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24 Cards in this Set

  • Front
  • Back

What is the definition of hypertension?

DD hypertension

Anxiety Disorders

Apnea, Sleep


Congestive Heart Failure Hyperaldosteronism


Myocardial Infarction


Toxicity, Amphetamine, Phencyclidine

White coat

Pathogenesis of essential hypertension

No definable cause.

Structural changes in vessel walls > Hypertrophy of smooth muscles > Sub-endothelial thickening > BV narrow > decreased ciruclation to end organs > ischemic damage in end organs

Pathologic changes in hypertension

Arteriolar sclerosis (hardening)


LV hypertrophy (and evenutally dilatation)

Atherosclerosis becomes more sever


Symptoms of high BP

Mostly asymptomatic until complications develop


History of end organ damage (e.g. stroke, worsening memory, chest pain, dyspnoea, palpitations)

Hypertension investigations

Urinalysis, Albumin excretion, blood electrolytes, blood fats, glucose, ECG

drugs for hypertension


Ace Inhibitors

Beta blockers

Calcium channel blockers

Angiotensin II receptor blockers

Non-pharmacological methods to decrease hypertension

Weight reduction (BMI < 25)

Dietary salt reduction (<6 )

Decrease OH consumption

Physical activity

Common causes of treatment failure

Non-compliance (maybe due to side effects)

Inappropriate or low dosage

Other underlying cause

What does the right marginal artery supply?


ECG - 2, aVF

What does the left marginal artery supply?


ECG - 1, aVL, V5, V6

What does the posterior interventricular artery supply?

Rightand left ventricles and posterior third of IVS

ECG - 2, 3, aVF

What does the anterior interventricular artery supply?

Rightand left ventricles and anterior two thirds of IVS

ECG - V3,V4

Cardiac vs Non cardiac chest pain



Fixed stenosis. ­ O2 demand à ischemia of myocardium due to insufficient supply. Demand-led ischemia Related to effort Predictable Symptoms over long term Low-medium Symptoms on minimal exertion Exercise testing: duration of exercise, degree of ECG changes, abnormal BP response eӣ

Unstable angina

Dynamic stenosis. Narrowing of lumen changes (i.e. ruptured plaque) or dynamic obstruction (i.e. prinzmental angina – vessel spasm) à ¯ O2 Supply-led ischemia Symptoms at rest Unpredictable Symptoms over short term High (complete vessel occlusion à rapid progression to MI) Frequent or nocturnal symptoms ECG changes at rest or with symptoms Elevation of troponin ture

acutemanagement of chest pain

M - morphineO – oxygenA – aspirinN – nitrates

Investigations:· ECGBloods– troponin

Systolic heart failure

Heart cannot contract - increased EF

Caused by myocardial ischemia

Diostolic HF

Heart cannot relax - Increased EF

Casued by HTN

featuresseen on a chest X-ray that suggest a diagnosis of heart failure
A – Alveolaroedema (bat winging)

B – Kerley B lines(interstitial oedema)

C – Cardiomegaly(hypertrophy)

D – Dilation ofupper lobe vessels

E –Pleural effusion

Management of HF

Lifestyle - Diet, Exercise, maintence of other problems

ACE inhib + ARBs - Decrease mortality and morbidity

Beta blockers - Decrease mortality and morbidity


Diuretics - Fluid retention

Aldosterone antagonists - e.g. Spiralactone

Heart transplant

When to heart transplant

· Endstage heart disease· Exhaustionof all alternative Tx. options· Lifeexpectancy of min. 10yrs after transplantation with a reasonable prospect ofreturning to an active lifestyle after transplantationxl

Exclusioncriteria:· Complicateddiabetes· Morbidobesity· Uncontrolledinfection· Inabilityto comply with complex medical therapy – e.g. neurocognitive decline· Activesubstance abuse – incl. smoking and excessive alcohol· Irreversibledegeneration of other organ systems· Acutemedical conditions – need to be controlled before transplantation

Management of dyslipideima

Diet and exercise


Fibrates - increase trasncription of lipoprotein lipase

Ezetimibe - inhibit abs of cholestrol only

Nicotinic acid

Four Types of dietary carbs