Cardiology

Question 1

Primary (essential) HTN

Answer 1

elevated systolic/diastolic BP as defined w/out a defined etiology

Question 2

secondary HTN

Answer 2

elevated BP with an identified cause

Question 3

resistant HTN

Answer 3

BP uncontrolled despite adherence to an appropriate 3 drug regimen, where all drugs are >50% recommended dose

Question 4

Refractory HTN

Answer 4

patient w/ resistant HTN, who cannot be controlled on >4 meds

Question 5

Masked HTN

Answer 5

bp consistently elevated out of offive , but does not met criteria for HTN in office

Question 6

MAP

Answer 6

Normal range 70-110 (<60 concern for insufficient perfusion through organs)

Question 7

HTN Urgency

Answer 7

severe HTN (>120 DBP) in asymptomatic pt

Question 8

HTN Emergency

Answer 8

Severe HTN (>120DBP) with acute end-organ damage

Question 9

HTN complications Brain

Answer 9

Brain:

Stroke, hemorrhage, cerebral atrophy and dementia

Question 10

HTN risk factors

Answer 10

Age 
obesity
family history
race
high NA+ diet
alcohol abuse
physical inactivity
diabetes
dyslipidemia
Hostility/rage
depression

Question 11

Secondary HTN (common cause)

Answer 11

#1 Chronic Kidney Disease
Renovascular disease/ renal artery stenosis
Mineralocorticoid excess
Sleep apnea / breathing disorders
Medications
     Steroids
     birth control (High Estrogen)
     NSAIDS
     SSRI
    Sudafed
    Cocaine/amphetamines

Question 12

Secondary HTN (Uncommon causes)

Answer 12

Pheochromocytoma
endocrine disorders
Coarctation of aorta

Question 13

Renovascular HTN (cause)

Answer 13

Older pt: atherosclerosis

Younger: Fibromuscular dysplasia

Question 14

HTN complications Eyes

Answer 14

Retinopathy, vitrious hemorrhage, imparred vision and blindness

Question 15

HTN complications Kidneys

Answer 15

CKD,

End stage renal disease

Question 16

HTN complications Cardiac

Answer 16

Coronary heart disease,
ischemic heart disease
Lft ventricular hypertrophy
heart failure
Acute Aortic Dissection
Arterial aneurism
Hypertensive emergency

Question 17

HTN Diagnosis

Answer 17

BP readings > 2 office visits, must be weeks or months apart
Home BP readings >130/80 mmHh
daytime <135/85 mmHg
Nighttime <120/70 mmHg

Question 18

Normal BP

Answer 18

<120/80

Question 19

Prehypertension (BP)

Answer 19

<139/89

Question 20

Stage 1 HTN (BP)

Answer 20

<159/99

Question 21

Stage 2 HTN (BP)

Answer 21

> 160/100

Question 22

Isolated systolic HTN

Answer 22

Systolic >140

Question 23

Isolated Diastolic HTN

Answer 23

Diastolic >90

Question 24

Key factors in PMH to indicate HTN

Answer 24

H/o HTN
Stroke
TIA
CAD
Heart failure
CKD
Peripheral Artery Disease
Diabetes/ dyslypidemia

Question 25

Key factors in Family History to indicate HTN

Answer 25

HTN Diabetes Dyslipidemia

Question 26

Key factors in Medication History to indicate HTN

Answer 26

``` Nsaids stimulants antidepressants high dose OCP cold remedies glucocorticoids Folk remedies/ OTC herbals ```

Question 27

Key factors in Social History to indicate HTN

Answer 27

``` Smoking alcohol illicit drugs work/life stress exercise diet sleep habits ```

Question 28

HTN initial symptoms - may indicate HTN emergency

Answer 28

``` headaches, dizziness, weakness, vision changes, SOB Chest Pain Claudication Palpitations fatigue Weight gain ```

Question 29

Evaluation HTN - Physical Exam

Answer 29

``` BP, Pulse BMI Waist circumference eyes neck - bruits Cardiac exam Lung exam abdominal exam extremities neuro exam ```

Question 30

Secondary HTN S&S

Answer 30

``` Age >30 Stage 2 HTN - unresponsive to Tx Episodic Morbid obesity- Snoring pallor, edema ```

Question 31

HTN Diagnostic labs

Answer 31

``` BMP +LFT or CMPFasting Lipids H-crit Urinanalysis ECG - see previous MI, arrhythmia Urine Albumin to creatinine ratio ```

Question 32

Pre-HTN and HTN non-pharmalogical treatment

Answer 32

``` Weight loss Decrease Dietary NA+ increase Physical Activity Moderation of alcohol (smoking cessation for decreased CVD) ```

Question 33

HTN treatment Pharmacological

Answer 33

Diuretics, CCB, ACE, ARB | BB (No longer used)

Question 34

Therapy recommendation for PreHTN

Answer 34

Non-pharmacological only

Question 35

Therapy recommendation for CKD or diabetes at any age

Answer 35

Pharmacologic treatment at BP 140/90

Question 36

Therapy recommendation for <60 but not with CKD or diabetes

Answer 36

Pharmacologic treatment at BP 140/90

Question 37

Therapy recommendation for >60 and not with CKD or diabetes

Answer 37

Initiate Pharmacologic treatment at BP 150/90

Question 38

CKD+HTN treatment

Answer 38

ACE or ARB

Question 39

>18 yo Black with HTN therapy

Answer 39

Thiazide or CCB

Question 40

>18 non black non CKD with HTN therapy

Answer 40

Thiazaide, CCB, ACE, or ARB

Question 41

HTN Follow up

Answer 41

With initiation - monitior every 2-4 weeks until BP is achieved Once stable - every 6 months, monitor K+ and Creatinine

Question 42

Resistant Hypertension Treatment

Answer 42

refer to HTN specialist | add on a 4th agent

Question 43

HTN Urgency Management

Answer 43

``` Lower BP over hours to days Goal of <160/100 or no more than 25-30% of baseline BP Furosemide - if not volume depleted Oral clonidine oral captopril- if not volume overloaded ```

Question 44

HTN Emergency Management

Answer 44

``` Immediate but careful reduction of BP Excessive hypotension may lead to ischemic complications IV Agents: Nitroprusside, nitroglycerin, Nicardipine labetolol esmolol hydralazine ```