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Merck Manual (Common Medical Topics) > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

definition of HTN

A

sustained elevation of resting systolic BP (≥ 140 mmHg), diastolic BP (≥ 90 mmHg), or both

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2
Q

etiology of HTN

A
  • primary (unknown cause; 85-95% of cases)

- secondary

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3
Q

probably MCC of secondary HTN

A

primary aldosteronism

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4
Q

pathophysiology of HTN must involve what 2 mechanisms?

A
  1. increased CO

2. increased TPR

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5
Q

what are the possible pathophysiological causes of HTN?

A
  • abnormal sodium transport
  • sympathetic nervous system
  • renin-angiotensin-aldosterone system
  • vasodilator deficiency
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6
Q

4 mechanisms controlled renin secretion

A
  1. afferent arteriolar wall tension
  2. macula densa receptor
  3. circulating angiotensin (negative feedback)
  4. sympathetic nervous system (stimulates secretion)
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7
Q

do pathologic changes occur early in HTN?

A

no

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8
Q

what are the risks of severe or prolonged HTN?

A
  • CAD and MI
  • HF
  • stroke (particularly hemorrhagic)
  • renal failure
  • death
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9
Q

what is the mechanism resulting in HTN’s complications?

A

arteriolosclerosis and atherogenesis

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10
Q

sxs of HTN

A

usually asymptomatic until complications develop

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11
Q

sxs of complicated HTN

A
  • dizziness
  • flushed facies
  • HA
  • fatigue
  • epistaxis
  • nervousness
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12
Q

what are the cardiovascular, neurologic, renal, and retinal symptoms caused by severe HTN (hypertensive emergencies)?

A
  • symptomatic coronary atherosclerosis
  • HF
  • hypertensive encephalopathy
  • renal failure
  • hypertensive retinopathy
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13
Q

what is one of the earliest signs of hypertensive heart disease?

A

4th heart sound

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14
Q

what are the retinal changes seen in hypertensive pts based on the 4 groups of the Keith, Wagener, and Barker classification?

A
  • grade 1: constriction of arterioles only
  • grade 2: constriction and SCLEROSIS of arterioles
  • grade 3: hemorrhages and exudates (in addition to vascular changes)
  • grade 4: PAPILLEDEMA
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15
Q

diagnosis of HTN

A

> 2 readings on 2 or more visits

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16
Q

testing for evaluation of hypertensive pt

A
  • BMP
  • FLP
  • UA and spot urine albumin:creatinine ratio
  • TSH
  • ECG
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17
Q

if UA detects albuminuria, cylindruria, or microhematuria, or if serum creatinine is elevated (1.4 mg/dL or more in men, and 1.2 mg/dL or more in women), what test should be done next?

A

renal US to evaluate kidney size

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18
Q

if pt is hypokalemic unrelated to diuretic use, what should the pt be evaluated for?

A

primary aldosteronism and high salt intake

19
Q

on ECG, a broad, notched P-wave indicates what, and why is it significant?

A
  • atrial hypertrophy

- may be one of the earliest signs of hypertensive heart disease

20
Q

which signs of hypertensive heart disease may occur later and indicate what?

A
  • sustained apical thrust and elevated QRS voltage w/ or w/o evidence of ischemia
  • LVH
21
Q

pts w/ what signs and sxs should be screened for pheochromocytoma?

A
  • labile, significantly elevated BP
  • HA
  • palpitations
  • tachycardia
  • excessive perspiration
  • tremor
  • pallor
22
Q

pts screened for pheochromocytoma, should also be screened for what and how?

A
  • sleep d/o

- sleep study

23
Q

does systolic or diastolic BP better predict fatal and nonfatal cardiovascular events?

A

systolic

24
Q

w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, and hemorrhage (grade 3 retinopathy)?

A

< 10%

25
Q

w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, hemorrhage, and papilledema (grade 4 retinopathy)?

A

< 5%

26
Q

what is the MCC of death among TREATED hypertensive pts?

A

CAD

27
Q

what is the MCC of death among INADEQUATELY treated hypertensive pts?

A

ischemic or hemorrhagic stroke

28
Q

does effective control of HTN prevent most complications and prolong life?

A

yes

29
Q

initial tx for HTN

A
  • weight loss and exercise
  • smoking cessation
  • diet; increased fruits and vegetables, decreased salt, limited alcohol
30
Q

when is medication started for HTN?

A

initial BP > 160/100, or unresponsive to lifestyle modifications

31
Q

JNC8 treatment target for ALL pts, including all those w/ a kidney d/o or diabetes

A

< 140/90 mmHg

32
Q

JNC8 treatment target for pts 60 years or older

A

< 150/90 mmHg

33
Q

how much time can be given for lifestyle modifications before starting meds?

A

6 months

34
Q

what should be the initial tx for non-black pts, including those w/ diabetes?

A
  • ACEI
  • ARB
  • CCB
  • thiazide
35
Q

what should be the initial tx for black pts, including those w/ diabetes?

A
  • CCB

- thiazide

36
Q

what should be the initial tx for non-blacks and blacks w/ CKD, w/ or w/o diabetes?

A
  • ACEI

- ARB

37
Q

name the diuretics

A
  • hydrochlorothiazide
  • chlorthalidone
  • indapamide
  • triamterene
  • spironolactone
  • amiloride
  • triamterene
  • furosemide
  • torsemide
38
Q

name the ACEIs/ARBs

A
  • lisinopril
  • benazepril
  • fosinopril
  • quinapril
  • ramipril
  • trandolapril
  • candesartan
  • valsartan
  • losartan
  • olmesartan
  • telmisartan
39
Q

name the BBs

A
  • metoprolol succinate
  • metoprolol tartrate
  • nebivolol
  • propranolol
  • carvedilol
  • bisoprolol
  • labetalol
40
Q

name the dihydropyridine CCBs

A
  • amlodipine

- nifedipine

41
Q

name the non-dihydropyridine CCBs

A
  • diltiazem

- verapamil

42
Q

name the vasodilators

A
  • hydralazine
  • minoxidil
  • terazosin
  • doxazosin
43
Q

name the centrally-acting agents

A
  • clonidine
  • methyldopa
  • guanfacine

Merck Manual (Common Medical Topics) (1 decks)

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