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My ABFM Important > Cardiology > Flashcards

Cardiology Flashcards

1
Q

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

A
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2
Q

Diagnosis of HTN?

A

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

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3
Q

HTN in children

A

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

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4
Q

Starting age for BP monitor

A

Age 3 onwards and annually

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5
Q

Secondary work-up for HTN in children

A

None.
If FmHx of obesity, patient is obese

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6
Q

Causes for secondary HTN in adult

A

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

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7
Q

Renal artery stenosis

A

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

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8
Q

HTN treatment based on race

A

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

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9
Q

Work of thiazide and CCB in African American

A

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

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10
Q

Side effect of thiazide (renal excretion)

A

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

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11
Q

Thiazide side effect (Increase excretion)

A

Sodium
Potassium
Magnesium

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12
Q

When ACE/ARB is given?

A

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

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13
Q

ACEi side effect?

A

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

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14
Q

CCB types

A

Dihydropyridine: Amlodipine, Nifedipine, Felodipine and Nicardipine

Nondihydropyridine:
Verapamil > Diltiazem

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15
Q

Dihydropyridine VS Nondihydropyridine

A

Dihydropyridine:
Vasodilator. No cardiac contractility or AV nodal conduction

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

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16
Q

Define resistant HTN

A

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

17
Q

Suboptimal therapy for resistant HTN

A
  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
18
Q

Aldosterone antagonists for HTN

A

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

Add spironolactone or eplerenone

19
Q

Resistant HTN and OSA

A

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

20
Q

Treatment for HTN which causes decline in renal function?

A

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

21
Q

HTN in ischemic heart disease

A

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

22
Q

HTN in HF

A

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

23
Q

Post MI HTN medications

A

B-blocker + ACEi/ARB + Aldosterone antagonists

24
Q

CAD HTN medications

A

Diuretic + B-blocker + ACEi/ARB + CCB

25
Q

A. fib HTN medications

A

B-blocker + CCB

26
Q

DM HTN medication

A

Diuretic + B- Blocker + ACEi/ARB + CCB

27
Q

CKD HTN medication

A

ACEi/ARB

28
Q

Recurrent stroke prevention

A

Diuretic + ACEi/ARB

29
Q

BPH medication

A

Alpha blocker

30
Q

HTN in older

A

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

31
Q

Systolic and Diastolic murmurs

A

TPAM

RSSR : Systolic
TPAM
SRRS : Diastolic

32
Q

Aortic Stenosis

A

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

33
Q

Cardiac resynchronization therapy in HF

A
  1. LVEF <= 35%
  2. NYHA 2, 3, 4 on meds
  3. QRS duration >=150 ms
  4. Life expectancy > 1 year
34
Q

ICD in HF

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

Aldosterone receptor antagonists for HF

A
  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

36
Q

Reduction of heart rate in HF

A

B- blocker
if not tolerated than non-dihydropyridine CCB

Digoxin only if A.fib or Flutter present

37
Q

Drugs to avoid in HFrEF

A
  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
38
Q

What is Ivabradine used for?

A
  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.

My ABFM Important (4 decks)

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