hypertension & CAD Flashcards
modifiable risk factors for CAD
- dislipidemia
- smoking
- hypertension
- diabetes
- obesity
- thrombogenic factors
- sedentary lifestyle
non-modifiable risk factors for CAD
- family history of CAD
- age
- sex
levels of risk associated with CAD
- smoking
- hypertension (DBP >90 mmHg)
- serum total cholesterol level (>240 mg/dL)
high blood pressure puts you at risk for what?
heart disease and stroke
hypertension increases RR by 2-4 fold for what
- CAD, stroke, HF, PAD, AF, CKD
- dementia: vascular, Alzheimer’s
- mild cognitive deficits
attributable risk for HTN
- stroke (62%)
- CKD (56%)
- HF (49%)
who gets hypertension?
- males > females up to age 64
- females > males after age 65
HTN is more common and severe in what race?
African Americans
other risk factors for HTN?
- positive family history
- obesity
- diabetics
SBP or DBP more important as a CAD risk factor for persons over 50?
SBP
hypertension fact/statistic
persons who are normotensive at age 55 have a 90% lifetime risk of developing HTN
cerebral perfusion autoregulation
persons with chronic hypertension have a higher MAP
CNS damage conditions
- hypertensive encephalopathy
- hemorrhagic stroke
- ischemic stroke
renal system damage conditions
acute renal failure
cardiopulmonary system damage conditions
- acute decompensated HF
- acute coronary syndrome (including MI)
- acute pulmonary edema
- dissecting aortic aneurysm
ophthalmologic damage conditions
- exudates
- papilledema
- retinal hemorrhages
what is blood pressure?
- pressure exerted by circulating blood upon the walls of blood vessels
- refers to the pressure in the systemic circulation
blood pressure varies with what?
- strength of heartbeat
- elasticity of arterial walls
- volume and viscosity of blood
- health, age, and physical condition of person
- location of measurement
what is hypertension?
- systemic arterial blood pressure is elevated
- based on the average of 2 or more readings taken at 2 or more visits
primary hypertension
- aka essential HTN
- accounts for 95% cases of HTN
- no established cause
secondary hypertension
- 5% of HTN cases
- secondary to other potentially rectifiable causes
identifiable causes of secondary HTN
- sleep apnea
- drug induced or related causes
- CKD
- primary aldosteronism
- renovascular disease
- chronic steroid therapy or Cushings syndrome
- pheochromocytoma
- coarctation of the aorta
- thyroid or parathyroid disease
HTN pathophysiology
- ANS
- intravascular fluid volume = aldosterone stimulation
- vascular autoregulation
- renin-angiotensin aldosterone system (RAAS)
RAAS picture
look at notes
HTN symptoms
- headache
- dizziness
- blurred vision
- shortness of breath (especially with exertion)
- chest pain
- rapid pulse, palpitations
- malaise and fatigue
- OFTEN NO SYMPTOMS AT ALL
normal BP numbers
SBP = <120/<80 mmHg
elevated BP numbers
SBP= 120-129 mmHg
DBP= <80 mmHg
treatment: life style modifications
stage 1 HTN BP numbers
SBP= 130-139 mmHg
DBP= 80-89 mmHg
treatment: life style modifications (+ meds for those with CVD)
stage 2 HTN BP numbers
SBP= >140 mmHg
DBP= >90 mmHg
treatment: life style modifications and meds
BP goals for general >60 years
< 150/90 mmHg
BP goals for <60 years
< 140/90 mmHg
BP goals for black americans (any age; with or without DM)
< 140/90 mmHg
BP goals for adults with DM who are not black
< 140/90 mmHg
BP goals for adults with CKD
< 140/90 mmHg
weight reduction leads to reduction in SBP….
5-20 mmHg/10kg weight loss
adopting DASh eating plan leads to reduction in SBP of
8-14 mmHg
reducing dietary sodium leads to reduction of SBP of
2-8 mmHg
physical activity leads to reduction in SBP of
4-9 mmHg
moderation of alcohol reduction leads to reduction of SBP of
2-4 mmHg
thiazide type diuretics
- Hydrochlorothiazide
- Chlorthalidone (acts on distal convoluted tubule and inhibits Na and Cl transport) (also has longer mechanism of action and more potent
how do ACE inhibitors work?
block Angiotensin I from converting into Angiotensin II
how do Angiotensin Receptor Blockers (ARB) work?
block the effects of Angiotensin II receptors
what do calcium channel blockers do?
slow HR and lower BP
acute coronary syndromes (ACS)?
- unstable angina
- MI
- non ST elevation MI (NSTEMI)
- ST elevation MI (STEMI)
pathogenesis of acute coronary syndromes
plaque rupture > platelet adhesion > platelet activation > partially occlusive arterial thrombosis & unstable angina > microembolization & NSTEMI > totally occlusive arterial thrombosis & STEMI
spectrum of acute coronary syndromes
look at notes
what is angina?
- occurs with activity and stress
- pain is described as pressure, squeezing, heaviness and may be associated with diaphoresis, nausea or vomiting and/or shortness of breath
- relieved with rest or nitroglycerin
cardiac markers
picture in notes
anti-ischemic treatment for NSTEMI
- bed rest
- nitroglycerin
- oxygen
- morphine
- beta blocker (metoprolol)
- possibly calcium channel blocker (verapamil)
- ACE inhibitor for decrease LV function
anti-platelet/anti-thrombotic treatment
- aspirin
- heparin
- add platelet GP IIb/IIIa receptor antagonist
early invasive strategy (aggressive?)
cath lab
early conservative medical management
look at notes
STEMI criteria
- elevated serial enzymes
- ST elevation in 2 or more leads
hospital discharge care
A: aspirin & anticoagulants B: beta blockers & BP C : cholesterol & cigs D: diet & diabetes E: education & exercise
candidates for cardiac cath
- MI
- known CAD
- positive stress test
- not reach target HR on stress test
- possible HF
- structural deformities
- identify bacterial infection
goal of cardiac cath (left system)
- identify location of CAD for PCA or CABG
- measure LV ejection fraction
- if needed, measure aortic valve
risks of cardiac cath procedure
- very rare, death, MI, stroke, renal failure
- bleeding 2-5% (biggest risk)
- allergic reaction to dye
patient population for percutaneous transluminal coronary artery (PTCA/stent)
- blockage greater than 70%
- Patient is a candidate for CABG (left main disease, proximal LAD, triple vessel disease)
intra-procedure
- receives heparin
- GP IIb/IIIa inhibitor
- nitroglycerin
PTCA/stent patient directions
- stay in bed for 4-6 hrs after procedure
- may resume regular activities in 4-5 days
- discharged from hospital in 1 day
- if received stent, discharged on anticoagulant
