Summary Cardiovascular Conditions - DEARSIM Format
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Course
Foundation in Clinical Medicine
Institution
St Georges
A thoroughly summarised revision tool to understand cardiovascular medicine.
Key features include:
1. Most common conditions such as hypertension, coronary artery disease, heart failure, arrhythmias and more.
2. Pathophysiology and clinical presentation including buzzwords tailored for exam p...
Essential Hypertension (Primary)
Definition Persistently raised arterial blood pressure – with no identifiable cause
Epidemiology M: 34% and F:32% - rises to >60% in people aged 60+
Aetiology Increased cardiac output (early hypertension)
Raised peripheral resistance in small arterioles
Renin released from kidneys in response to glomerular under-
perfusion/reduced salt intake
Autonomic nervous system
, Causes: arteriosclerosis (hardening/stiffening of artery walls) and
atherosclerosis (patchy accumulation of fat in arterial walls)
Risk Factors Age, sex [up to 65 M>F, and 65-74 W>M], ethnicity, social deprivation,
lifestyle, stress/anxiety
Symptoms Severe headaches, chest pain, dizziness, difficulty breathing, nausea,
vomiting, blurred vision or other vision changes, anxiety
Signs
Investigations BP reading = above 140/90 (suspect HTN), over 180/120 (opt for
ABPM/HBPM
If 180/120+ (and presents life-threatening symptoms) = same day
referral for elevated HTN
No symptoms = carry out tests for organ damage (if present start
treatment immediately
No organ damage = repeat BP within seven days
Must be confirmed with:
ABPM – 2 measurements per hour during waking hours (14
measurements on average)
HBPM – (if ABPM not tolerated) 2 measurements, 1 minute apart;
twice daily (morning and evening) for 4-7 days
TARGET ORGAN DAMAGE:
- 12-lead ECG for left-ventricular hypertrophy
- Renal function tests and urine tests (protein/albumin/blood)
- Eye screening/fundoscopy for hypertensive retinopathy
(HR: retinal haemorrhage – flame-shaped haemorrhage)
- Assess CV risk: Hba1c and cholesterol
- QRISK3 (10 year risk of person developing cardiovascular disease)
Management Lifestyle changes: diet, exercise, stress, smoking, alcohol, coffee
Under 40, stage 1 HTN, no end organ damage = refer for secondary
HTN investigations
Under 80, stage 1 HTN and 1 of: target organ damage, established
CVD, renal disease, diabetes, QRISK 3 of more than 10% = start
treatment
Under 60, stage 1 HTN and QRISK3 below 10% = consider treatment
Any age with stage 2 HTN = treatment
White coat HTN = patients with persistently raised BP in clinic whose
home/ambulatory blood pressure monitoring readings are lower (>20/10 mmHg)
Signs in clinic = tachycardia, sweating or palpitations
Masked HTN = clinic BP measurements are normal but higher when outside clinic
(ABPM/HBPM)
, Secondary Hypertension
Definition Persistently raised arterial blood pressure – as a result of underlying
condition
Epidemiology
Aetiology Can be a result of:
Renal diseases: renal artery stenosis
Congenital cardiovascular diseases: aortic coarctation
Endocrine diseases: Cushing disease, Conn’s syndrome
Pregnancy
Medication: NSAIDs, steroids, contraceptives
Aortic dissection:
Atherosclerosis and constant exposure to high blood pressure =
wakening of aortic wall = intimal tear = blood flow into the tear
SSx: sudden, severe pain of anterior chest, nausea, vomiting,
syncope, sweating
- Can lead to myocardial ischaemia or tamponade
Targets for management:
Aim for BP of <140/90 in people <80 and <150/90 in people >80 [in
clinic]
Exceptions:
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