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24 Cards in this Set

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What is the definition of hypertension?

DD hypertension

Anxiety Disorders

Apnea, Sleep


Cardiomyopathy


Congestive Heart Failure Hyperaldosteronism


Hyperthyroidism


Myocardial Infarction


Stroke


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)


Nephrosclerosis


LV hypertrophy (and evenutally dilatation)


Atherosclerosis becomes more sever


Aneurysms



Symptoms of high BP

Mostly asymptomatic until complications develop




Headache


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

Diuretics


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?

RV




ECG - 2, aVF

What does the left marginal artery supply?

LV




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

                              

stableangina

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


Digoxin


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




Statins


Fibrates - increase trasncription of lipoprotein lipase


Ezetimibe - inhibit abs of cholestrol only


Nicotinic acid

Four Types of dietary carbs