hypertension, heart failure and cardiac arrhythmias Flashcards
(72 cards)
1
Q
what is hypertension
A
high blood pressure
2
Q
what is a major cause of hypertension
A
genes
- ties in slightly with gender and race
3
Q
what are the genes/environmetn interactions that can affect hypertension
A
race and gender
4
Q
what causes can you not do much about to reduce chance of hypertension
A
- genes
- race and gender
5
Q
what things can patients do to help reduce their risk of hypertension
A
- environmental factors
- in vast majority of patients this is all that needs changed
- inactivity
- stress
- obesity
- age
- salt
- alcohol
6
Q
what is normal blood pressure
A
120/80
7
Q
when do you call it hypertension
A
- once blood pressure reaches a certain threshold
- not just a one off measurement = do test 3 times
- hypertension when systolic = >140mmHg
- hypertension when diastolic = >90mmHg
8
Q
why is age a risk factor in hypertension
A
- as you age you bp rises
- the elasticity in you blood vessels decreases so pump pressure is higher
- but by itself age should not put you at risk
9
Q
what drugs can make you more at risk of hypertension
A
- some drugs can make hypertension more predictable
- non steroidal
- corticosteroids
- oral contraceptives
- sympathomimetics
10
Q
what is the outcome of hypertension
A
- at risk of a lot of CV diseases if you have high blood pressure
11
Q
what happens in cerebrovascular accident (CVA) if treat hypertension
A
reduces risk massively
12
Q
what happens in cardiovascular disease (CVD) if treat hypertension
A
doesn’t make much of a difference
- problem is hbp causes atherosclerosis and this still remains after treating hbp
13
Q
what happens to congestive heart failure if treat hypertension
A
decreases a lot
14
Q
what happens to renal damage if treat hypertension
A
decreases
15
Q
what happens to atherosclerosis if treat hypertension
A
- accelerated
- causes
= myocardial infarction
= stroke (bleed or atherosclerosis in carotid artery stroke)
= peripheral vascular disease
16
Q
what is a bleed stroke
A
vessel popped from too much pressure
17
Q
what can fail due to hypertension
A
renal system - get renal failure
18
Q
what are the causes of hypertension
A
- genes
- genetic/environment = race, gender
- environments = inactivity, stress, obesity, tobacco, age, salt and alcohol
19
Q
what are common triggers for hypertension
A
- none usually found
- have essential hypertension
20
Q
what is essential hypertension
A
- have no idea why it happens
- for a patient you can’t find the cause for disease
21
Q
what are rare triggers for hypertension
A
- renal artery stenosis
- endocrine tumours
22
Q
what is renal artery stenosis
A
- kidney arteries narrowed and blood flow reduced, kidney thinks bp has fallen and takes measures to try and improve bp = this compensation by the kidney makes it worse as it will make bp higher
- more likely in younger people as older people hypertension is more to do with inactivity
23
Q
what are some examples of endocrine tumours
A
- pheochromocytoma = adrenaline
- Crohn’s syndrome = aldosterone
- Cushing’s syndrome = cortisol
24
Q
what are the signs and symptoms of hypertension
A
- usually none
- may get headaches = more common in malignant hypertension
- may get transient ischaemic attacks (TIA’s)
25
what are TIA's
- mini strokes
- clot comes off and clocks vessel to the brain
- full neurological return in 24 hours = clot cleared like a normal clot
26
what are some indications for further investigations
- occurs in young patients
- resistant hypertension
- accelerated hypertension
- 'unusual' history
27
what is pheochromocytoma
tumour of adrenal gland that produces adrenaline
28
what is Cushing's syndrome
- too much cortisol
- absorb too much salt and water
- characteristics = personality changes, hyperglycaemia, moon face, CNS irritability, infections, oedema, fat deposits in face and back, thin skin, bruises, osteoporosis
29
what is renal artery stenosis
- one kidney is smaller as not had enough blood to grow properly
- get atherosclerosis in aorta = common at junction and renal arteries come off of aorta so occurs here
- causes narrowing of renal arteries so less blood to kidney so you get a small kidney and normal kidney
- small kidney is then also working at a higher pressure
30
what are the investigations for hypertension
- urinalysis = look at renal function
- serum biochemistry = electrolytes, lures and creatine; can be upset if you have a tendency to absorb more salt
- ECG
- occasionally = renal ultrasound, renal angiography and hormone estimations
31
what does it mean if you have serum lipids
atherosclerosis is high
32
how is hypertension treated
- aim of treatment is to bring blood pressure down to 120/90
- modify risk factors = try find reason patient can modify
- single daily drug dose
33
what is single daily drug dose
- people will remember to take drug once a day more than they will to take more
- great start
- better compliance
- beta blocker = doesn't stop the fact you can have vasoconstriction of vessels, can make asthma and COPD worse
- thiazide diuretic = can cause gout, start with this treatment for the elderly
- calcium channel antagonist
- ACE inhibitor = make PVD worse
34
what is heart failure a consequence of
hypertension
35
what is the role of the cardiorespiratory system
- ability of heart to give cardiac output into body necessary for the oxygen demands of the tissues
36
what is heart failure
- imbalance of needs of body and hearts ability
| - output of heart is incapable of meeting demands of the tissues
37
what are diseases caused by high output failure
- anaemia
| - thyrotoxicosis
38
what are diseases caused by low output failure
cardiac defect
- MI
- valve disease
39
what is left heart failure
- rare
- more commonly has problems as under more pressure
- means bp in lungs is raised and right side eventually too
40
what is right heart failure
- rare
- less common than left
- mainly follows left
41
what is another term for heart failure
congestive heart failure
42
what happens during systolic dysfunction
- diastole (filling) = enlarged ventricles fill with blood
| - systole (pumping) = ventricles pump out less than 40-50% of the blood
43
what happens during diastolic dysfunction
- diastole = stiff ventricles fill with less blood than normal
- systole = ventricles pump about 60% of blood, but amount may be lower than normal
44
what is the most common reason for heart failure
- pump not working
| - is more difficult pumping up rather than down as harder to pump against gravity
45
how do you cope with blood pressure fall
- increase blood vessel sympathetic tone
46
what happens once you start on cycle of heart failure
- just gets worse and worse
- compensation of body to help doesn't make it any better
- body assumes high bp is due to a haemorrhage and all mechanism to make it work try to fix haemorrhage but that's not the problem = this will put more fluid into pump but that makes it worse and raises bp even more
- causes oedema in pump and peripheral tissues
- go into spiral of heart failure
47
what is caused by heart muscle disease
- MI, myocarditis
| - diabetes, obesity
48
what is caused by pressure overload
- hypertension
| - aortic stenosis
49
what is caused by volume overload
- mitral incompetence
| - aortic incompetence
50
what is arrhythmias
- heart not in right rhythm so won't work
- atrial fibrillation
- heart block
51
what drugs can cause heart failure
- beta blockers
- corticosteroids
- anticancer drugs
52
what are the symptoms and signs of heart failure
- depends upon side of heart manly affected
- left heart not working
= lungs and systolic effects
= venous pressure builds up in the lungs causing fluid in lungs causing pulmonary oedema and breathlessness
= dyspnoea, tachycardia, low bp, low pulse
- right heart not working
= venous pressure elevated
= venous pressure build up in peripheral tissues
= swollen ankles, ascites, tender enlarged liver, poor GI absorption
53
what are the symptoms of heart failure overall
- shortness of breath
- swelling of feet and ankles = oedema, can cause pitting if pressed upon
- chronic lack of energy
- difficulty sleeping at night due to breathing problems = more HF means more pillows, may even sleep upright as can't lie flat
- swollen or tender abdomen with loss of appetite
- cough with frothy sputum
- increased urination at night
- confused and/or impaired memory
54
what is the treatment of heart failure
```
- acute = emergency hospital management
= oxygen, morphine, frusemide
- chronic = community based
= improve myocardial function
= where possible treat the cause
- treat any underlying causes = hypertension, valve disease, heart arhthymias, anaemia, hyoid disease
```
55
what is the drug therapy in chronic heart failure
- diuretics = increase salt and water loss, pee out extra fluid then get better quickly
- ACE inhibitor = reduce salt/water retention
- nitrates = reduce venous filling pressure
- inotropes = digoxin
56
what inotropes must you stop
- negative
| - these are beta blockers
57
what is a big problem with patients who've had an MI
- have a lack of muscle
| - needs treated
58
what is the most common problem to encounter with cardiac arrhythmias
fast
| - these people would have a heart beat of 160/170
59
what is a normal heart beat
60-100bpm
60
what is a fast arrhythmia
- tacky arrhythmia
- atrial fibrillation
- ventricular tachycardia
- problem = can only pump blood into coronary arteries during diastole but as you increase HR time in diastole reduces so less O2 going to coronary arteries so heart won't work
61
what is slow arrhythmia
- Brady arrhythmias
- heart block
- can be drug induced = beta blocker, digoxin
- less common
- can't conduct from atria to ventricle so rhythm maintain by pacemaker
- heart may only beat at 30bpm = if you stood up you wouldn't survive
62
what are pacemakers used for
treat Brady arrhythmias
| - increases slow HR
63
how do pacemakers work
- 2 wires
- 1 wire for seeing beat to check if its happening or not
- 1 wire to go into muscle that makes heart beat
- if HR drops then pacemakers kicks in to make HR back at set rate = keeps it at a minimum level
64
what is the theoretical risk of electrical interference in pacemakers
- electrical interference may cause pacemakers to stop working
- electrical fields = MRI, electrosurgery can't be done
- dental equipment are theoretically risk only = pulp tests are OK but avoid electromagnetic scalers
- can't got through airport scanners as risk of it stopping
65
how does an implanted pacemaker work
- wire going up through veins = goes through subclavian to vena cava then ventricles
- charge by putting something on skin surface and electromagnet charge it
66
what do you need to recognise in cardiac arrhythmias
- sinus rhythm
- asystole
- ventricular fibrillation
67
what do you need to know about in cardiac arrhythmias
- atrial fibrillation
| - myocardial infarction
68
what is the sinus rhythm
- P wave = atrial depolarisation
- QRS complex = ventricular depolarisation, narrow, signal moves very quickly, rapid conduction from AP node to muscle
- T wave = ventricular repolarisation
69
what is ventricular fibrillation
- unstable heart electrical activity
- heart attack, electrocution, long QT syndrome = made worse by some medicines, wolf-parkinson-white syndrome
- big spikes that are irregular
- different bits of muscle contracting at different times
- treat with defibrillates = implanted defibs used in high risk cases
- if no cardiac output then death follows
70
what is asystole
- wandering line, not flat line
| - but no rhythm = no output, heart not working
71
what is atrial fibrillation
- regularity of heartbeat gone = HB may still be 60bpm but it is irregular
- irregularly irregular heart beat
- treated with anticoagulants
72
what happens in a heart attack
- very irregular PQRST
