Hypertension and ACHD

Question 1

What is the first line treatment for hypertension?

This has 5 components.

Answer 1

Lifestyle changes

1. Salt restriction (5-6dg/day)
2. Reduce alcohol intake
3. Reduce weight (BMI 25)
4. Regular exercise
5. Smoking cessation

Question 2

List the 5 types of drugs used to treat hypertension.

Answer 2

1. Thiazide diuretics
2. Beta blockers
3. Calcium channel blockers
4. ACE inhibitors
5. Angiotensin receptor blockers

Question 3

Which 4 drugs can be used to treat hypertension with atrial fibrillation?

Answer 3

1. ARB
2. ACE inhibitors
3. Beta blockers
4. Non-dihydropiridine CCB

Question 4

Which 3 drugs should be used to treat hypertension in pregnancy?

Answer 4

1. Methyldopa
2. Beta blockers
3. CCB

Question 5

Which drug CANNOT be used to treat hypertension in heart failure?

Answer 5

Calcium channel blockers (will make heart failure worse)

Question 6

Which drug CANNOT be used to treat hypertension in peripheral vascular disease?

Answer 6

Beta blockers (they decrease peripheral circulation)

Question 7

How would you treat an acute hypertensive crisis?

Answer 7

Labetalol (IV)
Sodium nitroprusside (IV)

Question 8

What is primary/essential hypertension?

Answer 8

Hypertension with an unknown cause

Question 9

List 4 causes of secondary hypertension.

Answer 9

Renal/renovascular disease
Endocrine disease
Coarctation of the aorta
Iatrogenic

Question 10

List 5 examples of endocrine causes of secondary hypertension.

Answer 10

Phaeochromocytoma
Cushing's syndrome
Conn's syndrome
Acromegaly
Hypothyroidism

Question 11

List 2 examples of drugs which might cause secondary hypertension.

Answer 11

Hormonal/oral contraception

NSAIDs

Question 12

List 7 complications of hypertension.

Answer 12

Cerebrovascular disease (stroke)
Left ventricular hypertrophy
Heart failure
CAD (MI)
Peripheral vascular disease
Nephrosclerosis
Renal vascular disease

Question 13

Outline the 3 grades of hypertension.

Answer 13

Grade 1:
Systolic: 140-159
Diastolic: 90-99

Grade 2:
Systolic: 160-179
Diastolic: 100-109

Grade 3:
Systolic: 180+
Diastolic: 110+

Question 14

What are the 5 types of congenital heart defects that might be seen in adults?

Answer 14

Atrial septal defect (ASD)
Coarctation of aorta
Tetralogy of Fallot
Transposition of great arteries
Fontan circulation

Question 15

List 4 types of atrial septal defect.

How common is each one?

Answer 15

Secundum (75%)
Primum (15%)
Sinus venosus (10%)
Cor sinus (rare)

Question 16

What is a sinus venosus?

Answer 16

Atrial septal defect

Extra, small chamber before right atrium

Question 17

Describe the signs and symptoms of atrial septal defects. Consider:

a) Asymptomatic ASD (4)
b) Symptomatic ASD (3)

Answer 17

ASYMPTOMATIC:
Systolic ejection murmur
Abnormal ECG
Abnormal CXR
Incidental finding on echo

SYMPTOMATIC:
Dyspnoea
Stroke/embolism
Atrial fibrillation

Question 18

Describe the treatment of atrial septal defects. (2)

Answer 18

PERCUTANEOUS CLOSURE

• Only for secundum
• Stent used to close defect

SURGICAL CLOSURE
-Good prognosis if closure done before 25 yo

Question 19

Define coarctation of the aorta.

Answer 19

Congenital narrowing of a section of the aorta

Question 20

Describe the features of coarctation of aorta. (4)

Answer 20

May be long narrowing
May be discrete ridge of narrowing
May be before/after ductus arteriosus
May be before/after left subclavian artery

Question 21

Describe the clinical features of coarctation of the aorta. (6)

List 3 consequences of coarctation.

Answer 21

CLINICAL FEATURES:
Hypertension
Heart murmur (continuous or systolic)
Ejection click of mitral valve
Radio-femoral delay
Radial-radial delay
Rib notching on CXR

CONSEQUENCES:
Aortic aneurysm
Congestive heart failure
Premature CAD

Question 22

Describe the treatment of coarctation of the aorta. (3)

Answer 22

Patch aortoplasty
Balloon angioplasty
Bypass tube around narrowing

Question 23

List the 4 defining features of tetralogy of Fallot.

Answer 23

Pulmonary stenosis
Enlargement of right ventricle
Ventricular septal defect
Origin of aorta lies over septal defect

Question 24

Describe the treatment of tetralogy of Fallot. (2)

Answer 24

Systemic-pulmonary shunt

Complete repair

Question 25

List 3 different surgical methods of creating a systemic-pulmonary shunt in tetralogy of Fallot.

Answer 25

Blalock-Taussig procedure Waterston procedure Potts procedure

Question 26

Briefly describe the process of a complete repair of tetralogy of Fallot. (4)

Answer 26

1. Prior systemic-pulmonary shunt removed 2. Patch over ventricular septal defect 3. Resection of pulmonary obstruction 4. Transannular patch around the pulmonary valve annulus

Question 27

List 4 consequences of tetralogy of Fallot.

Answer 27

Increased risk of sudden death Broad QRS complex Atrial arrhythmias Pulmonary insufficiency

Question 28

Define "transposition of the great arteries".

Answer 28

congenital abnormality of the heart in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle Incompatible with life unless there is also a septal defect that permits the mixing of blood between the pulmonary and systemic circulations

Question 29

List 2 types of transposition of the great arteries.

Answer 29

D-type transposition (PA from the LV, aorta from the RV) L-type transpositions (PA arises from LV and aorta from RV, BUT ventricles are switched around which "corrects" the transposition)

Question 30

Describe treatment of D-type great artery transposition. (4)

Answer 30

Prostaglandins (in newborns) Balloon atrial septostomy Atrial switch (Mustard procedure) Arterial switch

Question 31

Describe complications of great artery transposition. Consider: a) D-type transposition (5) b) L-type transposition (4)

Answer 31

``` D-TYPE TRANSPOSITION Arrhythmias Sudden cardiac death Tricuspid valve regurgitation Right ventricular failure Baffle obstruction ``` ``` L-TYPE TRANSPOSITION Progressive heart failure Arrhythmias Sudden cardiac death Severe tricuspid regurgitation ```

Question 32

Define a surgical Fontan circulation.

Answer 32

Surgery correcting congenital abnormality so that there is: - only 1 ventricle - all other blood vessels go directly to the lungs

Question 33

List 4 indications for Fontan circulation surgery.

Answer 33

Tricuspid atresia Double inlet left ventricle Hypoplastic left heart Some variations of double outlet right ventricle

Question 34

List 5 complications of a Fontan procedure.

Answer 34

``` Arrhythmias Heart failure RA enlargement Thrombosis Polycytaemia ```