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LMCC > Cardio > Flashcards

Cardio Flashcards

1
Q

% of essential HTA vs secondary

A

> 85%

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2
Q

Lifestyle factors and other risk factors for essential HTA

A

Obesity, diet, Na, sedentary lifestyle, excess EtOH, stress

Rx

ATCD fam/ genetics

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3
Q

Causes of 2ary HTN

A

Endocrine: aldosterone excess (primary adrenal hyperplasia-most common, adrenal adenoma-conn syndrome), glucocorticoid excess, hyperT4, catecholamine excess (pheo)

IRC

Vascular: coarctation of the aorta, renal artery stenosis (young -fibromuscular dysplasia, old-atherosclerotic)

Obstructive sleep apnea

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4
Q

Name medications that can induce or aggravate HTN

A

NSAIDS, sympathomimetics, decongestants (pseudoephedrine, phenylephrine, oxymetazoline), cognitive stimulant (methylphenidate, dextroamphetamines), midodrine, cocaine

Corticos, EPO and analogs, androgens, estrogens, calcineurin inhibitors (cyclosporine, tacrolimus)

Licorice root (aldosterone like effect), antidepressants (MAOIs-selegiline, phenelzine, SNRIs-buproprion), SSRIs

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5
Q

Routine lab testing for HTN

A

Un inlays is and creatinine

Ions, glucose, BL, ECG

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6
Q

Work up for 2airy cause of HTN

A

T-SHIRT, PTH, 24h urine for metanephrines, aldosterone, renin, aldosterone/renin ratio, 24h urine cortisol, dexamethasone suppression test

Créat, GFR

ETT, Angie ct (coarctation), captopril renal scan, abdo echo ac Doppler, MRI (renal artery stenosis)

Sleep study

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7
Q

Dx of HTN

A

Bp> 140/90 on 3 separate occasions if office BP measurement

Ambulatory/home: >135/85

24h average BP measurement: 130/80

Si target organ damage or DB: single measurement > 140/90

A single measurement > 180/90

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8
Q

Classification of HTN

A

Pré HTN: 120-139/80-89

Stage1 HTN: 140-159/90-99

Stage 2: >160/100

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9
Q

Target organ damage from HTN

A

Cerebrovascular disease (ICT’ AVC, démence vasculaire)

Rétinophatie hypertensive
IC (HVG, dysfct)
MCAS (angine, IDM)
IRC
Maladie artérielle périphérique (claudication, dysfct érectile)
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10
Q

Targets for Na restriction, weight loss, Roy reduction, exercise and diet in HTA

A

<1.8 g/j Na
BMI<25 kg/m2
Waist circumference <102cm men. <88cm women

ROH<2 drinks/d
Exercise mod: >4 times a week, 120-150 min/w

DASH diet

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11
Q

DASH diet

A

High in veg, fruits, low-fat dairy, low in fat and sat fat

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12
Q

Which lifestyle change has the most significant effect on BP?

A

Diet change

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13
Q

Target TA for DB pts

A

130/80

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14
Q

When should u start antiTA medication

A

Average BP > 160/100

Or 140/90 with evidence of organ damage

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15
Q

Choice of 1st line agent for HTA

A

Thiazides diuretics, ACEI/ARBs, BCC LA, bblockers

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16
Q 
Anti TA Rx for
DB
Asthma
Prior MI
ANgina
IRC
IC
Migraines
Raynaud, coronary spasm
A 
DB: ACEI or ARB
Asthma: CCB (non DHP)
Prior MI: ACEI, bblocker
ANgina: bblocker, LA CCB
IRC: ACEI, ARB (with caution)
IC: ACEI, bblocker, aldosterone antagonist
Migraines: bblocker, long-acting CCB
Raynaud, coronary spasm: long acting CCB
17
Q

Common E2 of all anti HTA

A

Hypotension, especially postural

18
Q

ACEI E2

A

Dry cough (10%)-bradykinin related

19
Q

ACEI, ARB, Aldo antagonists

A

HyperK

20
Q

THiazide diuretics E2

A

HypoK, muscle cramps, tachyarrythmias

21
Q

B-blockers E2

A

Depression, fatigue, impotence, bradyarrhythmias

22
Q

Non DHP CCBs (diltiazem) E2

A

Bradycardia

23
Q

DHP ccbs E2

A

Leg edema, GERD

24
Q

Hypertensive urgency vs emergency

A

Urgency: BP > 180/120

Emergency: with impending or progressive target organ dysfunction

25
Q

Secondary causes of severe HTA

A

IRA (acute GN, scleroderma crisis), renovascular HTN, thyrotoxicosis, medication ( cocaine, MAOI, tyramine food), advanced IRC with volume overload, pheo, pregnancy-associated

26
Q

Symptoms of hypertensive emergency

A

Encephalopathy (headache , altered LOC, acute neuro deficits)
Aortic dissection, CHF, myocardial ischémie/infarction
Acute/progressive renal failure (oliguria), eclampsia (hyperreflexia, clonus, seizures)

27
Q

Investigations for hypertensive emergencies, urgencies

A

According to clinical suspicion: Routine labs , CXR, ECG, CT head, angioCT, testing for 2airy causes (toxicology, T-shirt, urine for metanephrines, Bhcg)

28
Q

Management of Hypertensive urgencies

A

No aggressive lowering of bp

29
Q

Management of hypertensive emergency

A

ICU, bp monitor, urgent IV anti hypertensive therapy, BP reduced by 25% in 60 min or less, then gradually lowered after, avoir organ hypoperfusion, target bp of 160/100 for initial 6-24h then gradual addition of oral agents

30
Q

AntiHTA in hypertensive emergencies

A

Labetalol: 1st line, except CHF

Nitroprusside: For many HTA emergencies, caution in IRC and increased ICP

Nitroglycérine: coronary ischémie and IC

Hydralazine: eclampsia

LMCC (5 decks)

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