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Cardiology > Hyper and hypotension > Flashcards

Hyper and hypotension Flashcards

1
Q

How many people over 65 hae hypertension

A

over 1/2

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2
Q

what is the most common risk factor for MI and stroke

A

uncontrolled hypertension

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3
Q

What race and ethnicity is htn seen more in

A

Men, african americans

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4
Q

Is there a genetic component to hypertension

A

yes

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5
Q

Different types of hypertension

A

Essential (Primary), Secondary, malignant

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6
Q

What percentage of people have essential hypertension

A

95%

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7
Q

Pre-hypertension

A

120-139mmHg / 80-90mmHg

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8
Q

Stage 1 hypertension

A

140-159mmHg/90-99mmHg

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9
Q

Stage 2 hypertension

A

> 160mmHg/ >100mmHg

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10
Q

How do you diagnose essential hypertension

A

2 or more readings during 2 or more visits with a mean BP of 140/90

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11
Q

When can you diagnose htn with just one reading

A

End organ damage

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12
Q

Is diastolic or systolic a greater predictor of risk in patients over 50?

A

Systolic

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13
Q

Is diastolic or systolic a greater predictor of mortality in patients under 50?

A

diastolic

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14
Q

What percentage of people get “white coat” syndrome

A

20-25%

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15
Q

Screening for individuals with normal bp

A

every 2 years

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16
Q

BP check for people with prehypertension

A

every year

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17
Q

Name some risk factors of primary hypertension

A 
Excess sodium intake
Excess alcohol intake
Obesity & weight gain
Physical Inactivity
Dyslipidemia
Type A personality
Vitamin D deficiency
OTC meds (NSAIDs, Decongestants, etc)
Family Hx
Ethnicity (African American) 
Age of onset/length of time
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18
Q

Symptoms in htn

A

Asymptomatic!

HA, dizziness, CP, palpitations, buzzing noise, fatigue, visual changes

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19
Q

PE findings for a person with Htn

A

retinopathy, papilledema, bruits, edema, CHF, weakness or confusion

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20
Q

What is some routine lab testing for Primary hypertension

A

electrolytes, BUN, creatinine, glucose, GFR, fasting lipid profile, TSH, UA,

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21
Q

What are some routine testing for primary hypertension

A

EKG, CXR and echo

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22
Q

Treatment of essential hypertension

A

Lifestyle modifications- weight loss, exercise, sodium restriction, stop smoking, increase potassium – for 6-12 months

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23
Q

How much does loosing 10kg decrease your blood pressure

A

5-20mmHg

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24
Q

How much can exercising 30min/day decrease your blood pressure

A

4-9mmHg

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25
Q

When do you start medication for hypertension

A

when lifestyle modifications fail

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26
Q

Diuretics

A

Stop Na from reabsorbing thus increasing the Na and water excretion

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27
Q

What do you need to monitor with loop diuretics

A

K- hypokalemia
Na- hyponatremia
Glucose- hyperglycemia
Uric acid- hyperuricemia

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28
Q

What are potassium sparing diuretics

A

Spironolactone

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29
Q

Beta blockers

A

decrease HR and cardiac output, decrease PVR, reduce renin activity

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30
Q

Cardioselective beta blockers

A

Inhibit beta 1 receptors

Metoprol, atenalol

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31
Q

Non cardioselective

A

Inhibit beta 1 and beta 2

Propanolol, labetalol

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32
Q

Side effect of beta blockers

A

bradyardia, fatigue/lethargy, impotence, hyperglycemia, masks signs of hypoglycemia

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33
Q

CCB

A

Cause peripheral vasodilation

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34
Q

Dihydropyridines

A

amlodipine, nifedipine

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35
Q

NonDihydropyridines

A

Slows conduction at the AV node

Verapamil, diltiazem

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36
Q

Side effects of CCB

A

Peripheral edema, constipation, HA, bradycardia (nondyhydropyridines)

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37
Q

ACE Inhibitors

A

Inhibit conversion of angiotensin 1 to angiotensin 2, and reduced aldosterone secretion

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38
Q

ARB

A

Directly inhibits angiotensin 2

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39
Q

Side effects of ACE and ARB

A

hyperkalemia, dizziness, angioedema and cough

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40
Q

are ACE’s and ARB’s indicated in pregnancy

A

NO they are contraindicated

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41
Q

What to ACE and ARB combined increase the risk of

A

Cancer

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42
Q

Alpha blockers

A

inhibits alpha1 receptors resulting in vasodilation of veins and arterioles. TX for BPH

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43
Q

Side effects of alpha blockers

A

Orthostatic hypotension, HA, dizziness

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44
Q

Central alpha-adrenergics

A

alpha 2 agonist redicing the sympathetic outflow from CNS producing a decrease in peripheral resistance - methyldopa

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45
Q

Side effects of Gentral alpha adrenergics

A

peripheral edema, drowsiness, dry mouth

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46
Q

Arteriolar dilators

A

RElax smooth muscles and produce peripheral dilation - hydralyzine and minoxidil (Rogaine)

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47
Q

Side effects of hydralazine

A

fluid/sodium retention, lupus like syndrome, T wave changes and excess hair growth

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48
Q

Does hydralyzine have a short or long half life

A

short- frequent dosing- 3X day

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49
Q

Direct renin inhibitors

A

Block the conversion of angiotensin to angiotensin 1’Aliskiren

50
Q

ARD of renin inhibitors

A

increase BUN/CR, hyperkalemia if used with ACE

51
Q

what is Prinzide

A

lisinopril +HCTZ

52
Q

What is lotrel

A

Benazepril + amlodipine

53
Q

Exforge HCT

A

Amlodipine +Valsartan + HCTZ

54
Q

For an african american what blood pressure medications work best

A

CCB & diuretics

55
Q

Forr a diabetes patient what blood pressure medications work best

A

ACE/ARB

56
Q

For CHF patient what BP meds work best

A

BB, diuretics, ACE

57
Q

For CAD what BP meds work best

A

BB, CCB

58
Q

For CKD what BP meds work best

A

ACE/ARB

59
Q

What is malignant htn

A

EMERGENCY- associated with end organ damage

BP >180/120

60
Q

What is end organ damage

A

retinal hemorrhages, renal failure encephalopathy, MI

61
Q

How do you treat malignant hypertension

A

Nitroprusside- can be titrated

Labetalol- IV bolus or continuous infusion

62
Q

How fast should you lower BP in malifnant Htn

A

no more than 25% initially

63
Q

Causes of secondary hypertension

A

1) Renovascular HTN - RAS 2. Primary Renal Dz. - due to glomerulonephritis, pyelo, ASHD 3. Primary Aldosteronism 4. Pheochromocytoma 5. Cushing’s Syndrome 6. Coarctation of the Aorta 7. Obstructive Sleep Apnea Syndrome
8. Hypothyroidism or Hyperparathyroidism 9. Drugs - cocaine

64
Q

What is the most common correctable cause of secondary hypertension?

A

Renovascular hypertension (renal artery stenosis)

65
Q

How does renal artery stenosis (RAS) cause hypertensoin

A

impairs blood flow to kiney, which increases renin and starts the cascade

66
Q

How do you diagnose RAS

A

Renal arteriography- gold standard
MRA/CTA
Renal US with duplex imaging

67
Q

Treatment of RAS

A

medication therapy or angioplast with stent

68
Q

If I have bilateral RAS are ACE and ARBs good choices

A

NO- can lead to worsening renal function

69
Q

I have unexplained hypokalemia and hypertension, why?

A

Primary aldosteronism

70
Q

What is the main cause of primary aldosteronism

A

aldosterone producing adenoma or bilateral adreanal hyperplasia

71
Q

What are the diagnostic features of secondary hypertension

A

Low -Plasma renin activity
High - plasma aldosterone concentration
CT adrenals

72
Q

Treatment of primary aldosteronism

A

Adenoma- adrenalectomy

No adenoma- medical therapy with aldosterone antagonist (spiranolactone)

73
Q

Phenochromocytoma symptoms

A

Epospdic eadache, sweating and tachycardia, sustained paroxysmal htn

74
Q

diagnosis of phenochromocytoma

A

1) 24 hour urine catecholamines and metanephrines
2) plasma fractionated metanephrines
3) CT or MRI of abdomen/pelvis

75
Q

What percentage of phenochromocytomas are in the abdomen

A

95%

76
Q

Treatment of phenochromocytoma

A

adrenalectomy

77
Q

Other causes of secondary hypertension

A

Cushings

Coactation

78
Q

symptoms of coarctation of aorta

A

hypertension in both upper extremitis and low on unobtainable in LE. may have CP or claudication

79
Q

Diagnosis of Coarctation

A

MRA, echocardiogram

80
Q

Treatment of coarctation

A

Surgical correction, balloon angioplasty with stent

81
Q

types of hypotension

A

cardiogenic shock

Orthostatic hypostions

82
Q

Cardiac output and normal value

A

the volume of blood pumped by the heart in a unit of time. Normal:5L/min

83
Q

Cardiac index and normal value

A

cardiac output corrected for body size Normal: 2.6- 4.2

84
Q

Stroke volume and normal values

A

VOlume of blood in each beat/contraction. Normal: 70 ml/beat

85
Q

Preload

A

the degree of ventricular filling during diastole

86
Q

afterload

A

impedance of the ejection of blood from the ventricle

87
Q

Ejection Fraction

A

The percent of the total blood volume in the ventricle at the end of diastole that is ejected during systole. Normal: 55-65%

88
Q

Pulmonary Wedge pressure

A

Left atrial pressure measurement - measures preload in left ventricle. Normal = 12mmHg

89
Q

What do you use to measure pulomnary wedge pressure

A

swan-ganz catheter

90
Q

Chardiogenic shock

A

Inadequate tissue perfusion due to cardiac dysfunctio/decreased cardiac output
Caused by severe reduction in cardiac index and elevation of SVR
Hypotension <80-90 and MAP 30mmHg lower than basline

91
Q

What is the most common cause of cardiogenic shock?

A

MI With LV dysfunction

92
Q

Other causes of cardiogenic shock

A 
Acute MR due to papillary muscle or chordae tendinae rupture
Ventricular free wall rupture
Pericardial tamponade
Myocarditis
End-stage cardiomyopathy
93
Q

Clinical manifestations of cardiogenic shock

A 
Hypotension
Cool extremities/Pallor appearance
Altered mental status
Decreased or absent urine output/ARF
Respiratory distress from CHF
94
Q

Diagnosis of Cardiogenic shock

A

Echocardiogram (mainy

(TEE), Hemodynamic Monitoring, Cardiac catheterization

95
Q

Normal pressure of the Right atrium

A

2-8 mmHg

96
Q

Normal pressure of the Right Ventricle

A

systolic- 15-20/ diastolic 8-15

97
Q

Normal pulmonary artery ressures

A

systolic 15-25/diatolic 8-15

98
Q

Normal Pulmonary artery wedge pressure

A

6-12

99
Q

Normal left ventricular end-diastolic pressure

A

6-12

100
Q

If PCWP high or low in cardiogenic shock

A

High

101
Q

Is PCWP high or low in septic shock

A

low

102
Q

treatment of cardiogenic shock

A

1) reprofuse
2) intraaoritc baloon pump- decreased myocardial o2 consumption
3) meds- inotropes or vasopressors

103
Q

Name some inotropes

A

Dopamine

Dobutamine

104
Q

Dopamine causes and dose

A

increases contractility and vasoconstriction

Dose: 5-50 mcg/kg/min

105
Q

Dobutamine causes and dose

A

increases contractility and cardiac output

Dose:5-40 mcg/kg/min

106
Q

Name some Vasopressors

A

Norepi

Epi

107
Q

What does norepi do and dose

A

vasoconstricts and increases contractility Dose: 1-30 mcg/min

108
Q

What does epi do and dose

A

increases cardiac output and decreases SVR

Dose: 7-35 mcg/min

109
Q

Orthostatic hypotension

A

symptomatic falls in bp after standing form a seated or supine position- may or may not have syncope

110
Q

Who is orthostatic hypotension more common in

A

elderly and diabetics

111
Q

what is the compensatory mechanism in which regulates bp

A

baroreceptors

112
Q

What is a normal change in SBP

A

5-10 drop

113
Q

What is a normal change in DBP

A

5-10 increase

114
Q

What is a normal change in HR

A

10-25 bpm increase with standing

115
Q

Causes of orthostatic hypotensio

A

volume depletion, autonomic dysfunction, medications, postprandial

116
Q

symptoms of Orthostatic hypotension

A

Dizziness, Lightheadedness, Blurred vision, Confusion, Near syncope/syncope

117
Q

Diagnosis of orthostatic hypotension

A

Check BP supine, sitting and standing 3 mins apart

118
Q

Labs that could be helpful in diagnosing orthostatic hypotension

A

BUN/Creatinine levels, anemia

119
Q

Treatment of rthostatic hypotension

A

increase salt and water intake, compression stockings,remove offending medications

120
Q

What medications can be used for orthostatic hypotension

A

Fludrocortisone

Midodrine

121
Q

Other name for orthostatic hypotension

A

postural hypotension

Cardiology (8 decks)

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