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DSE > Cardio > Flashcards

Cardio Flashcards

1
Q

What is HTN a major contributing factor in?

A 
Coronary artery dz
Stroke
CHF
Chronic renal failure
Atherosclerosis
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2
Q

Nl BP

A

<120/<80

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3
Q

Prehypertension

A

120-139/80-89

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4
Q

Stage 1 HTN

A

140-159/90-99

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5
Q

Stage 2 HTN

A

160-179/100-109

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6
Q

Blood pressure formula

A

CO x SVR

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7
Q

What are the primary factors determining blood pressure?

A

Sympathetic nervous system
Renin-angiotensin-aldosterone system
Plasma volume

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8
Q

What is the cause of the majority of HTN?

A

Idiopathic (primary)

Numerous genetic and environmental factors

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9
Q

When should one have clinical suspicion of secondary HTN?

A

Onset <30 or >50
Sudden onset of HTN
Sudden change in chronic HTN
Multi-drug resistant HTN

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10
Q

Risk factors for primary HTN

A 
Increasing age
Obesity
FHx
Physical inactivity
Ethnicity
EtOH
Smoking
DM
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11
Q

Secondary causes of HTN

A 
Renal
-Acute and chronic kidney dz
Adrenal
-Cushing's syndrome
Pheochromocytoma (intermittent sx)
Hyperaldosteronism (hypokalemia, HTN, metabolic alkalosis)
OCPs
Decongestants
NSAIDs
MAOIs
Cocaine
Wt loss meds
Stimulants
Hyperthyroid
Hyperparathyroid
Pregnancy
Coarctation of the aorta
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12
Q

End organ damage in HTN

A 
Claudication
Bruits
LVH
Retinopathy
Renal disease
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13
Q

Labs for HTN

A 
CBC
CMP
BUN/creatinine
FBS/Hgb A1c
Lipid panel
TSH
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14
Q

Additional testing for HTN

A 
CXR
ECG
Ambulatory BP monitoring
Echo
Labs for secondary causes
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15
Q

HTN eval

A

Pt seated for 5 minutes, feet flat on the floor, arm supported at heart level
Appropriate sized cuff
At least two readings…both arms
1/2 hr after eating, drinking, smoking

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16
Q

MOA of ACE inhibitors

A

Prevent conversion of angiotensin I to angiotensin II

Prevention of breadkdown of bradykinin

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17
Q

MOA of dihydropyridine calcium channel blockers

A

Work more in the peripheral vasculature, cause vasodilation

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18
Q

Contraindications of ACE/ARB

A

Pregnancy

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19
Q

MOA of nondihyrdopyridine CCBs

A

Work centrally on the heart
Have inotropic and chronotropic effects
Increase HR and contractility

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20
Q

Contraindication of dihydropyridine calcium channel blockers

A

Heart failure

Be careful using nondihyrdopyridines with BBs, specifically cardioselective because of decrease in HR

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21
Q

Examples of thiazide diuretics

A

Chlorthiadone
Indapamide
Hydrochlorothiazide

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22
Q

Examples of loop diuretics

A

Bumetanide
Furosemide
Torsemide

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23
Q

Examples of aldosterone antagonists

A

Spironolactone

Eplerenone

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24
Q

Examples of potassium sparing diuretics

A

Amilioride

Triamterene

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25
Q

When to use aldosterone antagonists for HTN

A

Esp spironolactone

Used in resistant HTN

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26
Q

Which diuretics are not affected by renal function?

A

Loops

27
Q

Which beta blockers are considered cardioselective?

A

Metoprolol
Atenolol
Bisoprolol

28
Q

Recommendations for HTN med dosing

A

Titrate to max dose, then add a second drug

29
Q

What is treating resistant HTN predicted on?

A

Lifestyle factors
Appropriate tx of secondary outcomes
Effective multi-drug regimens

30
Q

Med regimens for resistant HTN

A

Diuretic therapy
Combo therapy
Mineralcorticoid receptor antagonists
Beta blockers, central alpha 2 agonists, direct vasodilators

31
Q

What med regimen should be in place before diagnosing resistant HTN?

A

Thiazide
CCB
ACE/ARB

32
Q

What is the difference in ejection fraction between systolic and diastolic heart failure?

A

Systolic ~33%
Diastolic ~57%
Nl ~66%

33
Q

Causes of systolic heart failure

A 
Reduction in muscle mass (MI)
Dilated cardiomyopathies
Ventricular hypertrophy
-Pressure overload
--Pulmonary HTN
--Aortic/pulmonic valve stenosis
-Volume overload
--Valvular regurgitation
--Shunts
--High-output states
34
Q

Causes of diastolic heart failure

A 
Increase ventricular stiffness
Ventricular hypertrophy
-HCM
Infiltrative myocardial disease
-Amyloidosis
-Sarcoidosis
-Endomyocardial fibrosis
Myocardial ischemia and infarction
Mitral/tricuspid stenosis
Pericardial disease
-Pericarditis
-Pericardial tamponade
35
Q

Tx of stage A heart failure

A 
Stage A: not symptomatic and NO current evidence of structural heart dz, pts at high risk for heart failure
Aggressive risk factor control:
-Control HTN per current guideline recs
-Smoking cessation
-Control dyslipidemia per current guidelines
-Increased physical activity
-Encourage wieght loss if obeses
-Control diabetes per current guidelines
-Discourage EtOH and illicit drug use
36
Q

What is stage B heart failure?

A

Pts with structural heart disease but are asymptomatic

37
Q

Tx of stage B heart failure

A 
All txs for stage A
ACE inhibitor or ARB
-Pts s/p ACS/MI or reduced EF
BB select medications
-Pts s/p ACS/MI or reduced EF
38
Q

What 3 BBs are utilized in heart failure?

A

Carvedilol
Bisoprolol
Metoprolol succinate

39
Q

MOA of BBs

A

Inhibitor/block beta receptors
Net effect:
-Decreased sensitivity to circulating catecholamines
-Decreased HR/BP

40
Q

When should BBs be initiated in heart failure?

A

Only initiate beta blocker when heart failure is stable and pt is euvolemic

41
Q

What is the net effect of ACE inhibitors?

A

Arterial and venous vasodilation

Reduction of preload and afterload (reduced workload on heart)

42
Q

Absolute contraindications of ACE inhibitors

A

Hx of angioedema secondary to ACE inhibitor
Pregnancy (category X)
Bilateral renal artery stenosis

43
Q

MOA of ARBs

A

Block the AT1 receptor to stop the actions of angiotensin II
-Decreased vasoconstriction, aldosterone release, cellular growth promotion
Net effect:
-Arterial and venous vasodilation
-Reduction of preload and afterload (reduced workload on heart)

44
Q

Stage C tx for diastolic heart failure

A

Diuresis to relieve sx of congestion

Follow guideline driven indications for comorbidities

45
Q

Stage C tx for systolic heart failure

A 
All txs for stage A
ACEI or ARB
BB (select medications)
Diuretics
Devices
-Biventricular pacing
-Implantable defibrillators
46
Q

MOA of diuretics

A

Block Na resorption at the thick ascending loop of Henle

47
Q

MOA of aldosterone antagonists

A

Inhibits aldosterone
-Increased levels of aldosterone in HF to increase Na/H2O retention and improve CO
Weak diuretic effect

48
Q

Stage D heart failure tx

A 
All txs for stage A-C
Heart transplant
Chronic inotropic meds
Mechanical support
Palliative care/hospice
49
Q

MOA of sacubitril/valsartin

A

Valsartan: ARB
Sacubitril: inhibits neprilysin
-Net effect: Increase natriuretic peptides that decrease blood volume and preload

50
Q

Causes of HF exacerbation

A 
Acute coronary syndromes
Med nonadherence
Na/fluid restriction nonadherence
Uncontrolled BP
A fib
Addition of drugs that worsen HF
Pulmonary embolus
Infection
Excessive alcohol use
51
Q

S/sx of hypoperfusion in HF exacerbation

A

Cool extremities
Sleepy
Declining Na levels

52
Q

S/sx of congestion in HF exacerbation

A 
Orthopnea
DOE
High JVP
Pulmonary edema
Peripheral edema
Elevated BNP
Wt gain
53
Q

How to address congestion in HF exacerbation

A

Loop diuretics

+/- vasodilators

54
Q

How to address hypoperfusion in HF exacerbation

A

Positive inotropes

+/- fluid replacement

55
Q

How to address congestion and hypoperfusion in HF exacerbation

A

Mixture of diuretics, vasodilators, inotropes

56
Q

Vasodilators for HR exacerbation

A

Nitroprusside- not seen often
Nitroglycerin
Nesiritide

57
Q

Inotropes utilized for HR exacerbation

A

Dopamine
Dobutamine
Milrinone

58
Q

What are ACEs first line therapy for?

A 
Heart failure
Left ventricular dysfunction
In all pts with STEMI
NSTEMI with an anterior MI
Diabetes
Systolic dysfunction
Proteinuric chronic kidney dz
59
Q

Indications for ARBs

A

Similar to ACEs
Specific benefit with severe HTN with EKG evidence of left ventricular hypertrophy
ARB indicated in those who don’t tolerate ACEs

60
Q

Indications for thiazide diuretics

A

Volume control with heart failure or chronic kidney dz

61
Q

Indication for CCB

A

Rate control with atrial fib or control of angina

62
Q

Indications for BB

A

Acute MI
Rate control for A fib
Angina

63
Q

How is orthostatic hypotension evaluated?

A

Evaluated by measuring the individual’s BP and pulse rate while he or she is reclining and again after the individual swiftly moves to a standing position
Test is positive with systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within three minutes of standing

64
Q

Testing for orthostatic hypotension

A 
Tilt test
Chemistry panel- hypoglycemia, dehydration
CBC- anemia
Blood/urine cultures- sepsis
12 lead EKG
Echo
Holter/event monitor
UA
CXR/CT

DSE (14 decks)

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