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Clin Med I- CARDIO > HTN/Hypotension > Flashcards

HTN/Hypotension Flashcards

1
Q

Crista terminalis

A

Smooth muscular ridge in superior portion of RA. Divides muculi pectinati and RA auricle from smooth surface of RA

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2
Q

What is located at the orifice of coronary sinus?

A

Thebesian valve

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3
Q

What lies in the junction of the IVC and RA

A

Eustachain valve

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4
Q

Limbus of the fossa ovalis

A

Located on the medial wall of the RA

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5
Q

2 phases of Diastole

A

Passive (Rapid ventricular filling) and active (atrial contraction/rapid ventricular filling)

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6
Q

What valves close during diastole?

A

Semilunar

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7
Q

What valves close during systole?

A

AV

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8
Q

Prescribed drugs for HTN tx

A

Lisinopril (ACE-I), generic Norvasc-amlodipine (CCB), Hydrochlorothiazide

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9
Q

HTN defined as…

A

elevated BP with systolic greater than or equal to 140mmHg or diastolic greater than or equal to 90 mmHg

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10
Q

Systems and symptoms hypertension may present with

A

Brain- stroke, headache, confusion. Eye- vision problems, hypertensive retinopathy. Heart- myocardial infarction, heart failure, irregular heartbeat, coronary artery disease. Kidneys- Hypertensive nephropathy, renal failure, blood in the urine. Blood- elevated sugar levels. Also chest pain, difficulty breathing, pounding in chest, neck, ears

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11
Q

HIgh BP has increased risk of…

A

Myocardial ischemia/infarction, heart failure, stroke, and kidney disease (heart, brain, and kidneys affected)

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12
Q

Systolic BP

A

Maximum arterial pressure during cardiac contraction

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13
Q

Diastolic BP

A

Minimal arterial pressure during cardiac relaxation

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14
Q

What might BP fluctuate with?

A

Body temperature, diet (increased coffee intake), exercise, emotional state (very stressed), and medication (like diuretics)

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15
Q

Prehypertension

A

Systolic BP 120-139 OR diastolic 80-89mmHg

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16
Q

Hypertension, stage 1

A

Systolic BP 140-159mmHg OR diastolic 90-99mmHg

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17
Q

Hypertension, stage 2

A

systolic greater than 160, diastolic greater than 100mmHg

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18
Q

Mild HTN diagnosis should not be made until…

A

BP has been measured in at least 3-6 visits spaced over weeks to months

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19
Q

types of HTN

A

essential (primary), secondary, malignant, and urgency and emergency

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20
Q

2 major effects of HTN

A

Increased cardiac output and increased systemic vascular resistance

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21
Q

Factors that may cause primary/essential HTN

A

Pathogenesis may be related to many factors - Increased sympathetic neural activity, increased angiotensin II activiey, familial tendency if parents affected, reduced adult nephron mass

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22
Q

Pathogenesis of secondary HTN

A

HTN occurs as a result of underlying condition- primary renal disease, renovascular disease, hyperaldosteronism, pheochromocytoma, Cushing’s syndrome, oral contraceptives, Hypo/hyperthyroidism, hyperparathyroidism, OSA, coarctation of the aorta

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23
Q

Triad of hyperaldosteronism

A

Causes HTN, hypokalemia, and metabolic alkalosis

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24
Q

What is the major cause of secondary HTN in young children?

A

Coarctation of the aorta

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25
Q

HTN with retinal hemorrhages, exudates, or papilledema classified as..

A

Malignant HTN

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26
Q

HTN greater than 220/140 with progressive end organ damage classified as…

A

Hypertensive Emergency

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27
Q

HTN greater than 180/110 mmHg in asymptomatic patient with no evidence of end organ damage classified as…

A

Hypertension Urgency

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28
Q

Isolated Hypertension…

A

Isolated systolic hypertension (Systolic greater or equal to 140), isolated diastolic hypertension (diastolic BP greater than or equal to 90mmHg), and White Coat HTN

29
Q

What daily living factors may increases your changes of getting HTN?

A

RACE- being african american, AGE AND GENDER - males greater than 60 years old more affected (males over 55, females over 65), DIET- obesity, high sodium, high-fructose corn syrup, diabetes, dyslipidemia, excess alcohol, tobacco abuse, vitamin D deficiency, INACTIVITY, GENETICS, PERSONALITY TYPE- stressed, impatient, hostile, microalbuminuria, GFR less than 60 ml/min

30
Q

When does increase in HTN risk begin?

A

When BP is greater than 115/75mmHg in all age groups

31
Q

First sound heard signifying systolic BP

A

Karotkoff sound

32
Q

F/U for normal BP patient

A

every 2 years

33
Q

F/U for prehypertensive patient

34
Q

F/U for Stage 1 HTN patient

A

Confirm within 2 months

35
Q

F/U for Stage 2 HTN patient

A

If greater than 160/100 mmHg, evaluate or refer to source of care within 1 month. If greater than 180/110, evaluate and treat immediately or within 1 week depending on clinical situation and complications

36
Q

Tests to assess left ventricular hypertrophy

A

Echocardiography- more accurate measure than electrocardiogram

37
Q

Routine tests to order to determine cause of HTN

A

HEART FUNCTION- Echocardiogram or electrocardiogram, BLOOD- hematocrit, KIDNEYS- urinalysis and creatinine clearance, DIET- fasting glucose, lipid profile, electrolytes

38
Q

If you suspect primary renal disease causing HTN in patient, order…

A

creatinine levels and renal ultrasound

39
Q

To factor out secondary causes of HTN, order…

A

creatnine, renal ultrasound (PRIMARY RENAL DISEASE), ORAL CONTRACEPTIVES history, 24 hour urinary metanephrine and normetanephrine levels (PHEOCHROMOCYTOMA), 24 hour urinary aldosterone level (PRIMARY HYPERALDOSTERONISM), history, and dexamethasone suppression test (CUSHING’S SYNDROME), Tsh, serum PTH (HYPO/HYPERTHROIDISM), sleep study for OSA, CT scan for COARCTION OF THE AORTA, history and drug screen for drug induced HTN, and renal artery angiography for RENOVASCULAR DISEASE

40
Q

Tests to order if you suspect renovascular disease as cause for HTN

A

Duplex doppler studies, MRI/MRA, CT angiogram, renal artery angiography- gold standard

41
Q

When to suspect renovascular disease

A

HTN early onset before 30 years old, accelerated HTN, persistent HTN despite medications to reduce it, renal failure of uncertain etiology, acute renal failure precipiated by ACE-I or ARB, and abdominal bruit

42
Q

BP goal for someone with diabetes or renal disease

A

BP lower than 130/80

43
Q

Patient tx plan consists of…

A

Lifestyle modifications- weight reduction, DASH eating plan, dietary sodium reduction, exercise regularly, moderation of alcohol. Pharmacologic- more than 2/3rds need 2 meds for tx. start with inexpensive, then work your way up

44
Q

Most common meds in treating HTN

A

Thiazide diuretics or Ace-I, ARBs, BB, CCB

45
Q

Diuretics used in tx of HTN

A

Thiazide diuretics (Hydrochlorothiazide), loop diuretics (furosemide- LASIX), and potassium-sparing diuretics (Triamterine, spironolactone)

46
Q

Meds affecting renin-angiotensin pathway in tx of HTN

A

ACE-I (lisinoPRIL), ARBS/Angiotensin II Receptor Blockers (spells LOVe- LoSARTAN, OmeSARTAN, ValSARTAN), aldosterone antagonists (spironolactone- and potassium sparing diuretic)

47
Q

Beta blocker meds used in tx of HTN

A

MAP- metoprOLOL, atenOLOL, propranOLOL

48
Q

Calcium channel blockers used in tx of HTN

A

non-dihydropyridines- diltiazem and verapamil. and Dihydropyridines- Amlodipine, nifedipine

49
Q

Other meds used in tx of HTN

A

combined alpha and BB, alpha-1 blocker, and central alpha-2 agonists

50
Q

Combined alpha and BB

A

Carvedilol

51
Q

alpha-1 blocker

A

teraZOSIN, doxaZOSIN

52
Q

Central alpha-2 agnosists

53
Q

What factors may impair the ability to achieve goal BP?

A

improper BP measurement, inadequate diuretic therapy, OTC meds, herbals (Black licorice, st. john’s wort, ginseng), cold remedies (pseudoephedrine- nasal decongestant), and NSAIDS (ibuprofen naproxin)

54
Q

Tx in hypertensive emergency

A

admit to hospital asap- decrease blood pressure with IV drug therapies by no more than 25% within first hour. If stable, reduce BP to 160/110 mmHg over the next 2-6 hours. If patient remains stable, reduce BP to normal range over the next 1-2 days

55
Q

Risk of CVD doubles beginning at…

A

115/75 with each increased increment of 20/10mmHg

56
Q

Screening for orthostatic Hypotension

A

BP supine, sitting, and standin

57
Q

Causes of orthostatic hypotension

A

Severe volume depletion, baroreflex dysfunction, autonomic insufficiency, and venodilator antihypertensive drugs

58
Q

Orthostatic hypotension

A

BP drop systolic of more than 20 mmHg OR diastolic BP fall of more than 10 mmHg when person changes position from supine to standing

59
Q

Sx of orthostatic hypotension

A

postural unsteadiness, syncope, dizziness

60
Q

Clinical markers of cardiogenic shock

A

Systolic pressure less than 110 mmHg, tachycardia (more than 90 bpm), respiration rate less than 7 or greater than 29, urine output decreased (less than 0.5 ml/kh/hr), metabolic acidemia, hypoxemia, mental status changes

61
Q

Classification of SHOCK

A

SANdwiCH- septic/inflammatory, anaphylactic, neurogenic, cardiogenic, hypovolemic

62
Q

Cause of hypovolemic shock

A

(decreased preload)- acute blood loss, protracted vomiting/diarrhea, dehydration, third spacing

63
Q

Tx of hypovolemic shock

A

rehydrate, transfuse, treat underlying cause

64
Q

Causes of neurogenic shock

A

spinal cord injuries, regional anesthesia, drugs- loss of autonomic innervation of the CV system

65
Q

Causes of septic/inflammatory shock

A

anaphylaxis, toxin, trauma, infection/sepsis

66
Q

Tx of septic/inflammatory shock

A

ABC’s, IV fluid, pressors, and antibiotics

67
Q

Preload in cardiogenic shock

A

High preload with low cardiac output

68
Q

Tx of cardiogenic shock

A

Diuretics and vasodilators with or without pressors, IAPB, impella, ECMO, and left ventricular assist devices

69
Q

Ventricular assist devices

A

pumps- pusatile and continuous flow pumps

Clin Med I- CARDIO (10 decks)

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