Unit 6 - Cardiovascular system 5

Question 1

What monitoring needs to be carried out during hypertension treatment?

Answer 1

Monitoring BP following initiation of treatment using clinic measurements
- measure standing and sitting BP in people with
- type 2 diabetes
OR
- symptoms of postural hypotension
OR
- aged 80 or over
Advise people who want to self-monitor to use HBPM
- provide training and advice
ABPM and HBPM can be used in conjunction with clinic measurements in those who suffer from “white coat” or “masked” hypertension

Question 2

What is the target blood pressure for patients under 80 years old?

Answer 2

Clinic BP 140/90 mmHg

H/ABP 135/85 mmHg

Question 3

What is the target blood pressure for patients over 80 years old?

Answer 3

Clinic BP 150/90 mmHg

H/ABP 145/85 mmHg

Question 4

What are the classes of hypertension during pregnancy?

Answer 4

• chronic/pre-existing hypertension
• gestational hypertension
• pre-eclampsia
• severe pre-eclampsia

Question 5

Which antihypertensives are contraindicated in pregnancy?

Answer 5

• ACE inhibitors
• ARBs
• thiazide-like diuretics

Question 6

Which drugs are commonly used to lower blood pressure during pregnancy?

Answer 6

• labetalol

- nifedipine

Question 7

What is the target blood pressure for hypertension in pregnancy?

Answer 7

135/85 mmHg

Question 8

What is an atheroma?

Answer 8

Fatty plaque/deposit

Question 9

What is sclerosis?

Answer 9

is the stiffening of a tissue or anatomical feature

Question 10

What is the difference between artiosclerosis and atherosclerosis?

Answer 10

Arteriosclerosis is hardening and loss of elasticity WITHOUT the atheroma (plaque build up)

Question 11

What is the most common cause of occlusive vascular disease leading to stenosis and ultimately ischaemia in distal tissues?

Answer 11

Atherosclerosis

Question 12

Which vessels typically develop atherosclerosis?

Answer 12

Most often develops in larger and medium sized arteries

Question 13

How long does it take for atherosclerosis to develop?

Answer 13

Decades

Question 14

What are the consequences of atherosclerosis in coronary arteries?

Answer 14

Ischaemic heart disease
- angina
- stable
- unstable
Myocardial infarction
- NSTEMI
- STEMI

Question 15

What are the consequences of atherosclerosis in cerebral arteries and carotid arteries?

Answer 15

Cerebrovascular disease

• stroke
• transient ischaemic attack
• vascular dementia

Question 16

What are the consequences of atherosclerosis in renal arteries?

Answer 16

Renovascular disease

Question 17

What are the consequences of atherosclerosis in the aorta?

Answer 17

Aortic aneurysm

Question 18

What are the consequences of atherosclerosis in the vessels leading to the arms and legs?

Answer 18

• claudication

- peripheral gangrene

Question 19

What is the target of almost all CVD risk factors?

Answer 19

Endothelium

Question 20

What is one of the initiating factors in the development of atherosclerosis?

Answer 20

Endothelial dysfunction

Question 21

What signals endothelial dysfunction?

Answer 21

A defect in production in NO and subsequent impaired endothelium-dependent vasodilation

• increased endothelin (ET-1)
• increased ROS production

Question 22

What can predispose plaque build up?

Answer 22

Change in spacing of endothelial cells

Question 23

What is atherosclerosis?

Answer 23

Chronic inflammatory response of the arterial wall initiated by injury to the endothelium

Question 24

What can cause atherosclerosis?

Answer 24

An injury caused by the following risk factors

• hypertension
• hyperlipidaemia
• high LDL cholesterol
• an irritant
• nicotine
• certain diseases
• diabetes
• viral infection

Question 25

What is the progression of atheroma initiated by?

Answer 25

Response to injury/dysfunction of the intact endothelium

Question 26

What causes an inflammatory response and accumulation of leukocyte (monocyte) adhesion in the loosing endothelial junctions to form an atheroma?

Answer 26

Increased permeability and accumulation of oxidised LDL in the sub endothelial space

Question 27

What causes fatty streaks in the endothelium?

Answer 27

Monocytes differentiate into macrophages and engulf oxidised LDL by phagocytosis

• specialised foam cells formed
• oxidised LDL cannot be processed
• rupture
• fatty streak

Question 28

What is secreted by T-lymphocytes to induce smooth muscle cells to migrate from tunica media or tunica intima?

Answer 28

Cytokines

Question 29

What eventually happens to the artery when smooth muscle cells have migrated from the tunica media to the tunica intima?

Answer 29

• the artery becomes inflamed
• smooth muscle cells enlarge
• hard cover formed over the affected area
• fibrous cap forms to protect the lumen
• atheroma becomes calcified

Question 30

Where does a coronary atheroma develop?

Answer 30

Anywhere in major epicardial coronary arteries over several decades
- typically asymptomatic

Question 31

Where do coronary atheroma develop?

Answer 31

Often form at tortuosity and bifurcations where turbulent flow of blood
- endothelial shear stress is greater

Question 32

What is collateral vessel formation stimulated by?

Answer 32

Various growth factors upregulated in response to chronic or repetitive ischaemia
- a long term beneficial structural adaptation