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BDS2 BAMS > Hypertension, Heart Failure and Cardiac Arrhythmias > Flashcards

Hypertension, Heart Failure and Cardiac Arrhythmias Flashcards

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1
Q

what is hypertension

A

raised blood pressure

Systolic >140mm Hg
( > 160mm Hg in isolated systolic hypertension )
Diastolic > 90mm Hg
- Normal BP is 120/80

3 separate resting measurement and average

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2
Q

normal BP

A

120/80

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3
Q

is blood pressure constant

A

not a constant,
varies from person to person,
defined parameters where you would like the patient to lie

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4
Q

8 risk factors for hypertension

A

age

race

obesity

alcohol

family history

pregnancy

stress

drugs

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5
Q

how is age a risk factor for hypertension

A

Tends to rise with age as blood vessels get less elastic

Pulse pressure becomes higher, so systolic pressure rises (diastolic a little)

Age alone should not put you at risk – combination of factors

Risk factors change throughout life too

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6
Q

4 drugs that can increase risk of hypertension

A

Non steroidal
Corticosteroids
Oral contraceptives
Sympathomimetics

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7
Q

2 outcomes of hypertension

A

accelerated atherosclerosis
- can lead to Myocardial Infarction; Stroke; Peripheral Vascular disease

renal failure

risk of CV problems is proportional to BP
- treatment of HBP can reduce risk (except for coronary heart disease; atherosclerosis stays after treatment)

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8
Q

3 main influences on hypertension

A

environment
(inactivity, stress, obesity, tobacco, age, salt, alcohol)

gene/environment interactions

genes

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9
Q

common triggers for hypertension

A

none

this is essential hypertension
- can’t find source

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10
Q

essential hypertension

A

no triggers found

common

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11
Q

2 rare triggers for hypertension

A

renal artery stenosis

endocrine tumours

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12
Q

renal artery stenosis and how that can cause hypertension

A

Kidney helps alter BP

Kidney is maldiffused due to blockage (damaged vessels – narrow, weaken or harden)
- Thinks BP has dropped due to HBP lowering flow through in kidney, so then tries to retain salt and water = worsen HBP = worse kidney problems

Renal arteries of aorta at right angles – common area for atherosclerosis – can cause narrowing of artery so less blood flow in

can be congenital issue

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13
Q

3 endocrine tumours that can cause hypertension

A

Phaeochromocytoma (Adrenaline)

  • Tumour of adrenal gland
  • Adrenal gland sits on top of kidney

Crohn’s Syndrome (aldosterone)

Cushing’s Syndrome (cortisol)
- Tumour causing excess cortisol – so retaining too much salt and water

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14
Q

signs and symptoms of hypertension

A

Usually NONE

May get headache
- More common in ‘malignant hypertension’

May get Transient Ischaemic Attacks
- TIA’s are ‘mini strokes’ due to atherosclerosis caused by HBP – can be warning of HBP
Full neurological return in 24hrs

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15
Q

4 indications for further investigation

A

young patient

resistant hypertension

accelerated hypertension

‘unusual history’

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16
Q

5 investigations for hypertension

A

Urinalysis
- Biochemistry can be upset due to changes in absorption

Serum Biochemistry
- (electrolytes, urea & creatinine)

Serum Lipids

ECG
- occasionally

renal ultrasound, renal angiography, hormone estimations
- (need indication to do them)

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17
Q

aim of treatment for hypertension

A

BP < 120/90 mm Hg (aim for 140/90 otherwise no benefit of medicine)

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18
Q

treatments for hypertension

A

Modify risk factors

Single daily drug dose (higher compliance)

  • thiazide diuretic
  • beta blocker ; lower heart rate and cardiac output but may not help vasoconstrictors – poor evidence but still use
  • Calcium Channel antagonist
  • ACE inhibitor
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19
Q

4 single daily drugs used to treat hypertension

A
  • thiazide diuretic
  • beta blocker ; lower heart rate and cardiac output but may not help vasoconstrictors – poor evidence but still use
  • Calcium Channel antagonist
  • ACE inhibitor
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20
Q

side effect of thiazide diuretic

A

gout

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21
Q

side effect of beta blocker

A

COPD and asthma

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22
Q

side effect of ACE inhibitor

A

PVD

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23
Q

what drugs should be used in younger hypertension patients

A

Lower risk with beta blocker and ACE inhibitor for younger

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24
Q

what drugs should be used in older hypertension patients

A

thiazide diuretic and calcium channel blockers (less chance of being affected by long term side effects)

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25
what is heart failure
ability of heart to make a CO necessary for its function is compromised - cannot meet oxygen demands of tissues imbalance between body needs and ability of heart to delliver
26
2 types of heart failure
high output failure low output failure
27
2 causes of high output heart failure
anaemia - less RBC, can no longer HR to meet oxygen demand thyrotoxicosis
28
what type of heart failure is commonest
low output failure body’s demand is roughly the same but unable to pump as effectively
29
causes of low output heart failure
cardiac defect e.g. MI, valve disease
30
left heart failure
More chance of failure due to increase pressure and workload
31
right heart failure
can happen in isolation (MI or issue with lungs meaning harder to pump)
32
congestive heart failure
high pressure in lungs knock on left side as more to pump which then means right has to work more to pump into the lungs - both sides effected
33
does left or right heart failure happen in isolation usually
no
34
how can ventricle failure lead to heart disease
``` failure of ventricle, CO fall, BP fall, increase in blood vessel constriction, increase aldosterone – inc in BP and inc in constriction, ``` reduce CO causing circle to go round again as lower BP cycle gets worse and worse and worse – repeated cycles lead to heart failure brain assumes loss of BP is haemorrhage – increase fluid levels and platelets in body but pump failure is the issue – builds up pressure – leads to pulmonary oedema and oedema swelling
35
what is a simplified way to explain the commonest cause of heart failure
pump stops pumping around system – commonest issue | - certain areas easier to deliver oxygen over others
36
aetiology of low output failure (5)
Heart Muscle disease - MI, Myocarditis - (diabetes, obesity) Pressure Overload - Hypertension – more through = more likely to fail - aortic stenosis Volume Overload - mitral incompetence - Aortic incompetence Arrythmias - Atrial fibrillation - Heart Block Drugs - beta blockers - used to manage heart attacks, less likely to have arrhythmia (combine with cardiac muscle issue leads to heart failure) - corticosteroids - anticancer drugs
37
heart muscle diseases lead to low output failure
MI, mycarditis | diabetes, obesity
38
how does pressure overload lead to low output failure
Hypertension – more through = more likely to fail aortic stenosis
39
how does volume overload lead to low output failure
mitral incompetence Aortic incompetence
40
how does arrhythmia lead to low output failure
- Atrial fibrillation | - Heart Block
41
what 3 drugs can lead to low output failure
beta blockers corticosteroids anticancer drugs
42
how can beta blockers lead to low output failure
sed to manage heart attacks, | less likely to have arrhythmia (combine with cardiac muscle issue leads to heart failure)
43
flagpost symptoms of heart failure
shortness of breath swelling of feet and legs chronic lack of energy difficulty sleeping at night due to breathing problems swollen or tender abdomen with loss of appetite (ascites) - due to right side failure and venous pooling cough with frothy sputum increased urination at night confusion and/or impaired memory
44
how can heart failure cause difficulty sleeping at night
breathing problems usually sleep propped up – lie down get breathless (left failure causing pulmonary oedema
45
how do the symptoms and signs of heart failure change
depend upon 'side' mainly affected
46
left heart failure symptoms and signs
dyspnoea, tachycardia, low BP, low vol. Pulse, pulmonary oedmea (venous pressure building up on left side - lungs & systolic effects, fluid in lungs)
47
right heart failure symptoms and signs
swollen ankles (both affected) - pitting oedema ascites, raised JVP, tender enlarged liver, poor GI absorption (venous pressure elevated)
48
ascites
abnormal buildup of fluid in the abdomen swollen or tender abdomen with loss of appetite - due to right side failure and venous pooling
49
JVP
vertical distance between the highest point at which pulsation of the jugular vein can be seen and the sternal angle.
50
what can impact the signs and symptoms of heart failure
how the patient is positioned
51
acute treatment of heart failure
emergency hospital management Oxygen, morphine, frusemide (diuretic)
52
chronic treatment of heart failure
community based (most of the time) - improve myocardial function - reduce ‘compensation’ effects - where possible treat the cause
53
appearance acute heart failure on an X-ray
white area is fluid - larger than in health (less air in lungs) Heart width bigger – muscle problem, more flabby, poor contraction
54
4 underlying causes of heart failure you may treat
hypertension valve disease heart arrhythmias (atrial fibrillation) thyroid disease
55
4 drug therapies for chronic heart failure
Diuretics - increase salt and water loss ACE inhibitor - reduce salt/water retention, and reduce some compensation (hypertension) Nitrates - reduce venous filling pressure Inotropes - digoxin - work to make the heart more efficient - STOP negative inotropes - beta blockers! (make it worse)
56
tachy arrhythmias are
FAST commonest, 160-170 not 60-70, - can only move blood into coronary arteries during diastole so issue as increase HR the amount of diastole time shortens – reduces coronary artery flow, more likely to have MI
57
2 types of tachy arrhythmias
atrial fibrillation | ventricular tachycardia
58
brady arrhythmia are
SLOW less common, rhythm maintained by pacemaker, basal heart rate is 30bpm without – cannot stand
59
2 types of brady arrhythmia
- heart block | - drug induced (beta blocker, digoxin)
60
cardiac pacemakers
Electronic boxes used to treat BRADYARRHYTHMIAs Keep heart rate at a minimum level. Beats at a set rate.
61
risk with cardiac pacemakers
theoretical risk of electrical interference (as looking for very small electrical heart signals) - electrical fields - MRI, electrosurgery/diathermy - dental equipment THEORETICAL risk only (some electrical scalers) - Pulp Testers OK - avoid INDUCTION scalers
62
how an cardiac pacemaker works
Wire to see if heartbeat, and a wire to make cardiac muscle beat if no beat - Sit and do nothing if happy level of beats, will kick in if HR drops e.g. due to blockage Wire up through subclavian into superior vena cava and into right ventricle – sensing how often ventricle contracting compares against programme normal
63
when are cardiac pacemakers used
to treat bradyarrhythmias | - kick in if HR drops
64
sinus rhytm
PQRST wave P wave – atrial depolarisation QRS complex – Ventricular depolarisation - Narrow signals move quickly - Size of spike on size of muscle - Width of spike depends on conduction T wave – Ventricular repolarisation
65
ventricular fibrillation appearance on graph
Big broad irregular spikes – different bits conducting at different times
66
ventricular fibrillation is
Unstable heart electrical activity - Heart attack - Electrocution - Long QT syndrome (can be worsened by medicines) - Wolf-Parkinson-White syndrome No cardiac output - Death follows! Treat with ‘Defibrillation’ - Implanted defibrillators used in risk cases
67
consequence of ventricular fibrilllation
No cardiac output - Death follows! Treat with ‘Defibrillation’ - Implanted defibrillators used in risk cases
68
asystole is
Lack of any electrical activity Wandering line - Not flat line (not plugged in correctly)
69
atrial fibrillation appearance on graph
Appears normal but no P wave | - Regularity of heartbeat gone QRS is irregularly spaced
70
asystole appearance on graph
Wandering line | - Not flat line (not plugged in correctly)
71
atrial fibrillation is
Irregularly irregular heartbeat - Regularity of heartbeat gone (QRS is irregularly spaced) Common – managed with anticoagulants As can develop blood clots in atria and lead to stroke
72
how is atrial fibrillation managed
managed with anticoagulants | - As can develop blood clots in atria and lead to stroke
73
graph of heart attack
ST elevation

BDS2 BAMS (54 decks)

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