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Phase 2 PEDs > CV > Flashcards

CV Flashcards

1
Q

Infantile CHD S/S?

A

No mumurs initially

- Sweating w/ feeds OR FTT - 1st S/S

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2
Q

Older children w/ CHD may present w/?

A

Chest pain

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3
Q

Standard cardiac tests of PEDs?

A 
CXR - AP/LAT (r/o pulm dz)
O2 test
EKG
Echo
Cardiac Cath
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4
Q

Oxygen test is used to?

A

Differs lung vs Cardiac etiology in cyanotic infant

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5
Q

Oxygen test is performed how?

A
  1. Baseline SO2 or PaO2
  2. 100% O2 for 30m
  3. Recheck O2 sat/abg
    Results - no Change = cardiac process
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6
Q

MC symptomatic arrhythmia is?

A

SVT - responds to vagal maneuvers or adenosine

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7
Q

Definitive Dx cardiac test?

A

Echo > confirmed w/ Cardiac cath (dx/txt)

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8
Q

EKG may help differ what?

A

Hypertrophy from dilation

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9
Q

Fx murmur is AKA?

A

Benign or innocent

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10
Q

Types of Fx(benign) murmurs?

A

Fx murmur of peripheral arterial PS
Venous hum
Stills murmur (LV outflow)
Pulmonary flow murmur (RV outflow)

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11
Q

Types of pathologic murmurs?

A 
AS/PS - AR/PR
MS/TS - MR/TR
ASD/VSD
PDA
MVP
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12
Q

Still murmur attributes?

A

Systolic EJ
LLSB or between LLSB and apex
Musical vibratory
Upright will decrease intensity

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13
Q

V-Hum murmur attributes?

A 
Continuous murmur
Infraclavicular region (R>L)
Upright = louder
Changes = turn head, jugular vein compression
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14
Q

Carotid Bruit attributes?

A

Systolic EJ - neck, over carotid artery

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15
Q

Types of atrial dysrhythmias?

A

WAP - wandering atrial PM
PAC - Premature atrial contractions
A-Flut - Regular/Rapid - s/p surgery, myocarditis
A-Fib - Irregular/Rapid - s/p surgery, myocarditis
SVT

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16
Q

MC atrial dysrhythmias? attributes?

A

SVT - rapid, regular, narrow QRS

HR - 280-300 in infants

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17
Q

TXT of SVT?

A

Vagal maneuvers
IV adenosine
CV compromise = cardiovert

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18
Q

SVT may be caused by what other dysrhythmias?

A

WPW

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19
Q

Ventricular dysrhythmias?

A

PVCs - premature ventricular contraction
V-Tach
V-Fib

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20
Q

PVC attributes?

A

Benign - Premature beat - NO p-wave

- Wide/bizarre QRS

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21
Q

When should PVC be eval?

A

Syncope or Fam Hx

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22
Q

V-tach attributes?

A

> 3 Consecutive PVCs = serious dz

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23
Q

TXT of V-tach?

A

PVT - V-fib
Symptomatic pt = Cardiovert
Asymptomatic/alert = Lidocaine or Amiodarone

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24
Q

Types of Heart blks?

A

1st D* - Prolonged PRI - asymp
2nd D* - Mobitz I vs II
3rd D* - Complete HB

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25
Q

Difference between Mobitz I vs II?

A

Mobitz I

  • Progressive PRI prolonged until QRS drops - sleep
  • no txt

Mobitz II

  • PRI unchanged BUT QRS dropped intermittently
  • +- Pacemaker to PVT 3rd D*
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26
Q

Compete HB - 3rd D* attributes?

A

Atria and Ventricles have NO relationship

Must TXT

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27
Q

Fetal circulation shunts?

A

FO - R > L shunt between atria - bypass lungs
DA - R > L shunt between Pulm artery and Aorta - lungs
DV - Opening between Umbilical vein/IVC -O2 blood from placenta bypasses liver.

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28
Q

What is used to keep PDA open? and Why/When used?

A

Rx - Prostagladin E - to keep PDA open
IF
Cyanotic lesion is present

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29
Q

Types of acyanotic lesions?

A

ASD/VSD
PDA
Coarc
PS/AS

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30
Q

What type of shunt is an acyanotic lesion?

A

L > R shunt

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31
Q

MC congenital heart defect is?

A

VSD

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32
Q

VSD size correlation?

A

<3mm - Asymp
3-5mm - Mod S/S
> 5mm - CHF or FTT

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33
Q

VSD sounds like?

A

HARSH pansystolic murmur at LLSB

II-V

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34
Q

VSD W/u?

A

CXR - Biventricular enlargement, CHF, Cardiomegaly

EKG - LVH

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35
Q

VSD TXT?

A

1/3 - spon closure
> 3mm - Diuretics +- digoxin (reduce afterload)
Surgical if, FTT or Pulm HTN

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36
Q

When is surgery indicated for VSD?

A

FTT or Pulmonary HTN despite Rx TXT

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37
Q

ASD sounds like?

A

Early systolic at LUSB - I-III
- Fixed split of S2
+- rumbling diastolic murmur = flow across TV

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38
Q

ASD w/u?

A

CXR - RAE, Cardiomegaly, Pulm artery prominent

EKG - RAD, RVH (deviation to hypertrophy)

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39
Q

TXT of ASD?

A

Rare - mostly asymptomatic
BUT
Sig ASD shunt present >3yo - closure via cath/surgery

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40
Q

2nd MC congenital heart defect?

A

PDA

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41
Q

PDA s/s - size correlation?

A

Small - asymp

Mod-LRG - CHF

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42
Q

PDA sounds like?

A

Continuous machine like murmur

- LUSB infraclavicular > Left back

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43
Q

PDA pulses will be?

A

Bounding, w/ Widened pulse pressure

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44
Q

PDA eval?

A

CXR - full pulmonary silhouette/vascularity

EKG - RVH and +- LVH if pulm HTN present

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45
Q

PDA TXT?

A

Indomethacin- will close, CI if PDA is keeping PED alive

Cardiac cath

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46
Q

SE of Indomethacin for PDA?

A

Transient renal insufficiency

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47
Q

AS/PS s/s?

A

DOE and fatigue

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48
Q

AS sounds like?

A

II-III rough Systolic w/ EJ click of LUSB radiating to BACK

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49
Q

PS sounds like?

A

II-III rough Systolic w/ EJ click of RUSB radiating to NECK

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50
Q

AS/PS w/u?

A

CXR/EKG
PS - EKG = RAD/RVH and CXR = Pulm artery dilation
AS - EKG = LVH and CXR = LVH/Aortic dilation

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51
Q

TXT of AS/PS?

A

1L - Balloon valvuloplasty (PS > AS outcomes)

2L - Surgery - Fails or Subvalvular PS

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52
Q

Types of AS/PS?

A

Supra-valvular
Valvular
Sub-valvular

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53
Q

COA is AKA?

A

Coarctation of the Aorta

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54
Q

MC site of COA?

A

Thoracic next to DA

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55
Q

COA is ass/w what other lesions?

A

PDA
VSD
Aortic valve lesions

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56
Q

COA is ass/w what genetic anomaly?

A

Turners syndrome

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57
Q

COA sounds like?

A

I-II systolic murmur at LUSB w/ radiation to Left upper back next to scapula
+- continuous if collaterals develop

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58
Q

BP/Pulses of COA?

A

Femoral pulse - delayed/weaker than R radial pulse

BP Legs > Arms (HTN in arms)

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59
Q

COA is essential what?

A

Narrowed aorta

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60
Q

COA W/U? Infants vs Children?

A

CXR
Infants - RVH w/ cardiomegaly and PULM edema
Children - LVH, RIB NOTCHING and aortic bulge

EKG
Infants - RVH
Children - LVH

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61
Q

TXT of COA?

A

PG E1 - Alprostadil (PGE) - keeps DA open until
Surgery TOC
- Balloon angioplasty

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62
Q

Purpose of Prostaglandin E1 (PGE)?

A

Keeps DA open

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63
Q

Cyanotic lesions are essentially what type of shunt?

A

R > L - pushes deoxy blood into circulation

64
Q

Types of Cyanotic lesions?

A 
TOF
TGA
Tri-atresia
Trunc-arteriosus
TAVR - total anomalous venous return
Hypoplastic Left heart syndrome
Ebstein's Anomaly
65
Q

Mnemonic for Cyanotic lesions?

A

HE has 5Ts

66
Q

MC cyanotic heard defect?

A

TOF

67
Q

TOF attributes?

A

Requires all 4

  1. Overriding Aorta into RV
  2. PS
  3. VSD
  4. RVH
68
Q

What is the indicator of S/S severity w/ TOF?

A

Degree of PS

69
Q

What do TOF PEDs experience?

A

TET - Hypoxic spells in older PEDs

70
Q

What is a TET - Hypoxic spells?

A

Sudden - spon progressive cyanotic dyspnea
- loss of murmur
Resolves when - Squatting (increases Abd pressure)

71
Q

TOF sounds like?

A

I-III Rough systolic LUSB (aka PS)

72
Q

TOF w/u?

A

CBC - Polycythemia (Thombosis)
CXR - RVH - boot shaped heart
EKG - RAD/RVH

73
Q

TXT of TOF?

A

PGE if cyanotic at birth - keep PDA open
Surgery (TET spells is indication)
Bacterial endocarditis PRPH 6mo s/p surgery

74
Q

2nd MC cyanotic heart defect is?

A

TGA

75
Q

What is TGA?

A

Aorta begins at RV - Deoxy blood in circulation

Pulm artery begins at LV - Oxy blood cycles LV/Lungs

76
Q

In TGA does peripheral circulation receive O2?

A

NO - not unless L>R shunt present (PFO, PDA, ASD, VSD)

77
Q

Failure for baby to pink up at birth suggests what CHD?

A

TGA - cyanotic lesion

78
Q

TGA W/U?

A

EKG - RAD, RVH

CXR - egg on string shaped heart

79
Q

TXT of TGA?

A

PGE - keep L>R shunt open (PDA)

Surgery

80
Q

Tricuspid atresia is essentially what?

A

Underdeveloped RV

81
Q

What is required for life in Tricuspid atresia?

A

ASD - Systemic blood RA > LA

VSD - LV > RV into pulmonary arteries

82
Q

Mgmt of Tricuspid atresia if VSD not present?

A

PGE in order to keep PDA open at birth

83
Q

TXT of Tricuspid atresia?

A

PGE - keep PDA open

Surgery

84
Q

What is the blood flow of Tricuspid atresia?

A
  • IVC/SVC > RA > ASD > LA > LV > VSD > RV > Pulm arteries > Lungs
  • NO VSD - LV > Aorta > PDA > Pulm arteries > Lungs
85
Q

Truncus Arteriosus is essentially what?

A

Failure of septation of truncus causing no division of Pulmonary artery and Aorta

86
Q

What CHD is also present w/ Truncus Arteriosus?

A

VSD

87
Q

TXT of Truncus Arteriosus?

A

Surgery - septal creation (may require multiple surg)

AND close VSD

88
Q

Total Anomalous venous return is essentially?

A

Pulmonary veins (Oxy-bld) doesn’t connect to LA but instead to Right side of heart (RA or SVC)

89
Q

What is required for Total Anomalous venous return to be compatible w/ life?

A

ASD

90
Q

TXT of Total Anomalous venous return?

A

Surgery - Pulm vein connected to LA

91
Q

Hypoplastic Left heart syndrome is essentially?

A

Developmental failure of Aortic arch, Aortic valve, or MV - resulting in small LV

92
Q

What is required for Hypoplastic Left heart syndrome to be compatible w/ life?

A

DA - R>L shunting

93
Q

MC cause of cardiac deaths in 1st month of life?

A

Hypoplastic Left heart syndrome

94
Q

TXT of Hypoplastic Left heart syndrome?

A

PGE - keep DA open

- surgery - multiple

95
Q

Ebsteins Anomaly is essentially?

A

Malformed TV sits too low and leaflets are partly attached to RV causing it to act like the RA partially
AND
Fibrous TV annulus

96
Q

Ebsteins Anomaly is ass/w what other HD d/o?

A

TR - leaky TV

97
Q

Pathophys of Ebsteins Anomaly?

A

Blood leaks from RV into RA causing RAE >
RAE enlrg causes increased pressure in RA >
RA pressure causes R > L shunt through FO >
Cyanosis due to PFO (Patent foramen ovale)

98
Q

Ebsteins Anomaly pts will present as?

A

Cyanosis
CHF
Dyspnea

99
Q

Ebsteins Anomaly W/U?

A

CXR - Box haped heart, decreased pulm markings

EKG - RAD, RAH, Peaked/broad P-waves, RBBB

100
Q

EKG reading of Ebsteins Anomaly?

A

Tall, peaked P-waves (L-2 and V-1)
RAH/RAD (L1 - aVL)
RBBB

101
Q

What does cyanotic lesions generally require?

A

PGE1 to keep DA open (L>R shunt)

102
Q

All CHD/lesions causing CHF or HTN require?

A

Diuretics +- digoxin until surgery/def TXT (cath)

103
Q

Generally speaking when are acyanotic lesions corrected?

A

By 2yo w/ structural/developmental maturity

104
Q

UN-Txt lesions will generally all lead to?

A

Pulm HTN
CHF
SBE

105
Q

Trisomy 21 - downs is ass/w what CHD?

A

ASD, VSD, PDA

106
Q

XO - Turners is ass/w what CHD?

A

COA, AS

107
Q

Esophageal atresia is ass/w what CHD?

A

VSD - (VACTRL)

108
Q

Rheumatic fever is?

A

GAS strep infection cross reacting w/ Cardiac antigens causing Valvular scarring

109
Q

MC age of RF?

A

6-15yo

110
Q

Labs ordered for RF?

A

Anti-streptolysin O titer

111
Q

Dx of RF is based on what criteria?

A 
Jones criteria (2 Major -or- 1 Maj  + 2 minor)
\+ evidence of GAS infection, Increased ASO lab, scarlet fever or POS throat culture
112
Q

Major Jones criteria? (5)

A 
Carditis (Murmur, CHF, Pericarditis)
Polyarthritis
Sydenhams chorea
Erythema marginatum (pink serpiginous macs)
Sub-Q nodules
113
Q

Minor Jones criteria? (6)

A 
EKG changes - Prolonged PR or Heart BLK
Arthralgias
Fever (101-102)
Elevated ESR/CRP
Increased WBC
Hx of RF/RHD
114
Q

TXT of RF?

A

ABX - strep infection (PCN G Benz or Erythromycin)
ASA/NSAIDs - anti-inflammatory
(PO) CCS - prednisone or methylprednisolone (Carditis)

115
Q

RF prph?

A

PCN G Benz (IM) Q/28d

116
Q

Pericarditis is?

A

Inflammation of parietal/visceral pericardium

117
Q

MC etiology of pericarditis?

A

Viral

118
Q

MC bacteria to cause pericarditis?

A

Strep. Pneumo -or- S.A

119
Q

S/S of pericarditis?

A

SML effusion - well tolerated
LRG effusion BUT slow build - well tolerated
Rapid build of fluid = hemodynamic compromise

120
Q

When does pericarditis effusion become a problem?

A

If effusion builds rapidly

121
Q

Manifestations of PERICARDITIS?

A

Pulsus Paradoxus - >10mmHg w/ inspiration
Narrow pulse pressure
Kussmual sign
(CP, Dyspnea, Distended neck veins, Pericardial knock)
Edema/Ascites

122
Q

Pericarditis Imaging?

A

Echo - effusions
CXR - Rounded globular silhouette cardiomegaly
EKG

123
Q

Pericarditis Labs?

A

ASO titers - Viral titers

Cardiac Enzymes

124
Q

EKG results of pericarditis?

A

St elevation
Tachy-C
Electrical alternans - swinging heart in effusion

125
Q

Pericarditis TXT?

A

Pericardiocentesis - drain fluid
Viral - NSAIDs
Bacteria - Abx
CHF txt PRN

126
Q

When is pericarditis poor prognosis?

A

<6o old

Recurrent S/S

127
Q

Infective endoarditis is essentially?

A

Infection of the endothelial surface of heart resulting in vegetations MC on valve leaflets

128
Q

MC cause of in PEDs for infective endocarditis?

A

Viridian streptococci - PEDs w/ CHD w/out surgery
OR
S.A or Coag-Neg Staph - PEDs s/p cardiac surgery w/ prosthetic material

129
Q

Highest RF of infective endocarditis?

A

Hx of infective endocarditis
W/in 6mo - Prosthetic valves/material
Unrepaired congenital heart disease

130
Q

Other RF of Infective endocarditis?

A

Dental/oral procedure recently
Respiratory, GU, GI surgeries
RHD

131
Q

Neonate RF of infective endocarditis?

A

Central catheters or surgery

132
Q

MC early S/S of infective endocarditis?

A

Fever, Malaise, Wgt loss

Tachycardia - new/changed murmur

133
Q

W/U for infective endocarditis?

A

Blood Cx

134
Q

Difference between Acute vs Subacute infective endocarditis?

A

Subacute infective endocarditis - slow process

Acute infective endocarditis - similar to sepsis

135
Q

Acute infective endocarditis MC organism?

A

S.A.

136
Q

Infective endocarditis criteria?

A

DUKES criteria

  • HF
  • Splenomegaly
  • Petechiae
  • Embolic phenomena (Osler nodes/Roth Spots/Janeway lesions/Splinter hemorrhages)
137
Q

PVT of Infective endocarditis in High risk pts?

A

Prph Abx - all dental/resp/skin/muscle procedures
- (PO) Amoxicillin 30-60m before procedure
(Clindamycin or Azithromycin = PCN allergy)

138
Q

NL correct BP check protocol of PEDs?

A

> 3yo - Child sitting quiet 5m prior

139
Q

HTN - classified as?

A

Primary (Essential) HTN
and
Secondary HTN

140
Q

MC type of HTN in adolescents?

A

Essential HTN

141
Q

Obese children more likely to have what type of HTN?

A

Essential HTN

142
Q

MC cause of 2ndy HTN in PEDs?

A

Renal disease

143
Q

Which type of HTN is more severe?

A

2ndy HTN

144
Q

Which type of HTN occurs MC in younger PEDs?

A

2ndy HTN

145
Q

When to eval for 2ndy causes?

A

PEDs BMI is <85th%

BP >140/100

146
Q

2ndy causes of HTN + Turners syndrome indicates?

A

COA

147
Q

2ndy causes of HTN + Café-au-lait spots or Abd bruits indicates?

A

Renal Artery Stenosis

148
Q

2ndy causes of HTN + Precocious puberty indicates?

A

Renal artery stenosis

149
Q

2ndy causes of HTN + Edema indicates?

A

Renal disease

150
Q

2ndy causes of HTN + Excess sweating indicates?

A

Pheochromocytoma

151
Q

2ndy causes of HTN + Striae in boys indicates?

A

Drugs/Steroids

152
Q

Pediatric HTN eval?

A

UA, CMP (BUN/Cr,Lytes)

Renal U/S

153
Q

TXT of Stage 1 asymptomatic PEDs HTN?

A

Lifestyle mod only

154
Q

Stage 1 HTN essentially means?

A

No organ damage or systemic disease

155
Q

Indications for Rx in PEDs HTN?

A

Failed lifestyle Mod
Stage 1 HTN + symptomatic
Stage 2 HTN
DM

156
Q

HTN Rx by order used?

A

1L - CCB or ACEI

- Then - ARB, BB, Diuretic

Phase 2 PEDs (23 decks)

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