstable angina, renal failure.

31
Q

Distinguish between a hypertensive emergency and a hypertensive urgency

A

Hypertensive emergency:
= high BP associated with a critical event (e.g. encephalopathy, pulm oedema, AKI, MI)

Hypertensive urgency:
= high BP without a critical illness but may include malignant hypertension.

32
Q

What is main target BP aim of treating a HTN emergency?

A

Reduce diastolic BP to 110mmHg in 3-12hrs

33
Q

What is main target BP aim of treating a HTN urgency?

A

Reduce diastolic BP to 110mmHg in 24hrs.

34
Q

What IV drugs should be started in hypertensive emergency?

A
  1. Sodium nitroprusside
  2. Labetalol
  3. GTN (1-10mg/hr)
  4. Esmolol
35
Q

Oral treatment options for hypertensive urgency?

A

Amlodipine - 5-10mg OD
Diltiazem - 120-300mg daily
Lisinopril - 5mg OD
Note: ACEi and CCB is effective and well tolerated

36
Q

What is the safest and most effective oral treatment for hypertensive urgency (according to CVS booklet)?

A

Nifedipine 20mg BD + Amlodipine 10mg OD for 3 days.

After 3 days, continue with amlodipine 10mg OD.

37
Q

Triad of symptoms in pheochromocytoma?

Most common sign?

A

The triad:
Episodic headache
sweating
tachycardia

most common sign: sustained or paroxysmal HTN

38
Q

Investigation for phaeochromocytoma?

A

24hr urine collection.
Measure urinary metanephrines and catecholamines.
Measure plasma fractionated metanephrines and catecholamines.
CT scan or MRI of abdomen and pelvis - detect adrenal tumours. If these do not show, can do MIBG scan.

39
Q

Management of phaeochromocytoma?

A

Resection

40
Q

How to manage phaeochromocytoma before surgery?

A

Alpha adrenergic blockade and beta adrenergic blockade.

41
Q

Name of commonly used alpha adrenergic blockage used for phaeochromocytoma?

A

Phenoxybenzamine

42
Q

Which order are alpha adrenergic blockade and beta adrenergic blockades given to pt for phaeochromocytoma?
Describe dosage.

A

Alpha first - ALWAYS. Phenoxybenzamine is used. Initial dose is 10mg OD/BD. Dose is increased every 2-3days to control BP. Final dose is 20-100mg daily.

After use of alpha adrenergic blockade is achieved, can start beta-adrenergic blockade - usually 2-3 days pre-operatively.

43
Q

Investigations and findings for Cushing’s syndrome with HTN?

A

Blood glucose = hyperglycaemia
24hr urine cortisol excretion = elevated by 3x
Adrenal CT
Low dose - dexamethasone suppression test. = Show high cortisol.

44
Q

Investigations for primary aldosteronism with HTN?

A

Aldosterone:renin - plasma renin will be low, aldosterone will be high
Adrenal CT

45
Q

Complications of HTN?

A
  • Increased risk of morbidity and mortality from all causes
  • Coronary artery disease
  • Heart failure
  • Renal failure
  • Stroke
  • Peripheral vascular disease
46
Q

What is HTN a risk factor for?

A
  • cardiovascular disease
  • cerebrovascular disease
  • chronic kidney disease
  • peripheral vascular disease.
47
Q
A

Year 3 Medicine Block (56 decks)

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