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AGNP AANC Boards > CV ( primary and secondary HTN) > Flashcards

CV ( primary and secondary HTN) Flashcards

1
Q

What is the 1st line dx test for murmurs?

A

echo w/ doppler

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2
Q

Systolic Murmurs

A

MR ASS is a MVP

  • mid to late holosystolic
  • MR - mitral regurg
  • AS - aortic stenosis
  • S - systole
  • MVP - mitral valve prolapse –> will become MR , will hear a “click”
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3
Q

MR

A

blowing or high-pitched
May radiate to the LEFT AXILLA

location: apex, apical area, mitral area, 5th ICS by mid-clavicular line

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4
Q

Aortic Stenosis

A

systolic ejection murmur
May radiate to the NECK

end stage - heart failure, syncope, agina, high risk for sudden death

Location:
- aortic area , at the “base” of heart

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5
Q

MVP

A

mid-systolic click with late systolic murmur at the mitral area

sx: usually asymptomatic or may complain of palpitations chest discomfort, dixxy, sob
labs: echo, TEE

Loacation : “ apex” apical area

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6
Q

Diastolic Murmurs

A

MS ARDe

MS: mitral stenosis

AR - Aortic regurgitation

e; erbs point ( AR can be heard here

  • always indicative of heart disease*
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7
Q

MS

A

low pitched - diastolic rumbling murmur that is loudest at the apex (use bell)

sy: DOE, dypnea *, afibb *
location: apex, apical area, mitral area,

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8
Q

When to use the bell of stethescope

A

MS and listening for extra heart sounds

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9
Q

AR

A

early diastolic decresendo blowing murmur. Aterial pulses could be abnormal

location: 3rd 4th ICS at the left sternal border ( erbs point)

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10
Q

Heart sounds

S1, S2,

A 
s1 = systole
s2 = diastole
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11
Q

S3

A

early Diastole “ ventricular gallop”

  • normal in pregnancy
  • more common in children and young adults
  • Abnormal if found after age 40 , may indicate heart failure
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12
Q

S4

A

Late diastole ( atrial kick)

LVH ( stiff)

can be a normal finding in elderly

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13
Q

Grading Murmurs

A

Grades 1-3 ( no thrill)
Grade 4 - first time thrill is palpated
Grade 5-6 - heard thrill)

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14
Q

A-fibb

A

can be paroxysmal or persistent
its a reduction in cardiac output and increased risk of emboli formation

key to evaluate pt need for antithrombotic therapy ( heart valve abnormality raises risk)

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15
Q

A- fibb presentation , dx, tx, avoid

A

complains of sudden onset heart palpitations, accomplanied by weakness, dizziness, fatigue, dyspnea.

may have rapid pulse and hypotension

dx: EKG ( no discrete P waves, irregularly irregular)

refer to cards

avoid: caffiene, nicotine, decongestants, alchol

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16
Q

What is the CHA2DS2- VASC score

A

assess for afibb stroke/emboli score

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17
Q

what are the two biggest risk factors in developing a stroke/ emboli

A
  • hx of a stroke/TIA/thromboemolism

- 75 or older

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18
Q

what is first line anticoagulation therapy for people with valvular abnormalities? what are the drug interactions?

A

warfarin

  • Sulfa drugs
  • Macrolides
  • NSAIDS
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19
Q

what is first line anticoagulation therapy for people with NO valvular abnormalities? what are the drug interactions?

A

Factor Xa inhibitors

PPI, antacids, H2 blockers, NSAIDS, clopidogrel

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20
Q

How long does it take on warfarin for the INR to change?

A

2-3 days

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21
Q

Pt education for warfarin

A

eat the same amount of vitamin K rich food daily
too much will decrease INR

high vitamin K foods: green-leafy vegetables, broccoli, brussel sprouts, cabbage, mayonnaise

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22
Q

What is the INR goal for anticaogulation?

A

2-3

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23
Q

what to do if INR is 3.1-4.0

A

check for any presence of bleeding

decrease maintaince dose 10% per week

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24
Q

what to do if INR is 4.1-5.0

A

check for bleeding

hold one dose. decrease weekly dose by 10

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25
Q

Length of therapy for first episode of provoked ( surgury) / unprovoked ( venous thromboembolism)

A

minimum 3 months

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26
Q

When will a pt be on anticoagulation for life?

A

with recurrent VTE, VTE w/ risk factors, unprovoked isolated distala DVT, VTE w/ malignacy

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27
Q

Pulse deficit

A

count the apical and radial pulses at the same time then subtract the difference

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28
Q

Pulsus Paradoxus

A

a decrease in the systolic BP of > 10 during inspiration ( must be more than 10,

causes: cardiac tamponade, pericardial effusion, acute MI, constrictive pericarditis

pulmonary causes: asthma, tension pnuemo, emphysema

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29
Q

Othrostatic hypotension

A

a decrease in the systolic BP of at least 20 or the diastolic of 10 in 3 min

best ways to check bp : supine then standing

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30
Q

Impending AAA rupture presentation

A

elderly man who is a smoker, complains of sudden onset of severe abdominal pain accompanied by severe low back pain, will appear shock like or incidental finding on cxr

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31
Q

What is the most common cause of sudden death in young healthy athletes?

A

Hypertrophic Cardiomyopathy as it causes VT

  • want to ask about congential CVD in sports phsycials
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32
Q

Acute Infective Endocarditis ( bacterial) presenation

A

fevers, chills, weight loss, heart murmur w/ petechie, splinter hemmorages, janeway lesions, oslers nodes,

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33
Q

Acute Infective Endocarditis ( bacterial) PE

A

splinter hemmorages : non blanching reddish lines on nailbed

NONtender erythematous macules on the palms and soles ( jameaway lesions)

subcutaneous TENDER violaceous nodules on the pads of fingers and toes (oslers nodes)

hemmorahagic lesions on retina w/ pale centers ( roth spots)

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34
Q

Endocarditits prophaylsis

A

Amox 2 gm 1 -hour prior to procedure

if PCN allergy - Keflex

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35
Q

who is at high risk for endocarfitis

A

prosethic heart valve
hx of infectious endocarditis
cyanotic congetial heart dx, CHF

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36
Q

what are the high risk procedures?

A

dental work, colonoscopy, bronchocopy w/ biopsy, TTE

37
Q

What is HTN a major risk factor for?

A

stroke, MI, Vascular disease, CKD

38
Q

What is the most common cause of secondary HTN

A

renal artery stenosis - renovascular

39
Q

What is end organ damage in HTN

A 
Heart failure
Carotid plaques
PVD/PAD
LVH
Kidney
UA
40
Q

Heart Failure end organ damage

A

s3, s4, dyspnea, edema, rales, elevated JVD

41
Q

Carotid plaques end organ damage

A

carotid bruits, high risk CAD

42
Q

PVD/PAD end organ damage

A

decreased or absent peripheral pulses

43
Q

LVH end organ damage

A

left ventricular heave, or increased size of PMI

44
Q

Kidney end organ damage

A

hypertensive nueropathy

45
Q

UA end organ damage

A

may show RBC, protein

46
Q

Renal artery Stenosis

A

cause of secondary HTN, called also Polycystic kidney dx

  • will hear a bruit in upper abdomen or will have englarged kidneys

doesnt mean they have CKD

dont use an ACE

47
Q

Other causes of secondary HTN

A
  • Hyperthyroidism
  • Pheochromocytoma ( tumor on adrenal gland)
  • Primary Hyperaldosteronism ( HTN w/ low K, and elevated NA)
  • Cushing syndrome
  • Addisions ( will see HYPO)
  • Coactation of aorta ( picked in infancy
  • sleep apnea
48
Q

Pheochromocytoma

A

tumor on adrenal gland
triad of : headache, sweating and tachy w/ hypertension. the severe HTN will resolve in hours

Labs: 24 urine for metanephrines, and catecholamines

49
Q

Primary Hyperaldosteronism

A

HTN w/ hypokalemia and slightly hypernaturemia

Labs: plasma renin activiation and aldosterone concentration in AM

50
Q

Cushing syndrome

A

too much cortisol
- abdominal obesity, with skinny arms , round face with acne, straie red to purple color in breasts, dorsal hump

labs: lare night salivary cortisol and 24 hour urine free cortisol

normal caused by steroid use

51
Q

Addison disease

A

adrenal insufficency , hypo corticolism

craving of salty foods, diffuse hyperpigmentation on face,

low BP

labs will show elevated K, low NA ,

DX; morning cortisol levels

52
Q

Other factors that affect BP

A

NSAIDS
Estrogens
Stimulents
Diet

53
Q

what type of decongestants increase BP

A

pseeudophedrine / sudafed

54
Q

what is a cough supressent?

A

Dextromethorphan

55
Q

What is a normal BP

A

120/80 or less

56
Q

what is the biggest difference in the guidelines

A

the stages and the amounts

57
Q

how should you measure BP

A

emptied bladder,
support arm on a table,
measure in both arms use higher reading arm for measurement.
take 2 readers per visit one to two minute apart and average the readings

58
Q

How to dx HTN

A

two readings at least one min apart (average)
taken on two or three separate visits

if above 130/80 = HTN

can use out-of office self monitoring BP to confirm dx and for the titration of medication or if you suspect white coat

59
Q

what is the goal BP

A

130/80

60
Q

what is first line tx for HTN

A

lifestyle

  • weight loss
  • DASH ( can lower 11 off SBP)
  • sodium restriction
  • potassium increse
  • reduce alchol
  • 150 min of aerobic activity per week
61
Q

which pts get lifestyle + meds

A

DM< CKD< MI

62
Q

what drugs to avoid in people with HTN, CAD, SZ, mania

A

Decongestants : OTC cold and sinus drugs
Methylxanthines : theophylline , caffiene
Amphetamines
Appetitie Supressants : sibutramine

63
Q

what is goal for healthy older adult over 60

A

150/90

64
Q

goal BP for CKD or DM over 60

A

140/90

65
Q

first line tx for CKD

A

include ACEI or ARB

66
Q

First line tx for DM (ALL)

A

include ACEI or ARB

67
Q

first line tx for blacks

A

CCB and thiazide diuretic

68
Q

first line tx for non-blacks

A

Thiazide diuretic ACE, ARB or CCB

69
Q

when to recheck BP for goal of therapy

A

1 month

70
Q

goal for people with CV dx and ASCVD 10% or more

A

130/80

71
Q

goal for people with HFpEF

A

130/80 and start with and ACE / ARB or BB

72
Q

first line tx for people with Afibb

A

ARB

73
Q

first line tx for pregnancy

A

methyldopa, nifedipine, labetolol

avoid ACE ARB and aliskiren

74
Q

Examples of Thiazide diuretics

A

chlorthalidone ( highest potency)
HCTZ
indapamide

75
Q

exmaples of CCB

A

amilodipine, diltizem ER, nitredipine

76
Q

examples of ACE

A

catopril enalapril, lisinopril

77
Q

examples of ARB

A

eprosartan, losrtan, calsartan, candesarten

78
Q

Thiazide MOA

A

works on kidneys by increasing secretion of NA and chloride , loss of K, MG and decreases urinary calcium excretion

79
Q

Thiazide S/e

A

” think HYPER VS HYPO”

hyperglycemia ( don’t give to DM)
hyper triglyceridemia / hyper cholestrol
Hyperuriecemia

hypokalemia
hyponaturmia
hypomag

caution w/ people with severe sulfa allergy

contraindication: gout

Give to people with osteopenia/osteoporosis as it slows down urinary secretion of calcium. can decrease risk of hip fractures

80
Q

Loop diuretics

A

quick and potent ( lasix, Bumex)

dont give to people who are lithium - can increase kidney damage

na depletion

81
Q

Potassium sparing diuretics

A

interferes with the sodium-potassium exhange in the distal tube of kidneys

  • spironoactone, amiloride, triamterene
  • causes hyperkalemia ( dont combine with ACE-ARBS
82
Q

side effects of spironoactone

A

hirtisum

Galactorrhea, hyperkalemia, GI effects

83
Q

ACE and ARBS

A

preferred in DM, CKD

Adverse: dry cough , hyperkalemia

84
Q

Beta blockers

A

decreases vasomotor activity and cardiac output and inhibits norepinephrine release

B1 = heart and kidney

B2: - lungs, GI, uterus, vascular smooth muscles

Do not discontinue abruptly, wean

85
Q

beta blockers a/e and contraindications

A

Adverse effects:

  • broncospasm
  • bradycardia, HF,
  • PAD exacerbations
  • depression, sexual dysfucntion
  • avoid if they have chronic lung disease

contraindiaction;
- heart failure , 2nd or 3 rd heart block, bradycardia,
DM - can blunt or worsen hypoglycemia response

86
Q

CCB what type

A

blocks calcium channels in the heart and arterioles causing vasodilations depresses AV node

First line for blacks, raynaud’s dx

Dihydropyrdines : “pine” more potent, no negative effect on the cardiac contractility or conduction. use for HTN and stable angina

Non-dihydropyridines - more effect on the cardiac conduction and contractility. Less potent vasodilator. used for HTN, chronic stable angina, arrythmias

87
Q

CCB contraindiactions and a/e

A

grapefruit juice ( it will increase serum level causing toxcity)

2nd 3rd heart block, CHF

Adverse :
- headache flushing, ankle edema, constipation

88
Q

Alpha-blockers

A

blocks alpha receptors in peripheral arterioles resulting in profound vasodilation

  • terazosin (hystrin) / doxasozin (cardura) - can work for both BPH and HTN

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