Cardiovascular Disease

Question 1

what may breathlessness at rest indicate in a pt?

Answer 1

heart failure
respiratory problem

Question 2

what can an apprehensive, sweaty, pained expression indicate in a pt?

Answer 2

angina
myocardial infarction

Question 3

what CV disease can be indicted by finger clubbing?

Answer 3

congenital heart defect

Question 4

what can a pale nail bed indicate?

Answer 4

anaemia

Question 5

what is cyanosis?

Answer 5

blue discolouration of the lips or palate

Question 6

what medication can cause gingival hypertrophy?

Answer 6

nifedipine antihypertensive medication

Question 7

what is xanthelasma and what does it indicate?

Answer 7

-yellow plaques around eyes
-elevated cholesterol

Question 8

what is the most common cardiac rhythm abnormality?

Answer 8

atrial fibrillation

Question 9

what is the name given to a heart rate >100bpm?

Answer 9

tachycardia

Question 10

what is the name given to a heart rate <60bpm?

Answer 10

bradycardia

Question 11

what is hypertension?

Answer 11

persistently raised blood pressure >140/90mmHg

Question 12

where should a blood pressure cuffed be placed whilst taking a reading?

Answer 12

3cm above the anticubital fossa

Question 13

what is the name given to hypertension with no known cause?

Answer 13

primary hypertension

Question 14

what % of the population suffers from primary hypertension?

Answer 14

5-10%

Question 15

what are the known aetiologies of hypertension?

Answer 15

-renal disease
-pregnancy
-coarctation of the aorta
-endocrine tumours
-drugs e.g. steroids

Question 16

how does hypertension cause arteriolar sclerosis?

Answer 16

the vessels adapt to the raised pressure by increasing smooth muscle and hyaline content of the media

Question 17

what does it mean if an artery is aneurysmal?

Answer 17

it is abnormally dilated

Question 18

what is classified as severe hypertension?

Answer 18

> 180/110mmHg

Question 19

what are the symptoms of severe hypertension?

Answer 19

-dizziness
-headache
-epistaxis

Question 20

what are the risks of untreated hypertension?

Answer 20

-left ventricular failure (enlarges to cope with the extra pressure but eventually dilates and fails)
-MI
-stroke
-renal failure

Question 21

what is the most important predisposing factor for stroke?

Answer 21

hypertension

Question 22

how is hypertension diagnosed?

Answer 22

by accurate measurement of the blood pressure on at least 3 occasions over a 3-month period in a relaxed atmosphere

Question 23

what lifestyle modifications can a person with hypertension make in an effort to try reduce their blood pressure?

Answer 23

-weight reduction
-Increased exercise
-decreased alcohol consumption
-stop smoking
-low salt diet

Question 24

name 6 classes of antihypertensive medication

Answer 24

-diuretic
-B-blocker
-Ca antagonist
-ACE inhibitor
-angiotensin II receptor blocker
-adrenergic inhibitors

Question 25

what 3 groups should you split hypertension patients into?

Answer 25

-controlled hypertensive on treatment -high blood pressure detected in practice -malignant hypertensive

Question 26

how would you manage a pt with high blood pressure detected in practice?

Answer 26

refer to GP for further investigation elective treatment deferred

Question 27

how do you manage a malignant hypertensive pt?

Answer 27

bp>185/110mmHg high risk fo acute complications- refer urgently to GP/hospital

Question 28

name an oral side effect of nifedipine

Answer 28

gingival hyperplasia

Question 29

name an oral side effect of clonidine

Answer 29

salivary gland swelling

Question 30

name an oral side effect of diuretics

Answer 30

xerostomia

Question 31

name a dental complication of hypertension

Answer 31

increased post operative bleeding

Question 32

when is a pt's blood pressure too high for treatment in general practice?

Answer 32

160/110

Question 33

What organs are commonly affected by hypertension and how does this present?

Answer 33

Brain-stroke Eyes- retinal haemorrhages Aorta-aneurysm Kidney-renal failure Heart- MI, failure, left ventricular hypertrophy

Question 34

What is ischaemic heart disease?

Answer 34

An imbalance between supply of blood to the heart muscle and demand

Question 35

What % of males under the age of 60 have ischaemic heart disease?

Answer 35

>20

Question 36

What is the most common cause of IHD?

Answer 36

coronary atheroma

Question 37

Name 3 fixed risk factors of IHD

Answer 37

-age -male -family history

Question 38

Name 6 modifiable risk factors for IHD

Answer 38

-smoking -hypertension -diabetes -obesity / lack of exercise -alcohol -oral contraceptive

Question 39

Describe the pathogenesis of IHD

Answer 39

-formation of an atheromatous plaque within coronary arteries -this produces fixed constriction to blood flow -Endothelial lining is disrupted -thrombus formation occurs due to platelet adhesion -vessel lumen becomes narrowed

Question 40

What happens when an atheromatous plaque within an artery fissures?

Answer 40

An acute thrombus may form which can completely occlude the vessel leading to myocardial infarction

Question 41

Describe the composition of an atheromatous plaque which may form within an artery

Answer 41

Consists of a necrotic core containing cholesterol Surrounded by increased smooth muscle and fibrous tissue

Question 42

What are the clinical features of IHD?

Answer 42

-angina -breathlessness -nausea -sweating -pain in arm, neck or jaw

Question 43

How is diagnosis of IHD made?

Answer 43

-the patients history -ECG -coronary angiography -nuclear medicine scans of the myocardium

Question 44

What are the main aims when treating a pt with IHD?