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CP3 SURGERY > Vascular - HTN, Hyperlipidaemia, Aneurysm + Dissection > Flashcards

Vascular - HTN, Hyperlipidaemia, Aneurysm + Dissection Flashcards

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1
Q

If the lowest BP meausrement in clinical if >140/90, what is the next step?

A

Offer ABPM to confirm diagnosis

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2
Q

How is ABPM done

A

2 measurements per hour taken, average reading used

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3
Q

Stage 1 HTN

A

Clinic BP >140/90

ABPM >135/85

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4
Q

Stage 2 HTN

A

Clinic BP >160/100

ABPM >150/95

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5
Q

Stage 3 HTN

A

SBP >180

Or DBP >110

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6
Q

What % of adults have HTN

A

20-30%

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7
Q

What % of adults have isolated systolic HTN

A

> 50% of >60s

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8
Q

What does isolated systolic HTN double the risk of

A

MI

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9
Q

What % of HTN is1’

A

95%

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10
Q

2’ causes of HTN (7)

A 
Adrenal cortical disease 
RAS
CKD
Pheochromocytoma 
CoA
Neurogenic causes - incr ICP
Pregnancy
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11
Q

Def benign HTN

A

Gradual elevation of BP over years

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12
Q

Pathology of benign HTN

A

Gradual hypertrophy of mm media in aa walls –> reduced capacity to expand + incr fragility

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13
Q

Def malignant HTN

A

rapid sustained increase in BP

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14
Q

Pathology of malignant HTN

A

intimal proliferation, reducing luminal size

–> cessation of blood flow through small vessels

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15
Q

UnTx malignant HTN 1y mortality

A

20%

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16
Q

How is malignant HTN diagnosed

A

SBP >200 or DBP ?120 + bilateral retinal haemorrhages/exudates
+/- Papilloedema

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17
Q

pathological consequences HTN - Heart

A

LVH + dilation –> eventual failure

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18
Q

Pathological consequences HTN - aorta

A

AAA

aortic dissection

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19
Q

Patholgical consquences HTN - brain

A

Intracerebral haemorrhage

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20
Q

Pathological consequences HTN - kidney

A

CKD

Glomerular destruction

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21
Q

Pathological consequences HTN - eyes

A

HTN retinopathy

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22
Q

Ix HTN to assess for 2’ causes/complications (8)

A 
Urine dip (renal damage)
ECG - LVH
Echo - LVF
RAS - Renal aa doppler 
CKD - U+E eGFR
PCC - 3x 24h urine collection - metadrenaline/normetadrenaline 
HbA1c
Lipids
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23
Q

Who do you start on Anti-HTN meds

A

all stage 2 HTN
Stage 1 HTN + <80 + 1 of:
10y CV risk >20%
Or co-morbidities

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24
Q

Target BP HTN after Mx

A

<140/90

or <150 if >80

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25
Target ABPM HTN after Mx
<135/85 | <145 if >80
26
What is 1' hyperlipidaemic due to
Genetic predispositoin to abnormal lipid metabolism
27
Wha t is 2' hyperlipidaemia due to
Metabolic disturbance
28
Target total cholesterol
<5mM
29
Target LDL
<3mM
30
What are high levels of HDLs protective against
Atheroma
31
What is the QRISK calculator
Collates information on RF to estimate a 10y risk of MI/stroke
32
1st line Mx hyperlipidaemia
lifestyle
33
When to start statins for hyperlipidaemia
If lifestyle mods showing no affect
34
Mechanism of action statins
HMG CoA reductase inhibitors Stop 1st step cholesterol synthesis + Incr LDL receptor expression by hepatocytes --> decr LDL levels
35
When to take statins
At night
36
Common SE statins (3)
Nausea Headache Mm pains
37
Which drugs does statins interact w/
Cytochrome P450 pathway ones
38
What should be monitored whilst on statins
LFTs
39
Rare SE statins
Rhabdomyolysis
40
E.g.s of fibrates (2)
Bezafibrate | Gemofibrozil
41
Mechanism of action fibrates
PPAR alpha activators --> reduced triglycerides
42
What dangerous SE can fibrates in combo w/ statins cause
Rhabdomyolysis
43
Def Atherosclerosis
Inflammatory process involving the intima of large and med aa in systemic circulation
44
RF atherosclerosis (13)
``` Age Diet M Obesity DM HTN Hyperlipidaemia Low birth weight Type A personality Stress Lack of exercise Smoking Alcohol ```
45
Where does atheroma commonly occur
Aortic bifurcation Branch points Around ostia Sites of haemodynamic stress
46
What are Ostia
Funnel-shaped openings | Esepcially in abdo aorta near the kidneys
47
Clinical complications of atheroma (5)
``` Stenosis aa --> hypoperfusion Thrombus --> tot occlusion Bleeding into plaque Aneurysm Cholesterol embolism ```
48
Mx Atheroma
``` Antiplatelet agents (reduce risk complications) Modify RF ```
49
Mx atheroma if HTN
ACEi = 1st line | Bblocker/CCB/Diuretic
50
Mx atheroma if hyperlipidaemia
Statins
51
Mx atheroma if diabetic
Lifestyle +/- metformin +/- insulin
52
Def aneurysm
Focal dilation of an aa >150% its norm d
53
Way in which an aneurysm can present
Mass effects - P - neuro Sx (blurred vision/headaches) Embolic events Haemorrhagic effects - rupture
54
Causes Aneurysm (ADD IT)
``` Atherosclerotic - aortic/popliteal Developmental - Berry/Marfans/Ehlers Danlos Dissecting - Marfans/HTN Infection - endocarditis/syphillis Trauma ```
55
Def AAA
Dilations of abdo aorta ?3cm
56
What % of M >60 have AAA
5%
57
What is the screening programme for AAA in the UK
USS offered to M at age 65
58
PS - AAA rupture (4)
Severe continuous epigastric pain Radiating to the back Expansile abdominal mass Signs of shock
59
Who should AAA be suspected in?
Any male >50 PS w/ renal colic
60
Mx AAA
Emergency A-E resus | --> Theatre ASAP
61
Unruptured AAA Mx if <5.5cm
Monitor reg USS/CT | Modify RF
62
What % of monitored AAA will req surgery
75%
63
Indications AAA surgery (3)
If >6cm If expanding >1cm yr Symptomatic
64
What is EVAR
Endovascular aneurysm repair | Uses femoral aa to access + stent aorta under fluoroscopic guidance
65
Why is re-intervention sometimes needed w/ EVAR
Endoleaks
66
What % of pt w/ AAA have a popliteal aneurysm
10%
67
PS popliteal aneurysm
``` Asymp Or complicaations: Acute limb ischaemia Chronic limb ischaemia DVT ```
68
Ix popliteal aneurysm
USS (determine size) | Angiography (prior to surgery)
69
Mx popliteal aneuyrsm
Femoral-distal popliteal bypass graft
70
Def true aneurysm
All layers of aa wall are involved
71
Def false aneurysm/pseudoaneurysm
Surrounding soft tissues = lined by thrombus from wall of aneurysm
72
Cause of false aneurysm
trauma
73
Pathology - aortic dissection
Tear in intima --> blood tracking into media | Aa media splits --> force channel
74
Outcomes aortic dissection (3)
External rupture --> massive fatal haemorrhage Internal rupture --> double-chanelled aorta Cardiac tamponade
75
2 type of aortic dissection
Type A - involving ascending aorta (prox LSCA) | Type B - doesn't involve ascending aorta (distal to LSCA)
76
Ix aortic dissection
CXR - widened mediastinum CT - confirm diagnosis ECG - similar to MI
77
Complications aortic dissection - coronary aa
MI
78
Complications aortic dissection - brachicephalic trunk
Unequal arm pulses + central neuro Sx
79
Complications aortic dissection - renal aa
Haematuria Anuria AKI
80
Complications aortic dissection - SMA/IMA
Acute mesenteric ischaemia
81
Complications aortic dissection - iliac aa
Acute LL ischaemia

CP3 SURGERY (19 decks)

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