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Clinical Medicine > Cardiovascular Module > Flashcards

Cardiovascular Module Flashcards

1
Q

Hypertension Risk Factors

A 
Age/Gender - Men: Middle age; Women: Post Menopause
Race - African Americans
Family History
Obesity
Sedentary Lifestyle
Low potassium diet
High salt diet
Tobacco Use
Alcohol
Stress
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2
Q

What race is correlated with higher blood pressure?

A

African American

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3
Q

When do women have a higher risk for HPTN?

A

Post menopause

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4
Q

When do men have a higher risk of HPTN?

A

Middle Age

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5
Q

How is a sedentary lifestyle correlated with HPTN?

A

Indirectly affects BP due to direct effect on weight.

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6
Q

What chronic conditions are HPTN risk factors?

A

Sleep Apnea - correlated with obesity
Endocrine diseases
Kidney disease- change in response to ADH and Aldosterone

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7
Q

How does the brain affect blood pressure?

A

The brain controls the adrenergic system.

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8
Q

What hormones affect blood pressure?

A

Adrenaline
Aldosterone
Angiotensin II
ADH

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9
Q

What are the symptoms of HPTN?

A

Headache
Fatigue
Dizziness
End Organ Damage

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10
Q

What is the most common way HPTN is discovered?

A

Screening

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11
Q

How do most patients with HPTN present?

A

Asympomatic

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12
Q

What are the signs of HPTN?

A

Usually related to other contributing conditions and/or end organ damage.

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13
Q

Why should we treat HPTN?

A

Reduce the risk of cardiovascular events.

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14
Q

What cardiovascular events can occur due to HPTN?

A 
Stroke -  ischemic or hemorrhagic
Myocardial Infarction
Peripheral Arterial Disease
Congestive Heart Failure
Left Ventricular Hypertrophy
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15
Q

What is the effect on the heart with left ventricular hypertrophy?

A

Heart becomes weaker and the ventricle becomes smaller.

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16
Q

How do you choose a medication?

A 
Co-morbidity
Contraindications
Compliance
Limitation
Price
Side effects
Interactions
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17
Q

At what blood pressure would a patient sees benefits from medication?

A

> 140/90

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18
Q

According to the seventh national committee (JNC7) what is HPTN?

A

Elevated blood pressure in 2 or more visits.

Normal <80

Pre-hypertension: Systolic 120-139; Diastolic 80-89

Hypertension: systolic greater than or equal to 140; diastolic greater than or equal to 90

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19
Q

What is stage 1 HPTN?

A

SBP: 140-159
and/or
DBP: 90-99

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20
Q

What is stage 2 HPTN?

A

SBP >160
and/or
DBP >100

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21
Q

What is isolated systolic HPTN?

A

SBP > or equal to 140

DBP less than 90

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22
Q

What is isolated diastolic HPTN?

A

SBP less than 140

DBP > or equal to 90

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23
Q

What is optimal blood pressure?

A

SBP < 80

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24
Q

What is normal blood pressure?

A

SBP 120-129

DBP 80-84

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25
Q

What is high normal blood pressure?

A

SBP 130-139

DBP 85-89

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26
Q

What should be considered in a hypertensive patient with kidney disease?

A

More aggressive therapy and goals.

Ideally keep BP below 130/80

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27
Q

When should you consider starting a second medication for HPTN?

A

If BP is 20S/10D points higher from the target.

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28
Q

What are some calcium channel blockers?

A

Verapamil
Diltiazem
Amlodipine

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29
Q

What are side effects of calcium channel blockers?

A

Leg Edema- Dose dependent

Cancer?

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30
Q

What is long-acting Amlodipine used for?

A

Angina in COPD

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31
Q

What effect does Amlodipine have?

A

Vasodilator

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32
Q

What do Verapamil and Diltiazem do?

A

Effect heart rate

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33
Q

What negative impact can Verapamil and Diltiazem have?

A

Can worsen CHF

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34
Q

Is it beneficial to treat low risk patients?

A

Results unclear

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35
Q

What is the target BP for the elderly?

A

Variable

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36
Q

What work up should be done in those with HPTN?

A 
EKG
UA
Renal Function
Electrolytes
Glucose
CBC
Lipid Panel
ECHO
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37
Q

What drugs are superior in CAD?

A

Beta Blockers

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38
Q

What are some non-pharmacological approaches to HPTN?

A

Low sodium diet
Weight loss
Decrease alcohol intake
Aerobic exercise

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39
Q

What should be looked for in a UA with HPTN?

A

Protein in the urine

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40
Q

What are the top 4 medications for treating HPTN?

A

Diuretics (Thiazides)
Calcium channel blockers
Beta blockers
ACE Inhibitors/ Angiotensin Receptor Blockers

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41
Q

What medication is often used as an “add-on” for HPTN?

A

alpha blockers

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42
Q

What medication is inferior in protecting against stroke?

A

Beta blockers

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43
Q

What medication is often used in atrial fibrillation or CHF?

A

Beta blockers

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44
Q

What effect do beta-blockers have on migraines?

A

None

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45
Q

What are side effects of beta blockers?

A

Impaired glucose
Fatigue
Worsening COPD
Younger males - sexual dysfunction

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46
Q

What medication for HPTN is better after a heart attack?

A

Beta blockers

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47
Q

What are the types of beta blockers?

A

Selective

Non Selective

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48
Q

What are the thiazide medications?

A 
Hydrochlorthiazide
Chlorthalidone (longer hours 24-72)
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49
Q

What are common side effects of thiazides?

A

Hypokalemia
Glucose Intolerance
Hyperuricemia
Lipid disorder

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50
Q

What medications do not work in renal failure?

A

Thiazides

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51
Q

What is the most common dose for thiazides?

A

25 mg

Dose ranges from 6.5-50 mg

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52
Q

What are alpha 1 blockers used for?

A

Enlarged prostate symptoms

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53
Q

What are alpha 2 blockers used for?

A

Used in VERY high blood pressure

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54
Q

What are the side effects of alpha-1 blockers?

A

Dizziness

Orthostatic changes

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55
Q

What are the side effects of alpha 2 blockers?

A

Sedation
Fatigue
Depression
*Hypertensive rebound effect when medication is stopped

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56
Q

What are ACE inhibitors/ ARBs used for?

A

CHF
MI
Proteinuria
DM

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57
Q

What drug is highly contraindicated in pregnancy?

A

ACE I / ARB

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58
Q

What drugs for HPTN are #1 used in diabetics?

A

ACE I / ARB

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59
Q

What are the side effects of ACE I/ ARB?

A

*Dry cough
Hyperkalemia
Renal Failure

60
Q

Where to ACE I’s work?

A

Stop conversion of Angiotensin I to Angiotensin II to stop binding with the AT1 receptor preventing vasoconstriction.

61
Q

Where to ARBs work?

A

Block AT1 receptor which prevents vasoconstriction

62
Q

What are the components of arterial pressure?

A

Cardiac Output and Peripheral Resistance

63
Q

What are determines cardiac output?

A

Stroke Volume and Heart Rate

64
Q

What determines stroke volume?

A

Myocardial contractility and Size of the vascular compartment

65
Q

What determines peripheral resistance?

A

Vascular structure and function

66
Q

What happens to the elasticity of blood vessels with age?

A

Elasticity decreases

67
Q

What is the effect on blood pressure of increased myocardial contractility?

A

Increased Blood Pressure

68
Q

What is the effect on blood pressure of decreased myocardial contractility?

A

Decreased blood pressure

69
Q

What medications are used sparingly in hypertensive patients?

A

Hydralazine
A-Methyl Dopa
Minoxidil

70
Q

What HPTN medications work on the CNS?

A

Beta Blockers

Alpha 2 Agonists

71
Q

What HPTN medications work on the blood vessels?

A 
Alpha 1 Receptor Blockers
Calcium Channel Blockers
Vasodilators
AT1 Receptor Antagonists
ACE Inhibitors
72
Q

What HPTN medications work on the kidneys?

A

Diuretics
Beta Blockers
ACE Inhibitors

73
Q

What HPTN medications do African Americans respond well to?

A

Diuretics and Calcium Channel Blockers

74
Q

What HPTN medications do African Americans respond poorly to

A

ACE I and ARBs

75
Q

What HPTN medications have dose-dependent side effects?

A

Beta Blockers

Calcium Channel Blockers

76
Q

Should you look for a reason for secondary HPTN?

A

In general- looking for a reason has little value and is not cost effective unless there are clues suggestive for secondary causes.

77
Q

When do you treat secondary HPTN?

A

Severe or resistant to treat.
Acute Rise.
Age <30, non-obese, no family history, no other risk factors.
Malignant or accelerated with end organ damage.

78
Q

What work up should be performed for secondary hypertension?

A 
Renal Imaging
Plasma rennin activity
Plasma and Urine Catecholamines
MRA, duplex US
CTA
79
Q

What is the most common cause of secondary HPTN?

A

Renal Artery Stenosis

80
Q

What is the most underestimated cause of secondary HPTN?

A

Sleep Apnea

81
Q

What are the causes of secondary HPTN?

A 
Genetics
Abdominal bruits
Primary Hyperaldosteronism
Phenochromocytoma
Cushing's Syndrome
Sleep Apnea
Coaractation of the Aorta (evidenced by radial-femoral delay; check pulse in lower limbs)
Medications
82
Q

What is hypertensive urgency?

A

SBP Greater than or Equal to 180

DBP Greater than or Equal to 120

83
Q

What symptoms are seen in hypertensive urgency?

A

No symptoms or just a headache

84
Q

What are the common causes of hypertensive urgency?

A

Not taking medications

Too much salt

85
Q

What is the goal in treating hypertensive urgency?

A

Gradual reduction to safer level - 160/100

86
Q

How do you treat hypertensive urgency?

A 
Rest
Reduce anxiety
Restart medications
Add or increase dose
Decrease salt
Send home with follow up in a few days
87
Q

What is a hypertensive emergency?

A

End Organ Damage
SBP greater than or equal to 180
DBP greater than or equal to 120

88
Q

What are signs of a hypertensive emergency?

A 
Encephalopathy
Retinal Hemorrhage
Papiledema
Acute Renal Failure
Chest Pain
EKG Changes
89
Q

How do you treat a hypertensive emergency?

A 
*Nitroprusside
Nitroglycerine
Labetalol
Nicardipine
Clevidipine
Hydralazine
Enalaprilat
90
Q

Which medication is the most rapid and has the most potent duration of action?

A

Nitropusside
2-5 minutes
Important in hypotension

91
Q

What is a side effect of Nitroprusside?

A

Cyanide Toxicity >24 hours or with renal failure.

92
Q

Why do you want to avoid over reduction of blood pressure in stroke?

A

You must avoid ischemia to the surrounding healthy areas.

93
Q

What should be considered in management of acute pulmonary edema?

A

Consider nitroglycerine and diuretics; avoid Labetalol which could affect contractility.

94
Q

What management considerations are necessary for aortic dissection?

A

Nitroprusside should only be used after controlling the heart rate with a beta blocker.

95
Q

What should not be used in acute increases in sympathetic activity caused by pheochromocytoma or cocaine?

A

Beta Blocker alone- will have alpha adrenergic unopposed and this will raise BP.

96
Q

What should be used in acute increases in sympathetic activity caused by pheochromocytoma or cocaine?

A

Nitroprusside

Phetolamine (alpha adrenergic blocker)

97
Q

What causes orthostatic hypotension?

A

Autonomic reflexes are impaired or intravascular volume is depleted.

98
Q

What are risk factors for orthostatic hypotension?

A 
Elderly
Medications
Diabetic Neuropathy
Autonomic Dysfunction
Parkinsons
Pareneoplastic
Familial
99
Q

What is orthostatic hypotension similar to?

A

Aortic Stenosis
Arrhythmia
Postural Tachycardia Syndrome
Postprandial Hypotension

100
Q

What are symptoms of orthostatic hypotension?

A

Dizziness
Weakness
Syncope

101
Q

How is orthostatic hypotension diagnosed?

A

Fall of 20 systolic or 10 diastolic 2-5 minutes in supine position.

102
Q

What does an increase in heart rate of greater than 30 BPM suggest?

A

Postural Tachycaridia Syndrome

103
Q

What is the work up for orthostatic hypotension?

A

CBC
Renal Function
Glucose

104
Q

What is the treatment for orthostatic hypotension?

A 
Avoid/treat primary reason
Fluids
Arise slowly
Avoid long standing
Avoid coughing, hot weather, straining
Wear elastic stocking extended to the waist
Tense the legs

Increase salt and water consumption
Avoid large meals

105
Q

What medications are used to treat orthostatic hypotension?

A

Fludrocortisone
Midodrine alpha1 adrenergic
Caffeine

106
Q

What are the risk factors of coronary artery disease?

A 
Smoking
Dyslipidemia
Hypertension
Diabetes
Abdominal obesity
Psychosocial factors
Physical activity
Family History
Age
Gender
Collagen Vascular Disease
Infections!
Sleep apnea
Homocystiene
Cocaine
Methamphetamine
Takotsubo stress cardiomyopathy
Anemia
Arrhythmia
Hypoxia
107
Q

What are the symptoms of an MI?

A 
Chest Pain
SOB
GI
Diaphoresis
Dizziness
Fatigue
Sudden Death
108
Q

What are signs of an MI?

A 
Sweating
Increased heart rate
Change in blood pressure
New murmurs/ heart sounds
Chest congestion
Irregular heart beat
109
Q

What diagnostics are performed on someone with CAD?

A 
EKG
Cardiac Enzymes
CXR
CBC
Renal Function
Electrolytes
Transthoracic Echo
Stress Test/ coronary angiogram
110
Q

What are appropriate questions to ask about a patient’s chest pain?

A 
Location
Radiation
Quality
Duration
Response to medication
Provoking factors
Timing
111
Q

What is the pathophysiology of an aortic dissection?

A

A tear in the aortic intema which could involve branch vessels, the aortic valve, or could enter the pericardial space.

112
Q

What can aortic dissection cause?

A

Ischemia
Aortic regurgitation
Cardiac Tamponade

113
Q

Who is most likely to get aortic dissection?

A

Mostly men aged 60-80.

114
Q

What is the most predisposing factor for aortic dissection?

A

Hypertension

115
Q

What are risk factors for aortic dissection?

A 
Hypertension
Inflammatory changes such as vasculitis, Giant Cell Arterities, Takayasu, Syphilitic Aortis, RA
Marfan Syndrome
Ehler-Danlos Syndrome
Aortic coarctation
Turner Syndrome
CABG
Cardiac catheterization
High Intesnsity Weight Lifting
116
Q

What are the signs and symptoms of aortic dissection?

A 
Severe sharp or tearing chest pain
Syncope
CVA
Myocardial Infarction
Painless in cases like DM
Patients are usually hypertensive but not always.
117
Q

How is aortic dissection diagnosed?

A 
CXR
Ct scan
MRI
Aortogram
TTE
118
Q

How is a Type A aortic dissection treated?

A

Surgically

119
Q

What is a Type A aortic dissection?

A

An aortic dissection which occurring in the ascending aorta.

120
Q

What is a Type B aortic dissection?

A

An aortic dissection occurring in the descending aorta.

121
Q

How is a Type B aortic dissection treated?

A

Medically

122
Q

What is peripheral vascular disease?

A

Accumulation of lipid and fibers in the intimal and medial layers of the vessel.

123
Q

What are the risk factors of PVD?

A 
Age >50
DM
Smoking
Men
Family History
HTN
Hyperlipidemia
Homocysteinemia
Metabolic Syndrome
124
Q

What are the symptoms of PVD?

A 
Claudication
Diminished pulses
Tissue loss
Ulcer gangrene
Limb threatening ischemia
Erectile dysfunction (common iliac disease)
Bruit, pale, ulcer, loss of hair
Nerve involvement
125
Q

What imaging should be ordered for PVD?

A

CTA
MRA
Angiogram

126
Q

How is PVD managed?

A

Smoking
Risk Factors
Exercise
Phosphodiesterase inhibitors

127
Q

How is PVD treated?

A

Angioplasty
Stent
Bypass graft - Aorto-femoral or axillo-femoral

128
Q

What is the ankle-brachial index?

A

The blood pressure difference between the ankle and the brachial artery.

129
Q

What ankle-brachial difference may indicate PVD?

A

<0.9

130
Q

What is a normal Ankle-Brachial Index?

A

1-1.2

131
Q

What are the symptoms of acute PVD?

A 
Embolus or Thrombosis
Pain
Low Pulse
Numbness
Pallor especially on elevation
Cool limb
Acidosis
132
Q

How is acute PVD treated?

A 
QUICKLY!!
Irreversible damage occurs >3 hours
Heparin
TPA
Catheter based
133
Q

What causes chronic venous insufficiency?

A

Trauma
DVT
Obstruction

134
Q

What are the symptoms of chronic venous insufficiency?

A

Edema
Dull Pain
Skin Changes
Ulcers

135
Q

What causes superficial thrombophlebitis?

A

Intravenous catheters
Trauma
Pregnancy

136
Q

What are the symptoms of superficial thrombophlebitis?

A

Pain
Redness
Tenderness
Tends to improve in 1-2 weeks

137
Q

How is superficial thrombophlebitis treated?

A

Head
NSAID
Anticoagulation
ABX with infection

138
Q

What causes deep vein thrombosis?

A 
Cancer
Immobilization
Coagulopathy
Birth Control
Major surgery
139
Q

What are the symptoms of DVT?

A

Pain
Swelling
Redness
Pulmonary Embolism

140
Q

What is Virchow’s Triad?

A

The three factors leading to thrombosis:
venous stasis
vessel wall injury
altered blood coagulation

141
Q

How is a thrombus formed where there is no inflammation?

A

through phlebothrombosis

142
Q

What leads to a thrombus formation where inflammation is present?

A

The thrombus would cause inflammation of the vein walls or what we call thrombophlebitis. This will eventually lead to thrombus formation.

143
Q

What is Virchow’s Triad?

A

Stasis
Hypercoagulability
Intimal Change

144
Q

What are venous thrombi?

A

Accumulation of platelets in response to inflammation which attach to the vein wall adn contain a tail-like attachment made of WBCs, RBCs, and fibrin.

145
Q

How do you diagnose a DVT?

A

Duplex US
D-Dimer
Venogram
Serial US

146
Q

How is a DVT treated?

A

Anticoagulation
Thrombolysis
Greenfield Filter

147
Q

When is a Greenfield Filter used?

A

when anticoagulation therapy is contraindicated

Clinical Medicine (4 decks)

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