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Cardio > HTN part 1- Exam 1 > Flashcards

HTN part 1- Exam 1 Flashcards

1
Q

What is systolic BP? What is diastolic BP? What is a normal reading?

A

systolic: The measurement of pressure against the arterial walls when the heart contracts and pushes out blood

diastolic: The measurement of pressure against the arterial walls when the heart is filling (between beats)

normal: LESS than 120 and LESS than 80

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2
Q

What are 3 severe complications that can arise from long standing HTN?

A

Heart disease
Neurological disease (stroke)
Renal disease

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3
Q

What population is most commonly affected by HTN? When does it show up? What are some common consequences?

A

non-Hispanic blacks and even more specifically BLACK MEN

HTN manifests earlier, is more severe, higher rates of morbidity and mortality d/t stroke, LVH, CHF, ESRD than white Americans

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4
Q

What is the pathogenesis behind HTN? Why is arterial BP important?

A

BP = cardiac output x systemic vascular resistance

Maintenance of arterial BP is necessary for organ perfusion

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5
Q

_______ results from complex interactions between genetic, endogenous and environmental factors aka there is no identifiable underlying cause

Name some potential causes

A

essential HTN

Sympathetic nervous system hyperactivity
Renin-angiotensin system activity
Defect in natriuresis
Abnormal cardiovascular or kidney development
Elevated intracellular calcium and sodium levels

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6
Q

What is the pathogenesis behind sympathetic nervous system HTN? What pt population? How does it present?

A

Acetylcholine and norepinephrine release

younger pts that present with tachycardia and elevated cardiac output

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7
Q

Briefly describe the RAAS system in a nutshell. Where do ACE inhibitors work?

A

ACE Inhibitors block the conversion of Angiotensin I to Angiotensin 2

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8
Q

What is the natriuresis effect?

A

↑ salt intake triggers ↑ in BP which promotes ↑ natriuresis to bring BP values back into normal range. Defects in this process cause HTN

aka loss of salt or lack thereof

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9
Q

Changes in ______ or ______ increases the risk of HTN - think aging and hardening of vessels

A

aortic elasticity

microvasculature

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10
Q

Why does cardiovascular or renal dysfunction lead to HTN?

A

This can also lead to damage in circulation to the brain and kidneys which would also affect our ability to control BP due to decreased fluid excretion, unmanaged hormones, etc.

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11
Q

Intracellular sodium is elevated in (primary/secondary) HTN. What else can it lead to?

A

primary HTN

can lead to increased intracellular calcium which can lead to increased vascular smooth muscle tone

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12
Q

What are the overall risk factors for HTN?

A

Obstructive sleep apnea
Excessive Alcohol Use
Cigarette Smoking
NSAID use
Obesity
Low potassium or high sodium intake
Metabolic syndrome

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13
Q

______ is the MC cardiovascular disorder in the US. What is the cause?

A

primary/essential HTN

no identifiable cause that accounts for 90-95% of HTN cases

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14
Q

_____ is HTN caused by another condition.

A

Secondary HTN

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15
Q

What is isolated systolic HTN defined as? What is the common pt population? What is it caused by?

A

A form of essential HTN when systolic BP ≥140 but diastolic BP <90

older pts

secondary to arterial stiffness and atherosclerosis

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16
Q

Why is stiffness of the arteries a problem in isolated systolic HTN? Which number (systolic or diastolic) is more correlated with adverse cardiovascular events?

A

Stiffness of arteries leads to less diastolic recoil therefore we do not see the increased pressure effect

systolic BP

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17
Q

What is white coat HTN defined as? What is the tx? What is the common pt population?

A

Persistently elevated BP (>140/90) in office but normal BP outside of a medical setting

Research suggests that so long as BP remains normal at home, treatment is unnecessary

MC in elderly pts

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18
Q

What is masked HTN? What is it caused by? What is the tx?

A

Normal BP in office but elevated BP at home

lifestyle:
Tobacco
Caffeine
Stress

If cuff is accurate, need to tx pts

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19
Q

What is pseudohypertension caused by? What is the tx? What is the MC pt? What do you need to order to confirm dx?

A

Results from calcification in peripheral vessels and causes falsely elevated BP resulting in symptomatic overtreatment

hypotension s/s

MC in elderly

take intra-aortic BP reading

20
Q

What are the 3 goals of evaluating for HTN?

A

Assess presence of target-organ damage related to HTN

Determine the presence of other cardiovascular risk factors and disease

Evaluate for possible underlying secondary causes of HTN

21
Q

**What is the criteria to dx hypertension?

A

A diagnosis of HTN is based on TWO or more accurately measured and seated BP readings on TWO or more different occasions (unless its an hypertensive emergency)

22
Q

**What is the criteria to use home BP readings?

A

3 days of checking twice daily, once in the morning at least 1 hour after taking meds and once in the evening

23
Q

**What are the ACC/AHA guidelines for normal/elevated/stage 1/stage 2 HTN?

A
24
Q

What are the 2 exceptions when dx HTN?

A

hypertension presenting with unequivocal evidence of life-threatening end-organ damage

blood pressure is greater than 220/125 without life-threatening end organ injury

25
Q

What is the textbook way to measure BP accurately?

A

Should be taken in both arms, two times, spaced 1-2 minutes apart at first office visit - ESPECIALLY IF WE HAVE AN ELEVATED BP READING TO START!!

use the higher value obtained

26
Q

When are automated BP devices not accurate?

A

A. Fib

27
Q

What is an important history question to ask when working a pt up for HTN?

A

Have you had something like this before?

Previous antihypertensive therapy and its effect on BP?

28
Q

What medications are known to cause HTN? What is the major one?

A

**Contraceptives, NSAIDs, amphetamines, black licorice

29
Q

What should the PE focus on when working a pt up for HTN?

A

After obtaining our initial vitals and determining HTN - our PE should focus on identifying any evidence of end organ damage

30
Q

What labs should you order for HTN?

A

Urinalysis
BMP - need electrolytes, glucose, and BUN/Cr!
EKG
Fasting Lipid Profile
TSH

31
Q

What are 4 major complications of HTN?

A

-Structural and functional changes in the heart and vasculature

-Increased risk of thrombosis

-Increase in morbidity and mortality

  • target-organ damage that varies between person and person (TIA, stroke, retinopathy, PAD, renal failure, LVH, congenital heart disease, HF)
32
Q

What is hypertensive cardiovascular dz? What are some common presentations?

A

Long standing HTN causes the heart to have to pump against pressure all the time (think going to the gym and lifting weights 24/7). This causes the muscle to thicken and stiffen, making it less functional

Dyspnea, edema
Palpitations, chest pain
LV heave or S4 gallop
LVH criteria on EKG

33
Q

Cerebrovascular Hypertensive Disease major predisposing factor for both _____ and _____. Is it more related to SBP or DBP? Is it preventable?

A

ischemic and hemorrhagic stroke

SBP

can be prevented with appropriate HTN management

34
Q

Cerebrovascular Hypertensive Disease also increases risk for _______ both _____ and _____ types

A

dementia

both vascular and Alzheimer types

35
Q

hypertensive renal disease that is untreated can result in _______ and is more common complication in _____ patients. Can you reverse the damage?

A

nephrosclerosis

black patients

difficult to reverse damage but can be prevented

36
Q

What is hypertensive retinopathy? **What are the 3 clinical pearls associated with hypertensive retinopathy? What makes it worse?

A

Narrowing of the retinal arteries

Development of exudates, cotton-wool spots, and retinal hemorrhages

when combined with DM

37
Q

What is atherosclerosis?

A

Condition that causes narrowing and/or hardening of arteries
Cause by and contributes to increased B

38
Q

What is an aortic aneurysm vs dissection?

A

aneurysm is all the layers of the blood vessel are ballooned out vs dissection is the layers of the blood vessel are falling apart/peeling away

dissection is way worse!

39
Q

What is the non-pharm management of HTN? Which ones are proven to have the most impact?

A
40
Q

**What are the ACC/AHA guidelines for HTN management for normal/elevated/stage 1/stage 2 HTN?

A
41
Q

What is the goal BP for all pts with HTN? What is first line meds for non-black pts? black pts?

A

less than 130/80

non-black pts:
thiazide, ACEI/ARB or CCB

black pts:
thiazide or CCB (amlodipine is Prof Long’s fav)

42
Q

Consider looking at this chart again for comorbid conditions

A
43
Q

How often should you f/u if BP is NOT well controlled? How often do you need to order labs? When should you order an EKG?

A

we follow up every 4 weeks if uncontrolled!

Lab monitoring is NOT needed if BP is controlled, unless other disease processes are present

EKG could be obtained every 2-4 years depending on baseline EKG and any symptoms that present

44
Q

When starting ACEI, need to order _______

A

need to order BMP to check electrolytes

45
Q
A

Cardio (24 decks)

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