Cardiovascular Flashcards
what is isolated systolic hypertension?
systolic pressure >160 with a diastolic pressure <90
what initial labs should be drawn with a hypertensive patient
serum creatinine postassium glucose fasting lipid profile UA electrocardiogram
A ratio of aldosterone to plasma reinin activity (PRA) greater than what is suggestive of primary aldosteronism.
20
if a patient presents w/ HTN, hypokalemia and difficult to control BP what should they be evaluated for?
primary aldosteronism
how are aldosterone levels attempted to be suppressed?
high sodium diet
If a patient has difficult to control BP, spells of palpitations, HA and marked elevated BP what should be suspected?
pheochromocytoma
What test is highly sensitive for pheochromocytomas?
plasma metanephrines
What are diastolic pressures <65 associated with?
increased stroke risk
IV meds for hypertensive emergencies
labetalol (alpha/ beta blocker)
nicardipine (CCB)
fenoldopam (dopamine-1 agonist)
when should antihypertensive meds be started in patients who don’t attain BP goals w/ lifestyle changes?
after 6-12 months of nonpharm therapy
ADR of diuretics
urinary frequency
muscle cramps
ADRs of ACE inhibitors
cough
angioedema
ADR of beta blockers?
bradycardia sexual dysfunction
what is an alpha-2 agonist used for BP?
clonidine
what are alpha-1 antagonists?
doxazosin, terazosin
what is used to treat primary aldosteronism?
aldosterone antagonist (sprionolactone)
most commonly affected valvues for valvular heart disease
aortic and mitral
aortic valvue disease is more common in what sex?
male
most common cause of valvular heart disease?
rheumatic fever
do stenotic valvular lesions lead to pressure overload or volume overload?
pressure
symptoms seen with aortic stenosis
exertional angina
effort-related syncope
dysnpea (from LV systolic/ diastolic dysfunction)
symptoms seen w/ aortic regurgitation
foreceful heartbeat/ palpitations (increased LV stroke volume)
angina
exertional dyspnea
what valvular condition can present w/ exertional dyspnea, palpitations, hemoptysis
mitral stenosis
what valvular disease present with a systolic, crescendo-decresendo at upper sternal border?
aortic stenosis
what valvular problems presents with a diastolic rumbe at LV apex?
mitral stenosis
what valvular condition presents w/ holosytolic murmur at LV apex that radiates to axilla?
mitral regurgitation
what type of valvular problems presents with a decrescendo diastolic “blow” parasteneral
aortic regurgitation
what are some peripheral manifestations of increased pulse pressure (associated w/ aortic regurgitation)
pulsatile flow in nail beds
head bobbing
rapidly rising falling carotid pulse
bobbing uvula
Diagnostic studies for valvular heart diseases
EKG
chest x-ray
echo
treatment for mitral stenosis
heart rate control (beta blockers or CCB)
treatment for acutely symptomatic mitral regurg
afterload reduction- nitroprusside or hydralazine
diuretics
treatment for aortic regurgitation
afterload reduceion w/ ACEI or CCB
what signals the development of tight mitral stenosis
short S2 to OS interval, prolonged diastolic murmur, left arterial enlargement
what toxicity should be considered in patients presenting w/ a-fib w/ regular ventricular response?
digoxin
bradyarrythmias w/ progressively increasing PR intervals before a dropped QRS complex
Type-1 second degree block (Wenckebach)
