Untitled | Flashcards

Question	Answer
primary hypertension is more common than secondary hypertension - true or false?	TRUE
there is often an underlying disease process in secondary hypertension - true or false?	TRUE
secondary hypertension can be reversed by....	treating the underlying causes
malignant hypertension is manifested by intense artery spasm - true or false?	TRUE
what are the impacts of malignant hypertension on the eye, brain and kidney?	EYES - may show retinal haemorrhage or exudate. WILL show papilledema. BRAIN - increased intracranial pressure - headache, vomiting, subarachnoid and cerebral haemorrhage. KIDNEYS - haematuria, proteinuria and acute renal failure
clinical manifestations often appear early in hypertensive patients - true or false?	FALSE
low stroke volume can be caused by which types of shock?	hypovolaemic, obstructive, cardiogenic
which types of shock cause vasodilation?	septic, anaphylactic and neurogenic
what are the clinical manifestations of non-progressive shock?	sympathetic nervous system activation - cerebral ischaemia, ('faintness'), tachycardia, sweating, anxiety, pale, cool limbs, decreased urine output, increased thirst, increased respiratory rate
in progressive shock, blood pressure can be maintained - true or false?	TRUE - with appropriate medical intervention. if untreated will progress to irreversible shock
in irreversible shock, tachycardia may lead to cardiac arrest - true or false?	TRUE
urine output is usually decreased in shock patients - true or false?	TRUE
what is stenosis?	narrowing
what is regurgitation?	valvular regurgitation is when valves will neither open or close completely, allowing backflow of blood
what are the complications of mitral valve stenosis?	flow resistance increases, left atrial pressure increases, eventually causing pulmonary congestion and palpitations, angina, weakness, atrial fibrillation and paroxysmal nocturnal dyspnoea
heart murmur occuring after S2 is typical of....	aortic regurgitation
aortic valve stenosis can lead to a decrease in systolic pressure, long term angina, syncope and dyspnoea - true or false?	TRUE
aortic valve regurgitation can lead to..	pulmonary oedema
artificial pacemakers are usually used for...	bradycardia
atherosclerosis is a progressive disease characterised by...	narrowing of the arteries caused by formation of fatty plaque that hardens over time causing a decrease in blood flow
in the atherosclerotic necrosis core, the accumulation of cholesterol crystals in the macrophages forms ....	foam cells
angina is chest pain due to ischaemia, caused by what?	atheroscelerosis, vasospasm or thrombosis
myocardial infarction is...	irreversible myocardial injury resulting in necrosis of a significant portion of myocardium
conduction defects are problems in...	valves - like stenosis or regurgitation
heart failure is...	failure of the heart to pump adequate, oxygenated blood for systemic and pulmonary circulation. can be left or right sided, or both. usually the left side is affected first
what are some factors that can lead to ischaemic injury?	atherosclerosis, vasospasm, thrombosis, cold
stable plaques can easily rupture or burst, leading to blood clotting inside the artery - true or false?	FALSE - only unstable plaques ever do this
stable plaques partially block vessels - true or false?	TRUE
stable angina is caused by an increase in...	oxygen demand - eg exercise
unstable angina can occur, with a sudden onset of pain, when?	at rest
silent myocardial ischaemia involves an absence of ...	pain
variant/prinzmetal angina is caused by...	vasospasm (pain at rest when coronary arteries spasm)
ischaemia deprives cells of which two factors needed for cellular metabolism?	oxygen and glucose
infarction is most often caused by....	thrombosis, embolism, anything that can cause ischaemia
what does the typical pain pattern look like for a patient with myocardial infarction?	severe chest pain, travelling up the jaw, down the left, or both arms. can last for 15 minutes to several hours
whats the typical ECG shape look like in myocardial infarction?	ST elevation or depression
which tests would provide biochemical evidence of myocardial infarction?	troponin and creatine kinase myocardial band
what is dilated cardiomyopathy?	a condition in which the heart becomes dilated and stretched with no obvious cause and cannot pump effectively
what are 3 possible causes of dilated cardiomyopathy?	congenital defects, coronary artery disease or hypertension
what is hypertrophic cardiomyopathy?	excessive ventricular growth, to the point where the ventricle is enlarged and stiff and the heart can't pump effectively
what is restrictive cardiomyopathy?	abnormally rigid ventricular walls - the heart cannot fill with blood effectively
in class 1 heart failure, physical activities are limited - true or false?	FALSE
left sided heart failure usually causes pulmonary oedema - true or false?	TRUE
right sided heart failure usually causes systemic oedema - true or false?	TRUE
productive cough with pink frothy sputum is usually seen in left or right sided heart failure?	left sided heart failure
low output heart failure is characterised by what?	cool, pale skin (systemic vasoconstriction)
urine output is usually reduced in patients with heart failure - true or false? and why?	TRUE - this is due to reduced cardiac output, and an increase in the release of anti-diuretic hormone from the posterior pituitary gland to combat a decrease in blood pressure
right sided heart failure usually occurs as a result of left sided heart failure - true or false?	TRUE - this is caused by unresolved venous congestion in systemic circulation
list 3 manifestations of left sided heart failure	productive cough with pink frothy sputum, pale and cold limbs, wheezes and crackles in lung sounds
what are the mechanisms of organic nitrates?	the enzymatic degradation of organic nitrates produces nitric oxide. nitric oxide facilitates smooth muscle cell relaxation in the vascular wall by activating potassium channels leading to hyperpolarisation. it dilates veins and arteries. it reduces coronary artery spasm. it redistributes coronary blood towards ischaemic areas via collaterals
what are commonly seen side effects of organic nitrates?	postural hypotension and headache
what is the mechanism of aspirin?	it inhibits COX1 irreversibly and blocks the conversion of arachidonic acid to thromboxane A2
what is the mechanism of clopidogrel?	it blocks adenosine diphosphate receptors on platelets, preventing platelet activation
what is the mechanism of tirofiban?	it blocks receptors for fibrinogen which forms bridges between platelets
what is the mechanism for heparin?	it inhibits thrombin to prevent activation of fibrin formation and platelets
what is the mechanism of fibrinolytic drugs?	they convert plasminogen to plasmin which breaks fibrin threads, associated with bleeding risk
what is the first-line therapy option for patients with stable angina? what is the next step if this is ineffective?	organic nitrates are the first choice. if this is ineffective, they can be combined with B-adrenoceptor blockers or calcium channel blockers
what is the mechanism of oxygen used to treat acute coronary syndromes?	reperfusion and revascularization
what is the mechanism of opioids used to treat acute coronary syndromes?	analgesia and depression of the sympathetic nervous system, slowing heart rate
what is the mechanism of anti-platelets, anti-thrombins and thrombolytics used to treat acute coronary syndromes?	they prevent thrombus formation
what is the mechanism of B-adrenoceptor blockers and ACE inhibitors used to treat acute coronary syndromes?	they reduce cardiac workload and the metabolic demands of the heart
percutaneous coronary intervention (PCI) is performed how long after patient presentation?	no longer than 90 minutes
which is the most commonly prescribed 'first line' therapy in younger (under 55) patients with hypertension?	ACE inhibitors
a stepped approach, in which new medications are added to current therapy until the target blood pressure is achieved, has what advantage?	minimising adverse events and maximising patient compliance
what effect does angiotensin 2 have?	vasoconstriction, salt retention, stimulation of aldosterone release from adrenal glands, hypertrophy and hyperplasia
release of renin from the granular cells in the kidney in response to a fall in blood pressure results in...	the conversion of angiotensinogen to angiotensin 2
which drug would be best to treat hypertension in pregnancy?	methyldopa
for which class of antihypertensives are the following adverse effects most common? - flushing and ankle oedema (vasodilation), and constipation (gastrointestinal nerves and smooth muscle)	calcium channel blockers
what does angiotensin converting enzyme do? (ACE)	it is present in the lungs, it converts angiotensin 1 to angiotensin 2, it is inhibited by 'pril' drugs, it degrades bradykinin
what would be the recommended treatment for a patient with a systolic blood pressure of 185, a diastolic pressure of 115, a low risk of cardiovascular event (<10%), and no evidence of end organ damage?	immediate commencement of antihypertensives (due to severe grade of hypertension), lifestyle changes and reassessment in 12 months (low risk of cardiovascular event and no evidence of end organ damage)
what can induce or aggravate hypertension?	pseudoephedrine, monoamine oxidase inhibitors, excessive salt and cocaine
an elderly patient (70) was given a thiazide diuretic for hypertension. after 6 weeks the doctor decided a second drug was needed to get her blood pressure to target. which would be most likely given her absence of complications?	ACE inhibitor
activation of the renin-angiotensin-aldosterone system in heart failure can be reduced by...	ACE inhibitors
what are the major cardiac effects of digoxin?	inhibits the sodium potassium pump, increasing intracellular calcium, increasing the force and efficiency of myocardial contraction, but slowing the rate. increases cardiac output
which class of drugs is used to treat angina and promotes redistribution of coronary blood flow towards ischaemic areas in collaterals?	organic nitrates

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	Created by Mellie Niller about 9 years ago