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CP2 - CBM > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Define Hypertension

A

Persistently elevated blood pressure (>140/90)

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2
Q

What are the causes of Hypertension?

A

Essential Hypertension (90%) - cause unknown

Secondary Hypertension

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3
Q

What are the different causes of secondary hypertension?

A 
Renal disorders
Cushing's syndrome and pituitary/adrenal tumours
Vascular disorders 
Thyroid disorders
PCC
Alcoholism 
Pregnancy
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4
Q

What are the common symptoms of hypertension?

A 
Headaches - particularly at the back of the head
Lightheadedness
Vertigo
Tinnitus
Altered vision
Syncope
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5
Q

What optic signs might be seen as a result of hypertension?

A

signs of changes to optic disc caused by hypertensive retinopathy

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6
Q

What is a hypertensive emergency?

A

> 180/110 - evidence of direct damage to one or more end organs producing symptoms, such as chest pain, breathlessness, confusion and drowsiness

In infants - hypertension my present as failure to thrive, breathlessness, seizures or irritability

In children, it may present as headaches, irritability, nosebleeds, facial paralysis, fatigue, failure to thrive or blurred vision

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7
Q

What are the risk factors of hypertension?

A 
Age
FH
stress
Sleep apnoea
Afro-caribbean or South Asian ethnicity
Excessive alcohol consumption
Obesity
Little or no exercise
High salt diet
Low potassium diet
Smoking
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8
Q

What investigations are done for high blood pressure?

A

Measure blood pressure re-check 2/3 times over next few weeks if <140/90

offer ambulatory blood pressure monitoring to confirm the diagnosis

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9
Q

What is the treatment of high blood pressure?

A

Arrange same day admission if there are signs of malignant HTN

Lifestyle advice

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10
Q

What are the signs of malignant hypertension?

A

180/110 with papilloedema and/or retinal haemorrhage

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11
Q

What is the first line treatment if patient is under 55 and non black?

A

ACEi

or ATII receptor blocker

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12
Q

What is the first line treatment if the patient is over 55 or black?

A

CCB

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13
Q

What is step 2 in treatment HTN?

A

ACEi + C or D

C + ACEi or D

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14
Q

What is step 3 in treatment of HTN?

A

ACEi + CCB + D

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15
Q

What is step 4 in tx of HTN?

A

ACEi + CCB + D
If potassium <4.5 - spironolactone
If >4.5 - alpha blocker, or beta blocker

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16
Q

What lifestyle factors are advised for HTN?

A

stop smoking
weight loss
avoid excess salt intake

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17
Q

What is atrial fibrillation?

A

Abnormal heart rhythm characterised by rapid and irregular heart beating

18
Q

What are the cardiac causes of AF?

A 
ischaemic heart disease 
rheumatic heart disease
cardiomyopathy
WPW syndrome 
atrial septal defect
pericarditis
cardiac surgery
19
Q

What are the pulmonary causes of AF?

A

pneumonia
carcinoma of the bronchus
pulmonary embolus

20
Q

What are the thyroid causes of AF?

A

hyperthyroidism

thyrotoxicosis

21
Q

What are the signs and symptoms of AF?

A 
irregularly irregular 
palpitations
dyspnoea
fatigue
dizziness
syncope 
angina
22
Q

What is the primary change seen in the AF?

A

progressive fibrosis of the atria - brought about by atrial dilation

23
Q

What is atrial dilation caused by?

A

Structural abnormalities in the heart that cause a rise in pressure within the heart.

Once dilation has occurred, RAAS is activated and there is a subsequent increase in matrix metalloproteases and disintegrins. This leads to atrial remodelling and fibrosis with loss of atrial muscle mass

Loss of atrial muscle mass - impulses generated by SAN do not go smoothly through myocardium

Electrical impulses - high rate but do not result in a heart beat.

24
Q

What investigations are done for AF?

A

History taking
examination
U+E/TFT - rule out thyroid causes

troponin if acute cardiac causes of AF suspected

ECG - no P wave

Atrial flutter - atrial rate typically 300 beats/min - sawtooth flutter wave

25
Q

What is the classification fo AF?

A

First detected
Paroxysmal - recurrent episodes that stop on their own in less than 7 days

Persistent - longer than 7 days

Permanent

26
Q

What is the management of AF in haemodynamically unstable patients?

A

immediate heparinisation and attempted cardio version with synchronised DC shock

If cardio version fails - IV amiodarone

27
Q

What are the two strategies for long term management of AF?

A

Rate control

Anticoagulation

28
Q

What is the aim of rate control in AF?

A

reduce heart rate at rest and during exercise but the patient remains in AF

29
Q

What drugs are preferred for rate control in AF?

A

Beta blockers
Calcium channel blockers

If co-existent heart failure - digoxin

30
Q

Who is rhythm control used in?

A

Younger patients - <65 years of age
Patients who are highly symptomatic
Patients with congestive heart failure
Individuals with recent onset AF

31
Q

How is conversion to sinus rhythm achieved?

A

Electrical DC cardio version and administration of B-blockers to control rate

32
Q

What agents are used for rhythm control in AF

A

sotalol
amiodarone
flecainide
others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine

33
Q

If patients are unresponsive to rate control, what is the treatment?

A

catheter ablation techniques

34
Q

In which patients are anticoagulants used?

A

Calculate CHA2DS2-Vasc score:
1+ in males
2+ in females –> Anticoagulation

35
Q

how is risk of embolism causing a stroke assessed?

A

CHA2Ds2 VASc score

C - CHD 
H- hypertension
A2 - aged 75_ 
D - DM 
S2 - prior stroke  TIA/ thromboembolism

V - vascular disease
A - 65-74
Sc - sex category

36
Q

What is the one year risk of major bleeding assessed by?

A

HASBLED score:

H - hypertension 
A - abnormal kidney/liver function
S- stroke
B - bleeding
L - unstable/high INR 
E - elderly - >65 
D - drug and alcohol use/medication predisposing to bleeding
37
Q

What anticoagulants are used in AF?

A

NOACs: Apixiban, rivaroxaban

Warfarin

38
Q

What is angina?

A

Exertional chest pain
Decreased blood flow to the heart due to atherosclerosis
through the coronary arteries
When exercising –> increase for blood goes up and demand Can’t be met: therefore chest pain

39
Q

What are the risk factors for angina?

A

Obesity
smoking
alcohol
diet + exercise

40
Q

What is the management for angina

A

GTN: sublingual
sit down and spray again
After 2 sprays - 999

Beta blocker or CCB (monotherapy = rate limiting)
Then both together
then long-acting nitrate, ivabradine, nicorandil or ranolazine

41
Q

Counselling for angina

A

Warn about nitrate free period
Warn about GTN: if 2 uses and still in pain - might be having a heart attack and need to call 999

Side effects of nitrates
Dizziness
headache (very common)

CP2 - CBM (5 decks)

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