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CARDIOLOGY - RIA > HYPERTENSION > Flashcards

HYPERTENSION Flashcards

1
Q

How do you use ABPM to confirm the diagnosis of HTN?

A

take at least 2 measurements every hour during the persons waking hours, and use the average of at least 14 measurements

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2
Q

How is HBPM used to confirm the diagnosis of HTN?

A

For each blood pressure recording, 2 measurements are taken with at least 1 minute between them.
Blood pressure is recorded twice a day; once in the morning and once in the evening
Recordings over at least 4 days (ideally 7)
Discard readings from 1st day + calculate average from remaining.

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3
Q

What values constitute STAGE 1/MILD HTN?

A

systolic; 135-149

diastolic; 85-94

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4
Q

What values constitute STAGE 2/MODERATE HTN?

A

sytolic; 150-179

diastolic; 95-119

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5
Q

What values constitute STAGE 3/SEVERE HTN?

A

systolic; > 180

diastolic; > 120

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6
Q

What values constitute ISOLATED SYSTOLIC HTN?

A

systolic; > 140

diastolic; <90

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7
Q

how is HYPERTENSIVE URGENCY defined?

A
  • no target organ damage
  • systolic > 180
  • diastolic > 110
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8
Q

what are the symptoms of hypertensive urgency?

A

headache, shortness of breath, nosebleed, severe anxiety

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9
Q

how is HYPTERTENSIVE EMERGENCY defined?

A
  • systolic > 180
  • diastolic > 120
  • target organ damage
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10
Q

what are some of the symptoms of a Hypertensive emergency?

A

chest pain, shortness of breath, back pain, headache, visual changes, difficultly speaking, numbness

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11
Q

what is the management for hypertensive emergency?

A
  • IV labetolol
  • IV nitroglycerin
  • and managed in ITU for close monitoring
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12
Q

what is the clinical use of ADRENALINE + why?

A

Anaphylactic shock + cardiogenic shock + cardiac arrest.

Stimulation of both alpha- and beta- adrenergic systems; causing systemic vasoconstritction (a), increase HR (B1) and bronchodilation (B2)

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13
Q

what is the clinical use of NORADRENALINE?

A

Severe hypotension + septic shock

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14
Q

what is the clinical use of DOPAMINE? and why?

A

Acute heart failure + cardiogenic shock

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15
Q

what is the clinical use of DOBUTAMINE?

A

Acute heart failure + cardiogenic shock + refractory heart failure

It is a sympathetic drug that directly stimulates the B1 receptors.

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16
Q

what are chemoreceptors sensitive to?

A

high Co2 + O2 + acidosis

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17
Q

name 5 medications that can cause a rise in blood pressure.

A
  • oral contraceptive pill
  • calcineurin inhibitors
  • steroids
  • nsaids
  • antidepressants
  • stimulants e.g. cocaine
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18
Q

what endocrine disorder is suspected with; unexplained hypokalaemia w/ urinary K+ wasting

A

PRIMARY HYPERALDOSTERONISM

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19
Q

name 4 characteristics of cushing’s disease.

A
  • ecchymoses
  • central obesity
  • moon shaped/cushingoid facies
  • proximal muscle weakness
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20
Q

list endocrine tumours that could be a cause of secondary hypertension.

A
  • phaechromocytoma
  • primary hyperaldosteronism
  • conns
  • cushings
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21
Q

what is a neuroendocrine tumour of the chromaffin cells of the adrenal gland?

A

PHAECHROMOCYTOMA

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22
Q

what are the triad of symptoms that present with PHAECHROMOCYTOMA, and what hormone is this due to?

A
  • pounding headache
  • palpitations
  • sweating

noradrenaline + adrenaline

23
Q

what is the management of PHAECHROMOCYTOMA?

A
  • propranolol

- phenoxybenzamine (alpha blocker)

24
Q

what are the 3 primary causes of PRIMARY HYPERALDOSTERONISM?

A
  • familial
  • idiopathic
  • conns
25
Q

what is the pathology behind FAMILIAL HYPERALDOSTERONISM?

A

Pituitary gland releases adrenocorticotropic hormone which stimulated the adrenal gland leading to high aldosterone level

26
Q

what is the pathology behind CONNS SYNDROME?

A

Adenoma on adrenal gland

27
Q

what is the pathology behind IDIOPATHIC HYPERALDOSTERONISM?

A

tumour of the zona glomerulosa of the adrenal gland leading to high aldosterone secretion

28
Q

what is a secondary cause of PRIMARY HYPERALDOSTERONISM?

A

Cirrhosis/HF lead to fluid overload which leads to low perfusion of kidneys causing renin stimulation –> aldosterone stimulation

29
Q

what is the treatment for PRIMARY HYPERALDOSTERONISM?

A
  • K+ sparing diuretics; SPIRONOLACTONE

- Surgical removal if due to conns tumour

30
Q

how does spironolactone work in treating primary hyperaldosteronism?

A

aldosterone antagonist in DCT

31
Q

what is FIBROMUSCULAR DYSPLASIA?

A

appearance caused by areas of stenosis alternating with small aneurysms in renal blood vessels

32
Q

what is the BLOOD PRESSURE aim for a diabetic?

A

< 130 / 80 mmHg

33
Q

what is BLOOD PRESSURE aim for elderly ( > 80 years) ?

A

< 150 / 90 mmHg

34
Q

what is BLOOD PRESSURE aim?

A

< 140 / 90 mmHg

35
Q

mechanism of spironolactone

A

blocks the action of aldosterone in the kidneys resulting in Na excretion and K+ reabsorption

36
Q

management of stage 1 HTN in non black and < 55 years

A

ACEi or ARB

37
Q

management of stage 1 HTN in black and aged < 55 years

A

Calcium channel blocker

38
Q

step 3 management of HTN

A

ACEi/ARB & CCB & thiazide like diuretic

39
Q

symptoms of malignant hypertension

A

visual disturbances, headaches

40
Q

BP in malignant HTN

A

< 200 systolic
or
> 130 diastolic

41
Q

fundoscopy findings in malignant HTN

A
  • retinal haemorrhages
  • retinal exudates
  • papilloedema
42
Q

LVH signs on ECG

A
  • increased R wave amp in lead I, aVL, V4-6

- increased S wave depth in lead III, aVR, V1-3

43
Q

heart related complications from HTN

A
  • LVH

- IHD w/ or w/o/ HF

44
Q

4 signs of hypertensive retinopathy

A
  • hard exudates
  • flame haemorrhages
  • papilloedema
  • cotton wool spots
45
Q

string of beads appearance of renal vessels due to…

A

areas of stenosis alternating with small aneurysms

called: fibromuscular dysplasia

46
Q

clinical use of adrenaline

A
  • anaphylactic shock
  • cardiogenic shock
  • cardiac arrest
47
Q

clinical use of noradrenaline

A
  • severe hypotension

- septic shock

48
Q

clinical use of dopamine

A
  • acute heart failure

- cardiogenic shock

49
Q

clinical use of dobutamine

A
  • acute heart failure
  • cardiogenic shock
  • refractory heart failure
50
Q

hypokalaemic alkalosis

A

primary hyperaldosteronism

51
Q

name 3 symptoms of low potassium

A
  • muscle cramping
  • palpitations
  • cramping
52
Q

name 2 causes of primary hyperaldosteronism

A

Conns syndrome - unilateral aldosterone producing adenoma

bilateral adrenal hyperplasia

53
Q

electrolyte findings in addisons

A

low sodium

high potassium

54
Q

4 groups of medications that can cause hypertension (4)

A
  • combined contraceptive pill
  • NSAIDs
  • calcineurin inhibitors e.g. cyclophosphamide
  • antidepressants

CARDIOLOGY - RIA (8 decks)

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