Cardiology Flashcards
Primary (essential) HTN
elevated systolic/diastolic BP as defined w/out a defined etiology
secondary HTN
elevated BP with an identified cause
resistant HTN
BP uncontrolled despite adherence to an appropriate 3 drug regimen, where all drugs are >50% recommended dose
Refractory HTN
patient w/ resistant HTN, who cannot be controlled on >4 meds
Masked HTN
bp consistently elevated out of offive , but does not met criteria for HTN in office
MAP
Normal range 70-110 (<60 concern for insufficient perfusion through organs)
HTN Urgency
severe HTN (>120 DBP) in asymptomatic pt
HTN Emergency
Severe HTN (>120DBP) with acute end-organ damage
HTN complications Brain
Brain:
Stroke, hemorrhage, cerebral atrophy and dementia
HTN risk factors
Age obesity family history race high NA+ diet alcohol abuse physical inactivity diabetes dyslipidemia Hostility/rage depression
Secondary HTN (common cause)
#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/amphetaminesSecondary HTN (Uncommon causes)
Pheochromocytoma
endocrine disorders
Coarctation of aorta
Renovascular HTN (cause)
Older pt: atherosclerosis
Younger: Fibromuscular dysplasia
HTN complications Eyes
Retinopathy, vitrious hemorrhage, imparred vision and blindness
HTN complications Kidneys
CKD,
End stage renal disease
HTN complications Cardiac
Coronary heart disease, ischemic heart disease Lft ventricular hypertrophy heart failure Acute Aortic Dissection Arterial aneurism Hypertensive emergency
HTN Diagnosis
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
Normal BP
<120/80
Prehypertension (BP)
<139/89
Stage 1 HTN (BP)
<159/99
Stage 2 HTN (BP)
> 160/100
Isolated systolic HTN
Systolic >140
Isolated Diastolic HTN
Diastolic >90
Key factors in PMH to indicate HTN
H/o HTN Stroke TIA CAD Heart failure CKD Peripheral Artery Disease Diabetes/ dyslypidemia
Key factors in Family History to indicate HTN
HTN
Diabetes
Dyslipidemia
Key factors in Medication History to indicate HTN
Nsaids stimulants antidepressants high dose OCP cold remedies glucocorticoids Folk remedies/ OTC herbals
Key factors in Social History to indicate HTN
Smoking alcohol illicit drugs work/life stress exercise diet sleep habits
HTN initial symptoms - may indicate HTN emergency
headaches, dizziness, weakness, vision changes, SOB Chest Pain Claudication Palpitations fatigue Weight gain
Evaluation HTN - Physical Exam
BP, Pulse BMI Waist circumference eyes neck - bruits Cardiac exam Lung exam abdominal exam extremities neuro exam
Secondary HTN S&S
Age >30 Stage 2 HTN - unresponsive to Tx Episodic Morbid obesity- Snoring pallor, edema
HTN Diagnostic labs
BMP +LFT or CMPFasting Lipids H-crit Urinanalysis ECG - see previous MI, arrhythmia Urine Albumin to creatinine ratio
Pre-HTN and HTN non-pharmalogical treatment
Weight loss Decrease Dietary NA+ increase Physical Activity Moderation of alcohol (smoking cessation for decreased CVD)
HTN treatment Pharmacological
Diuretics, CCB, ACE, ARB
BB (No longer used)
Therapy recommendation for PreHTN
Non-pharmacological only
Therapy recommendation for CKD or diabetes at any age
Pharmacologic treatment at BP 140/90
Therapy recommendation for <60 but not with CKD or diabetes
Pharmacologic treatment at BP 140/90
Therapy recommendation for >60 and not with CKD or diabetes
Initiate Pharmacologic treatment at BP 150/90
CKD+HTN treatment
ACE or ARB
> 18 yo Black with HTN therapy
Thiazide or CCB
> 18 non black non CKD with HTN therapy
Thiazaide, CCB, ACE, or ARB
HTN Follow up
With initiation - monitior every 2-4 weeks until BP is achieved
Once stable - every 6 months, monitor K+ and Creatinine
Resistant Hypertension Treatment
refer to HTN specialist
add on a 4th agent
HTN Urgency Management
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
HTN Emergency Management
Immediate but careful reduction of BP Excessive hypotension may lead to ischemic complications IV Agents: Nitroprusside, nitroglycerin, Nicardipine labetolol esmolol hydralazine
