Cardiovascular Flashcards
BP equation
BP = HR (heart rate) x SV (stroke volume) x PVR (peripheral vascular resistance)
* Increase in any part of formula will increase BP
Brain: outcome of HTN
stroke, vascular (multi-farct) dementia
Cardiovascular system: outcome of HTN
atherosclerosis, myocardial infarction (MI), left ventricular hypertrophy (*most common), heart failure
Kidney: outcome of HTN
hypertensive nephropathy, renal failure
Eye: outcome of HTN
hypertensive retinopathy w/ risk of blindness
Wt reduction for HTN and dyslipidemia: recommendation and average SBP reduction rate
BMI = 18.5-24.9
SBP reduction = 5-20 mm Hg/10 kg Wt loss
DASH eating plan for HTN and dyslipidemia: recommendation and average SBP reduction
Rec: diet rich in fruit, vegies, low-fat dairy product
SBP reduction = 8-14 mm Hg
Sodium reduction in HTN: recommendation and average SBP reduction
Rec: 2.4 g Na or 6g NaCl
SBP reduction = 2-8 mm Hg
Aerobic exercise for HTN and sydlipidemia: recommendation and average SBP reduction
Rec: moderate to vigorous aerobic exercise min. 40 min/day, 3-4 days per wk
SBP reduction = 4-9 mm Hg
Alcohol consumption for HTN: recommendation and average SBP reduction
Rec: Men- limit to < 2 drinks/day, women; limit to < 1 drink/day
SBP reduction = 2-4 mm Hg
Meds for HTN and other cardiac meds: Classes (6)
Diuretic (thiazide) ACEI ARB (Diuretic, ACEIs and ARBs are the main HTN meds) CCB Beta-blockers Aldosterone antagonist
Good HTN meds for Afro-Am Pts
Diuretics and CCBs
*Afro-Am Pts tend to not respond to ACEIs
Diuretic (thiazide): examples, mechanism, adverse effects
E.g.: HCTZ (HydroDiuril), chlorthalidone (Hygroton)
BP= HR x SV x PVR (decrease PVR)
Ca sparing. Less effective w/ GFR < 30 mL/min/1.73
ACEI (-pril): examples, mechanism, adverse effects
E.g.: Lisinopril (Prinivil, Zestril), enalapril (Vasotec) BP= HR x SV x PVR (decrease PVR) K sparing (hyperkalemia risk w/ inadequate fluid intake, renal impairment, when used w/ aldosterone antagonist. Cough (use ARB instead). Do not use during pregnancy
ARB (-sartan): examples, mechanism, adverse effects
E.g.: Losartan (Cozaar), telmisartan (Micardis) BP= HR x SV x PVR (decrease PVR) K sparing (hyperkalemia risk w/ inadequate fluid intake, renal impairment, when used w/ aldosterone antagonist. Do not use during pregnancy. Do not use w/ ACEI
Ca channel blocker (CCB): examples, mechanism, adverse effects
Dihydropyridine examples: Amlodipine (Norvasc), all w/ -ipine suffix
Other CCB example: Diltiazem (Cardizem LA)
BP= HR x SV x PVR (decrease PVR)
Ankle edema. Avoid use or use w/ caution in Pts w/ HF, renal or hepatic impairment
Beta-adrenergic antagonist (beta-blockers, -lol suffix): examples, mechanism, adverse effects
Cardioselective: Atenolol (Tenoretic), metoprolol (Toprol, Lopressor)
Non-cardioselective: propranolol (Inderal), labetalol
BP = HR (decrease) x SV (decrease) x PVR
Avoid non-cardioselective beta blocker in Pts w/ low airway Dz
Aldosterone antagonist: examples, mechanism, adverse effects
E.g.: Spironolactone (Aldactone), eplerenone (Inspra)
BP = HR x SV x PVR (decrease)
Gynecomastia risk w/ prolonged use. Hyperkalemia risk w/ ACEI, ARB use or volume depletion including excess diuresis
Normal BP range
SBP < 120 and DBP < 80 mm Hg
Elevated BP range
SBP 120-129 mm Hg and < 80 mm Hg
Stage 1 HTN range
SBP 130-139 mm Hg or 80-90 mm Hg
Stage 2 HTN range
SBP =/> 140 mm Hg or DBP =/> 90 mm Hg
Hypertensive emergency
> 180 mm Hg and/or > 120 mm Hg
Elevated BP: intervention, drug Thx consideration
120-129/80 mm Hg
Non-pharmacological Thx
Reassess BP in 3-6 months
Stage 1 HTN: intervention, drug Thx consideration
130-139/80-90 mm Hg
Non-pharmacological Thx, reassess BP in 3-6 months. *Reasess in 1 mo. w/ clinical ASCVD or estimated 10 yr CVD risk =/> 10%.
First line: thiazide diuretics, CCBs, ACEIs or ARBs
Stage 2 HTN: intervention, drug Thx consideration
Non-pharmacological Thx and BP lowering med
Reassess BP in 1 mo.
Consider initiating 2 1st line agents of different classes.
Hypertensive urgency vs. hypertensive emergency
Urgency: HTN w/ minimal or no acute target organ damage (SBP > 180 mm Hg and/or DBP > 120 mm Hg)
Emergency: HTN w/ acute target organ ischemia and damage
Encephalopathy, hemorrhagic/ischemic stroke, papilledema, ACS, HF, pulmonary edema, aortic dissection, proteinuria, hematuria, acute renal failure
Dyslipidemia: Screening guidelines
- Complete lipid profile (fasting) starting at age 20 (then every 5 years)
- Older than age 40 years, screen every 2 to 3 years
- Preexisting hyperlipidemia: Screen annually or more frequently
Total Cholesterol values: Normal, borderline, high
- Normal: Less than 200 mg/dL
- Borderline: Between 200 and 239 mg/dL
- High: Greater than 240 mg/dL
HDL Cholesterol values: Normal (men, women)
Men: Greater than 40 mg/dL
Women: Greater than 50 mg/dL
- Greater than 60 mg/dL is HIGH!
Which medications can increase HDL?
Statin, niacin
LDL Cholesterol values: Optimal, high, very high
Optimal: Less than 100 mg/dL
High: 160 - 189 mg/dL
Very high: Greater than 190 mg/dL
Triglycerides: Normal
Normal: Less than 150 mg/dL
Dyslipidemia/hyperlipidemia Tx
Life style changes: Wt reduction, regular exercise, DASH diet, lowering saturated fat, smoking cessation)
Lipid-lowering medications
Statins
Statin drug interactions
- Avoid grapefruit juice
- Fibrates
- Antifungals (itraconazole, ketoconazole)
- Macrolides (erythromycin, clarithromycin, telithromycin)
- Amiodarone (Cordarone)
- some CCBs (diltiazem, amlodipine, verapamil)
Causes of secondary HTN (HTN w/ identifiable cause)
- Sleep apnea
- Drugs
- CKD
- Primary aldosteronism
- Renovascular Dz
- ushing’s or long term corticosteroid use
- Pheochromocytoma
- Coarctation of the aorta
- Thyroid or parathyroid Dz
Hypertensive urgency: definition
BP > 180/ >120; HTN w/ minimal or no acute target organ damage; must be reduced within a few hours
Hypertensive crises: PO Thx
CCB: Nicardipine PO 30 mg (repeat q8hrs until the target BP is achieved)
Captopril PO 12.5-100 mg (q8hrs)
Labetalol PO 200 mg (repeat q 3-4hrs)
Clonidine 0.2 mg loading then 0.1 mg q1hr (clonidine is unpredictable so use carefully)
Hypertensive crises: IV Thx
Nitroprusside: 0.25 - 10 mcg/kg/min Labetalol 20 - 80 mg IV push q10 min Nicardipine 5-15 mg/hr Nitroglycerin 5 - 1000 mcg/min Esmolol 0.5 mg/kg loading dose then 0.05-0.2 mg/kg/min Hydralazine: 10-20 mg q 20-30 min
Hypertensive emergency: definition
HTN w/ acute target organ ischemia and damage; decrease MAP by 25 per cent within min to 2 hrs w/ IV agents. Goal = DBP , 110 mm Hg within 2-6 hrs.
Hypertensive emergency: clinical manifestation
Neurologic: encephalopathy, hemorrhagic or ischemic stroke, papilledema
Cardiovascular: ACS, HF, pulmonary edema, aortic dissection
Renal: proteinuria, hematuria, acute renal failure