HTN/Hypotension Flashcards
Ventricular septal rupture PA sat
elevated due to left to right shunt
hypokalemia at the time of diagnosis and difficult-to-control hypertension
primary hyperaldosteronism, will have metabolic alkalosis too. A ratio ≥70 with a PAC of ≥15 ng/dL and a PRA ≤1 ng/mL/hour
Initial BP >140/90
No time for lifestyle changes, straight to meds (2 meds.) Reassess in 1 month.
Biggest risk factor for HFpEF
HTN
Aging BP
Increased SBP, decreased DBP, increased pulse pressure, increased aortic pulse wave velocity due to increased resistance, decreased NO release.
Autonomic neuropathy
drop in BP without a compensatory rise in heart rate.
Cardiodepressor syncope
marked drop in heart rate followed by a drop in blood pressure.
POTS
modest drop in blood pressure accompanied by an extreme rise in heart rate
normal orthostatic response
5-10 mm Hg drop in SBP, 5-10 mm Hg increase in DBP, and increased heart rate (10-25 bpm)
meds that cause HTN
NSAID, oral contraceptives, stimulants (such as cocaine or amphetamines), antidepressants, and glucocorticoids
aortic dissection, severe pre-eclampsia or eclampsia, and pheochromocytoma
reduce BP to <140 in first hour of treatment. Use labetalol.
Elevated RA pressure
Elevated PCWP
> 10.
15.
African American antihypertensive even if diabetic
thiazide diuretics or calcium channel blocker
ARNI NYHA
Class II-III
Newly diagnosed HTN, Get.
EKG to look for left ventricular hypertrophy, rhythm disturbances, and myocardial infarction
Resistant htn
can get sleep study as part of workup
expected change in creatinine with ACEI/ARB
30% increase, keep going
cardiogenic shock MI PCI
Only culprit lesion (100% occlusion)
Droxidopa causes fewer HF exacerbations than
midodrine
drugs that cause orthostatic hypotension
terazosin, tizanidine (muscle relaxant), trazodone (and other antipsychotic/antidepressant medications), and carvedilol (with its alpha-blocking properties
bilateral alveolar infiltrates
pulmonary edema
Inotropy.
Cardiogenic shock with preserved BP.
Reduced BP.
Dobutamine.
Norepi.
stage 1 htn
130-139/80-89.
treat with lifestyle interventions and reassessment of blood pressure in 3-6 months.
treat fibromuscular dysplasia with
antihypertensive therapy including ACEI/ARB-> percutaneous balloon angioplasty
hypertensive emergency treatment
lower <25% in hour 1,
160/100 mm Hg next 2-6 hours, and then eventually to normal over the next 24-48 hours.
Acute HF: IV nitrog/nitrop.
Nicardipine (do not use in AS)
relationship between hypertension and cardiovascular disease risk
log-linear. A 20 mm Hg higher SBP and 10 mm Hg higher DBP= 2x MACE
Preggo htn
Assess for proteinuria to diagnose pre-eclampsia.
