BCR TBL 1.5 - Hypertension, Cardiovascular Risk, MI and Heart Failure

What is the definition of hypertension according to UK guidelines?

Systolic ≥140 mmHg and/or Diastolic ≥90 mmHg

What is the most common type of hypertension?

Essential (primary) hypertension

Name one key modifiable risk factor for hypertension.

High salt intake

What dietary recommendation can reduce blood pressure?

Reduce sodium intake to 1.5–2.4 g/day

Which system is activated in response to low salt intake?

Renin-angiotensin-aldosterone system (RAAS)

What is white coat hypertension?

Transient BP elevation in clinical settings

What type of hypertension is caused by an underlying condition?

Secondary hypertension

What is a classic feature of phaeochromocytoma?

Paroxysmal hypertension, palpitations, pallor, headache, sweating

What secondary hypertension is associated with low potassium?

Primary hyperaldosteronism (Conn’s syndrome)

Which renal condition is a major secondary cause of hypertension?

Renovascular disease

What is hypertensive retinopathy?

Damage to retina due to high blood pressure

What eye sign suggests malignant hypertension?

Papilloedema

What cardiac structure is affected first in hypertensive heart disease?

Left ventricle (LVH)

What is diastolic dysfunction?

Impaired relaxation of the left ventricle

What does LVH increase the risk of?

Atrial fibrillation

What is the role of the left atrium in diastolic dysfunction?

It compensates for LV stiffness, enlarges over time

What is a common renal complication of hypertension?

Chronic kidney disease (CKD)

What brain-related condition can be caused by hypertension?

Stroke

What classifies a hypertensive emergency?

Elevated BP + acute organ damage

What is the first-line drug for hypertension in under-55s?

ACE inhibitor or ARB

What is the first-line drug for hypertension in over-55s or Black patients?

Calcium channel blocker

What are two key components of lifestyle management in hypertension?

Weight loss and reduced sodium intake

What tool is used to assess CV risk in hypertension?

SCORE2

What is the earliest lesion in atherosclerosis?

Fatty streak

What cells are involved in early plaque formation?

Foam cells (lipid-laden macrophages)

What is a vulnerable plaque?

Thin fibrous cap + lipid-rich core; prone to rupture

What is the outcome of plaque rupture?

Thrombosis and potential infarction

What is Virchow’s triad?

Endothelial injury, stasis, hypercoagulability

What is the predominant composition of arterial thrombi?

Platelets (white thrombus)

What is the predominant composition of venous thrombi?

Fibrin and RBCs (red thrombus)

Which lipid increases atherosclerosis risk the most?

LDL cholesterol

What is the function of HDL cholesterol?

Reverse cholesterol transport

What class of drugs lowers LDL cholesterol?

Statins

What scoring system estimates cardiovascular risk?

SCORE2

What is the pathophysiology of stable angina?

Fixed atherosclerotic plaque reduces flow during exertion

What causes unstable angina or MI?

Plaque rupture and thrombus formation

What is the most specific cardiac biomarker for MI?

Troponin

What ECG change is seen in STEMI?

ST-segment elevation

Which coronary artery supplies the anterior wall?

Left anterior descending (LAD)

Which leads show inferior MI?

Leads II, III, aVF

Which infarct type affects solid organs like heart?

White infarct

Which infarct type occurs with reperfusion?

Red infarct

What causes myocardial necrosis in MI?

Ischemia and loss of oxygen supply

How soon does irreversible damage occur in MI?

20–40 minutes

What ECG finding indicates chronic infarction?

Pathological Q waves

What is a common early complication of MI?

Ventricular arrhythmias (VT, VF)

What mechanical complication causes mitral regurgitation?

Papillary muscle rupture

What is Dressler’s syndrome?

Autoimmune pericarditis post-MI

What does LV aneurysm increase the risk of?

Thrombus and arrhythmias

What is ejection fraction (EF)?

% of blood pumped out of LV per beat

What EF defines HFrEF?

EF < 40%

What EF defines HFpEF?

EF ≥ 50%

What classification system rates HF symptoms?

NYHA classification (I–IV)

What is the primary cause of HFpEF?

Diastolic dysfunction (e.g. from HTN)

What neurohormonal system worsens HF over time?

RAAS and sympathetic nervous system

What hormone causes sodium and water retention?

Aldosterone

What are first-line drugs to reduce mortality in HFrEF?

ACEi/ARB, Beta-blockers, MRA, SGLT2 inhibitors

What drugs relieve symptoms only in HF?

Diuretics

What is the hallmark sign of pulmonary edema?

Pink frothy sputum

What is the most common symptom of left-sided HF?

Dyspnoea

What sign indicates right-sided HF?

Pitting leg edema

What causes raised JVP?

Increased right atrial pressure

What device prevents sudden cardiac death in low EF?

ICD (implantable cardioverter-defibrillator)

What lifestyle change improves HF prognosis?

Low-sodium diet, fluid restriction, exercise

What is Beck’s triad?

Hypotension, muffled heart sounds, raised JVP (cardiac tamponade)

What arrhythmia is common in LVH from HTN?

Atrial fibrillation

What score predicts stroke risk in AF?

CHA₂DS₂-VASc score

What is first-line stroke prevention in AF?

Anticoagulation (DOAC or warfarin)

What medication class reduces HR and mortality in HF?

Beta-blockers

What is the effect of aldosterone on the kidney?

Na+ and water retention; K+ excretion

What electrolyte is low in primary hyperaldosteronism?

Potassium

What are the 5 P's of phaeochromocytoma?

Pressure, Pain, Palpitations, Pallor, Perspiration

Which hypertension is seen in pregnancy?

Pre-eclampsia

What is the most common cause of death globally?

Ischemic heart disease

What patient group is at highest CHD risk?

Diabetics and South Asians

What tool assesses coronary calcium?

CT coronary calcium scan

What medication is essential post-PCI?

Dual antiplatelet therapy (aspirin + clopidogrel)

What is a red flag for right ventricular infarction?

Hypotension + clear lungs + raised JVP

Which ECG leads show posterior MI?

V7–V9 (posterior leads)

Which MI complication results in L→R shunt?

Ventricular septal defect (VSD)

What therapy improves survival in STEMI?

Early reperfusion (PCI or thrombolysis)

What is a late complication of MI involving scar tissue?

Left ventricular aneurysm

Which heart sound is associated with HFpEF?

S4 gallop

Which sound is common in HFrEF?

S3 gallop

What are signs of advanced heart failure?

Cachexia, cool extremities, hypotension

What is the primary pathologic hallmark of atherosclerosis?

Intimal lipid accumulation

Which cells maintain fibrous cap stability?

Smooth muscle cells

Which MI has worst prognosis?

Anterior STEMI (LAD occlusion)

Which HF patients benefit from SGLT2 inhibitors?

All EF ranges, especially HFrEF

What is the role of natriuretic peptides in HF?

Promote natriuresis, vasodilation

Which imaging confirms LV function in HF?

Echocardiography

What is the treatment goal in HFpEF?

Symptom relief and comorbidity control

What lifestyle modification lowers BP the most?

Weight loss

Which condition mimics MI with normal coronaries?

Takotsubo cardiomyopathy

What are "foam cells"?

Macrophages filled with oxidized LDL

What distinguishes NSTEMI from unstable angina?

Troponin elevation in NSTEMI

How is fluid overload monitored in HF?

Daily weight and fluid balance

What is the gold standard for coronary occlusion?

Coronary angiography

What is the effect of sympathetic activation in HF?

↑HR and vasoconstriction, worsens remodeling

What causes orthopnoea in heart failure?

Pulmonary congestion when lying flat