Cardiology

Question 1

2017 ACC/AHA Task force for BP Goals and treatment.

Answer 1

Question 2

Diagnosis of HTN?

Answer 2

Ambulatory BP monitoring
Home and Office with difference of 19/11 (20/10) mmHg

Question 3

HTN in children

Answer 3

> = 95th percentile BP for age, gender and height.

Question 4

Starting age for BP monitor

Answer 4

Age 3 onwards and annually

Question 5

Secondary work-up for HTN in children

Answer 5

None.
If FmHx of obesity, patient is obese

Question 6

Causes for secondary HTN in adult

Answer 6

Primary hyperaldosteronism
Get Aldosterone/renin ratio
Now sleep apnea has 30-40 %

Question 7

Renal artery stenosis

Answer 7

Age <30: Fibromuscular
Age>30: Atherosclerotic disease
ACEi: Renal insufficiency or hyperkalemia
Dx: MRA, CT angio or duplex renal

Question 8

HTN treatment based on race

Answer 8

Non-Black: Thiazide, CCB, ACEi or ARB
Black: Thiazide, CCB
DM: On ACEi or ARB

Question 9

Work of thiazide and CCB in African American

Answer 9

Thiazide: Improves HF than ACEi
CCB: Decreases stroke
Give ACEi/ARB for CKD and HF

Question 10

Side effect of thiazide (renal excretion)

Answer 10

HyperGLUC
G: Hyperglycemia
L: Hyperlipidemia and Increase lithium
U: Hyperuricemia
C: Hypercalcemia

Question 11

Thiazide side effect (Increase excretion)

Answer 11

Sodium
Potassium
Magnesium

Question 12

When ACE/ARB is given?

Answer 12

> 18 with CKD
All with DM
No ACEi + ARB together
Decreases progession of microalbuminuria in DM

Question 13

ACEi side effect?

Answer 13

Cough
Increases lithium toxicity
Angioedema (More in African American)
Reduced BP response to mono ACEi/ARB in African American

Question 14

CCB types

Answer 14

Dihydropyridine: Amlodipine, Nifedipine, Felodipine and Nicardipine

Nondihydropyridine:
Verapamil > Diltiazem

Question 15

Dihydropyridine VS Nondihydropyridine

Answer 15

Dihydropyridine:
Vasodilator. No cardiac contractility or AV nodal conduction

Nondihydropyridine:
Less-effective vasodilator. Slow AV conduction. + negative inotropic effect.

Question 16

Define resistant HTN

Answer 16

On >=3 medications
Most common: Poor adherence
Exogenous: Caffeine, alcohol, nicotine, cocaine, NSAIDs, OCPs, steroids, erythropoietin, herbal agents

Question 17

Suboptimal therapy for resistant HTN

Answer 17

1. Long acting diuretic: Chlorthalidone
2. Add spironolactone
3. No benefit to switching ACEi to ARB
4. Vasodilating: B-blocker (Carvedilol, labetalol, nebivolol)
5. Consider: Clonidine, hydralazine, alpha blocker

Question 18

Aldosterone antagonists for HTN

Answer 18

No hyperaldosteronism is present
GFR >= 30 and K+ <5

Add spironolactone or eplerenone

Question 19

Resistant HTN and OSA

Answer 19

Increase in aldosterone which causes pharyngeal edema and causes upper airway obstruction
Good for OSA

Question 20

Treatment for HTN which causes decline in renal function?

Answer 20

20-30% increase in creatinine
ACEi/ARB dilate efferent arteriole, Decreases IG pressure

Question 21

HTN in ischemic heart disease

Answer 21

1st is B-blocker
2nd: ACEi/ARB (after MI, DM, LV dysfunction)
3. Long acting nitrate: Only for angina. No role in HTN.

Question 22

HTN in HF

Answer 22

Diuretic + B-blocker + ACEi/ARB + Aldosterone antagonist

Question 23

Post MI HTN medications

Answer 23

B-blocker + ACEi/ARB + Aldosterone antagonists

Question 24

CAD HTN medications

Answer 24

Diuretic + B-blocker + ACEi/ARB + CCB

Question 25

A. fib HTN medications

Answer 25

B-blocker + CCB

Question 26

DM HTN medication

Answer 26

Diuretic + B- Blocker + ACEi/ARB + CCB

Question 27

CKD HTN medication

Answer 27

ACEi/ARB

Question 28

Recurrent stroke prevention

Answer 28

Diuretic + ACEi/ARB

Question 29

BPH medication

Answer 29

Alpha blocker

Question 30

HTN in older

Answer 30

Thiazide + CCB Target: SBP <150 in >=60 age

Question 31

Systolic and Diastolic murmurs

Answer 31

TPAM RSSR : Systolic TPAM SRRS : Diastolic

Question 32

Aortic Stenosis

Answer 32

Most common valvular disease Repeat Echo 3-5 years in asymptomatic Only Tx: TAVR

Question 33

Cardiac resynchronization therapy in HF

Answer 33

1. LVEF <= 35% 2. NYHA 2, 3, 4 on meds 3. QRS duration >=150 ms 4. Life expectancy > 1 year

Question 34

ICD in HF

Answer 34

1. LVEF <= 35% 2. NYHA 2, 3 on meds 3. Life expectancy > 1 year

Question 35

Aldosterone receptor antagonists for HF

Answer 35

1. EF >=45% 2. Increase BNP or HF admission within 1 year 3. GFR >=30 4. Creatinine <=2.5 5. Potassium <=5.0 Decreases hospitalization

Question 36

Reduction of heart rate in HF

Answer 36

B- blocker if not tolerated than non-dihydropyridine CCB Digoxin only if A.fib or Flutter present

Question 37

Drugs to avoid in HFrEF

Answer 37

1. CCB (Verapamil, diltiazem. Potent negative inotrophic effect) Use amlodipine for HTN 2. Most antiarrhythmic drugs 3. NSAIDs 4. Thiazolidinediones (water retention) Piaglitazone and Rosiglitazone

Question 38

What is Ivabradine used for?

Answer 38

1. Decrease HF hospitalization (2-3) 2. Stable HF <=35% 3. Maximum tolerated dose HF management 4. Sinus rhythm with HR of >=70 bpm 5. Sinus node modulator.