Cardio and HTN

Question 1

HTN emergency

Answer 1

> 180/120 with target organ dysfunction

Question 2

target organ dysfunction

Answer 2

encephalopathy
intracerebral hemorrhage
papilledema
acute MI
acute LV HF with pulm edema
dissecting aortic aneurysm
acute renal failure
MAHA (hemolytic anemia)
eclampsia

Question 3

HTN urgency

Answer 3

> 180/120 without target organ dysfunction

Question 4

HTN emergency tx goals

Answer 4

rapidly lower diastolic to 100-110 in 1-6 hrs

Question 5

HTN urgency tx goals

Answer 5

slowly lower bp in 1-2 days

Question 6

tx for HTN emergency with acute MI

Answer 6

nitro

Question 7

if HTN emergency and acute MI, don’t use

Answer 7

hydral (inc HR) and beta blocker/labetalol (dec cardiac contractility)

Question 8

tx for HTN emergency with pulm edema

Answer 8

nitro
loop diuretic (lasix)

Question 9

tx for HTN emergency and CHF

Answer 9

IV loop diuretic (lasix)
IV vasodilator (nitroprusside)
IV nitroglycerin
ACEI (enaliprilat)
fenoldopam

Question 10

problem with nitroprusside if acute renal failure

Answer 10

can inc risk for cyanide toxicity

Question 11

tx for uncomplicated HTN

Answer 11

thiazides > ACEI

Question 12

tx for HTN if DM

Answer 12

ACEI or ARB

Question 13

tx for HTN if CKD

Answer 13

ACEI or ARB

Question 14

tx for HTN if high risk CAD

Answer 14

ACEI or ARB

Question 15

tx for HTN if angina

Answer 15

beta blocker or calcium channel blocker

Question 16

tx for HTN if post-MI

Answer 16

beta blocker
ACEI
aldosterone antagonist (ex: spironolactone)

Question 17

tx for HTN if edema

Answer 17

diuretic

restrict diet to 2g sodium

Question 18

medication you can use with ACEI

Answer 18

calcium channel blocker

Question 19

medication not to use with ACE-I

Answer 19

K+ sparing diuretic like spironolactone (can give hyperkalemia)

Question 20

med for aortic dissection

Answer 20

beta blocker (esmolol is titratable) or labetalol or propanolol

Question 21

secondary med after beta blocker for aortic dissection

Answer 21

vasodilator like nitroprusside

Question 22

guy with HTN crisis is given labetalol and nitroprusside. develops lactic acidosis and low BP. 4 possible causes?

Answer 22

1. thiocyanate poisoning (toxicity from nitroprusside)
2. acute MI
3. labetalol OD
4. cyanide poisoning (toxicity from nitroprusside)

Question 23

sxs of cyanide toxicity

Answer 23

hypotension

metabolic/lactic acidosis

Question 24

sxs of thiocyanate toxicity

Answer 24

muscle cramps, seizures, inc reflexes

Question 25

pt with intramural hematoma distal to subclavian artery who has chest/back pain. dx? tx?

Answer 25

Class B Aortic Dissection.

Give beta blocker/nitroprusside (medical management if stable) or CT surg/stent

Question 26

cerebral blood flow vs bp graph. R shift w HTN means?

Answer 26

for a pt with HTN, you lose autoregulation of cerebral blood flow around 120 mmHg

Question 27

medication used for aortic dissection?

Answer 27

esmolol (titratable)

• alternative beta blocker is labetalol or propanolol
• • 2nd line is vasodilator (ex: nitroprusside)

Question 28

pt with mechanical valve, infection, fever and heart murmur. do TEE or TTE?

Answer 28

TTE first

then TEE