What are the three general groups of factors that can cause HTN?
What are the acute coronary syndromes?
What are the cardiovascular risk factors?
How does hypertension typically lead to heart failure?
Increased afterload > LVH > Stiff LV > Diastolic failure > Often leads to systolic HF
What are the possible causes of exacerbation of chronic heart failure?
Regularly taking meds?
What is primary hypertension?
Hypertension with no specific aetiology
Why are beta-blockers not preferred anti-hypertensives?
Heavy side effects
- Increased weight
- Insulin resistance
What some adjunct treatments for AMI?
Possibly other anti-platelets
Beta-blockers & ACE inhibitors
What are some causes of secondary hypertension?
Renal disease eg damage to nephrons
Renal artery stenosis
Adrenal secreting tumours
What are some signs that reperfusion has occurred?
Resolution of pain or ST elevation
Reperfusion Arrhythmia - Idioventricular rhythm
What is the target BP is patients with CV risk factors?
At what point in the CV system does the BP drop most significantly?
What is the mechanism of action of calcium channel blockers?
Inhibit the L-type Ca channels. Different types have different binding properties therefre can reducing contractility, SA activity, AV node conduction or vascular tone
Can be vascularly selective - dihydropyridine CCBs > arteriolar vasodilation > reduce afterload (Ca is required for SM contraction)
Or cardiac and vascular selective with negative inotropic and chronotropic properties > used for HTN, arrhythmias and angina
The WHO definition of AMI requires 2 out of 3 of the following criteria. Name those 3
Symptoms of myocardial ischaemia
Elevated cardiac enzymes (troponin or CK)
Typical electrocardiographic pattern involving the developent of Q waves, ST segment changes or T wave changes
What is the usual ejection fraction?
50% of ventricular volume therefore ~70ml (of 140ml)
Why are anterior infarcts the worse?
Because the area they supply contributes most to the ejection fraction
In which type of heart failure can ejection fraction be preserved? How?
Diastolic heart failure
Ventricle doesn't fill (eg due to mitral stenosis)
Why can heart failure trigger fluid retention?
Reduced CO > Reduced renal blood flow > Activation of RAAS > fluid retention
How does cardiac hypertrophy effect EDV?
Hypertrophic myocardium is less conpliance
Diastolic refill is impair
EDV is reduced
What is pulse pressure?
The difference between systolic and diastolic BP
When is high systolic BP seen in isolation?
Elderly with stiff arteries
What is the cut off for EDP over which point oedema/congestion will occur?
What is can be concluded for a LVHF patient with a normal echo?
Diastolic HF as EF is preversed
List the heart murmur in order of commonality?
1. Aortic Stenosis
2. Mitral Regurgitation
3. Aortic Regurgition
4. Mitral stenosis
Which is more life threatening, VF or VT?
Describe the pathophysiology of Wolff-Parkinson-White syndrome
Abnormal conduction pathways allow impulses to bypass the AV node and can lead to tachyarrhythmias
What causes a 3rd heart sound? When is it heart?
Sloshing of blood around the ventricle
Early to mid diastole
What causes a 4th heart sound? When is it heart?
Forceful contraction of the atria to overcome a stiff ventricle
How is the diagnosis of hypertension made?
BP >140/90 after 5mins seated and 2 readings 2 minutes apart
A follow up reading 1-4 weeks later
What are the classes of drugs used for the treatment of HTN? When is each used for first line?
A - ACEI or ARBs - If patient is <55y.o.
B - Beta-blockers - avoided due to side effects
C - Calcium channel inhibitors - If >55 or black
D - Diuretics - If there is a component of fluid retention
What are some side effects of beta-blockers?
Which anti-hypertensives are avoided in HF?