Valvular disease Flashcards
(71 cards)
When should you repeat BP readings and what should you do if that criteria remains
Repeat measurements if difference in readings between arms in >15mmHg
If the difference in readings between arms remains more than 15 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading
Define malignant hypertension
BP ≥ 200/130 mmHg
What are the 3 stages of hypertension
Stage 1 Hypertension: 140/90 to 159/99 mmHg
Stage 2 Hypertension: 160/100 to 179/119 mmHg
Stage 3 Hypertension: sBP ≥ 180 mmHg or dBP ≥ 120 mmHg
Who should you offer ABPM to
People with clinic blood pressure of 140/90 mmHg or higher
What do you do to confirm hypertension (2 criteria)
clinic blood pressure of 140/90 mmHg or higher and
ABPM daytime average or HBPM average of 135/85 mmHg or higher
What are the investigations for target organ damage (8)
Proteinuria – estimation of albumin:creatinine ratio (ACR) + test haematuria Glycated haemoglobin (HbA1C) Electrolytes Creatinine eGFR Total cholesterol and HDL cholesterol Fundi (hypertensive retinopathy) 12-lead ECG
Endocrine causes of hypertension (8)
Diabetes, hyperthyroidism, Cushing’s, Conn’s, hyperparathyroidism, phaeochromocytoma, Congenital Adrenal Hyperplasia, Acromegaly
Renal causes of hypertension (5)
Renal artery stenosis
Chronic glomerulonephritis, pyelonephritis
Polycystic kidney disease
Renal failure
Cardio causes of hypertension (2)
Coarctation of the aortaIncreased intravascular volume
Drugs that cause hypertension (3)
Sympathomimetics, corticosteroids, oral contraceptives
Pregnancy cause of hypertension
Pre-eclampsia
Causes of hypertension due to raised instravascular volume (3)
heart failure, liver failure, nephrotic syndrome
What abnormal heart sounds can you hear in hypertension (2)
may hear loud S2, S4
Mx of hypertension (think of the populations, also there is 4 stages)
HT diabetes or under 55 and not black ACEi or ARB then ACEi or ARB and CCB or thiazide-like diuretic then all all
Age 55 or black without diabetes CCB then CCB + ARB/ACEi or thiazide-like diuretic then all 4
Stage 4 os confirm resistant hypertension, seek help, or add spironolactone/alpha/beta blocker
Example of CCB (2)
Amlodipine
Verapamil
Common S.E. of ACEi (3)
Cough
High potassium
Increased creatinine
Common S.E. of CCBs (1)
Oedema
Common S.E. of BB (1)
Dizziness
Common S.E. of diuretics (3)
Dry mouth
Thirst
Low potassium levels
Common S.E. of alpha-blockers (1)
Dizziness
BP targets (clinic and home, for the two demographics)
<80 years
Clinic <140/90 mmHg
Home <135/85 mmHg
> 80 years
Clinic <150/90 mmHg
Home <145/85 mmHg
What is losartan
An AT2R antagonist
What causes the second heart sound
Thefirst heart sound(S1) is caused by the closing of theatrioventricular valves(thetricuspidandmitral valves) at the start of thesystolic contractionof theventricles
What causes normal physiological splitting of S2
inspiration lowers intrathoracic pressure, increasing the compliance of the pulmonary vascular bed, and augmenting right heart filling. Right ventricular systole is lengthened as a result, causing the pulmonic valve to close after the aortic valve, resulting in splitting of the second sound at 3LICS or 4LICS.
