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1, Cardiology > Jack's HTN and HTN meds / Cardiology > Flashcards

Jack's HTN and HTN meds / Cardiology Flashcards

1
Q

What are the 3 types of Cardiomyopathies?

A
  • Dilated Cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
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2
Q

What are the frequencies for the 3 cardiomopathies?

A
  • dilated cardiomyopathy 95%
  • hypertrophic cardiomyopathy 4%
  • restrictive cardiomyopathy 1%
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3
Q

Describe how dilated cardiomyopathies occur?

A

-the heart becomes weak and unable to empty the ventricles leading to dilation of the left ventricle

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4
Q

What are the causes of a dilated cardiomyopathy?

A
  • usually no identifiable cause
  • chronic alcohol abuse
  • myocarditis (usually from viral infection or other infection)
  • this condition does not go along with or relate to other cardiac conditions such as HTN, MI, etc.
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5
Q

What are the Sx of dilated cardiomyopathy?

A

-usually SOB

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6
Q

What are the typical PE findings of dilated cardiomyopathy?

A
  • elevated jugular venous pressure (JVP)
  • Rales
  • peripheral edema
  • EKG shows sinus tachycardia
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7
Q

What is dilated cardiomyopathy definitively Dx?

A
  • Echo/cardiac Cath shows cardiomyopathy with low systolic output and high diastolic pressure
  • echo also shows low cardiac output
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8
Q

What is the tx for dilated cardiomyopathy?

A
  • ACE inhibitors
  • beta blockers
  • diuretics
  • aldosterone inhibitors
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9
Q

What is Hypertrophic Cardiomyopathy?

A

-massive hypertrophy typically of the septal wall resulting in left ventricular outflow obstrucition

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10
Q

What causes hypertrophic cardiomyopathy?

A

-autosomal dominant inheritance

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11
Q

What are the Sx of hypertrophic cardiomyopathy?

A
  • Dyspnea usually with exertion or exercise
  • angina
  • fatigue syncope
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12
Q

What are the PE findings for hypertrophic cardiomyopathy?

A
  • sustained apical impulse (lasts longer than systole)
  • ***Bisferiens carotic pulse (a double peak per cardiac cycle)
  • prominent “a” wave (abnormal jugular venous pulse by the right atrium contracting against resistance)
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13
Q

What are the tests/studies findings in hypertrophic cardiomyopathy?

A
  • CXR is usually negative
  • EKG shows L V hypertrophy and exaggerated septal Q waves

-Echo shows L V H and a small L V (echo confirms Dx)

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14
Q

What is the tx for hypertrophic cardiomyopathy?

A
  • beta blockers
  • calcium channel blockers
  • surgical removal of hypertrophic material
  • pacing and implanted defibrillator may be necessary
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15
Q

Where is hypertrophic cardiomyopathy often seen in the newspapers?

A

-athletes dying from it will practicing or playing sports

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16
Q

Describe Restrictive Cardiomyopathy?

A

-poor diastolic filling and good ventricular contractions

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17
Q

Who gets Restrictive Cardiomyopathy?

A

-Amyloidosis–fibrosis most commonly

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18
Q

What are the presenting Sx for Restrictive Cardiomyopathy?

A

-SOB

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19
Q

What are the studies/tests findings for Restrictive Cardiomyopathy?

A
  • CXR may show enlarged heart
  • Echo/cardiac cath shows reduced left ventricular function
  • Biopsy of myocardial tissue may be needed for Dx
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20
Q

What is Primary/Essential hypertension?

A
  • HTN in which there is no single identifiable cause

- accounts for 95% of HTN

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21
Q

What is Secondary Hypertension?

A
  • HTN with an identifiable cause

- kids, teens, or patients where HTN was previously well controlled

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22
Q

What are the causes of Secondary HTN?

A
  • sleep apnea
  • drugs
  • chronic kidney disease
  • primary aldosteronism
  • renalvascular disease
  • Cushing’s or long term corticosteroid use (cause retained Na+ and fluids
  • Pheochromocytoma-epinepherine secreting tumor (rare)
  • coarctation of the aorta
  • thyroid or parathyroid disease
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23
Q

What are the readings for normal blood pressure?

A
  • < 120 / 80
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24
Q

What is Pre hypertension?

A

120-139 / 80-89

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25
Q

What is HTN stage 1 ?

A

140 -159 / 90-99

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26
Q

What is HTN stage 2 ?

A

< 160 / 100

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27
Q

What is HTN stage : severe

A

> 180 / > 110

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28
Q

What are the numbers/readings for HTN urgency?

A

> 220 / > 125

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29
Q

How does one initially Dx HTN, what readings?

A

-HTN = BP > 140 /90 on two or more separate occasions

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30
Q

What is HTN urgency tx?

A
  • a BP that must be reduced in within hours

- BP > 220 / > 125

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31
Q

What is HTN emergency?

A

-BP must be reduced within 1 hour because you are seeing acute end organ damage on PE/sudies

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32
Q

What are the Sx of HTN?

A
  • HA
  • chest pain
  • Dyspnea
  • mental status changes
  • visual changes–blurred or diminished vision

-usually no Sx at all so found on routine physical exam

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33
Q

What are the Lab findings for HTN?

A

-Papilledema
-UA
CXR
-EKG
-Blood work : CBC for thrombocytopenia, creatinine, BUN, Toponin, Creatine kinase

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34
Q

What is the Tx for Secondary HTN?

A
  • Sleep apnea– cpap and wt reduction
  • Drugs–stop offending agent
  • chronic kidney disease–
  • renovascular disease–ACEI
  • Cushing’s or long term corticosteroid use–surgical removal or stop steroid
  • Pheochromocytoma–surgical removal or adenoma
  • thyroid or parathyroid disease– remove offending tissue
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35
Q

What are the tx for essential HTN?

A
  • Wt reduction
  • DASH diet
  • reduce sodium intake
  • increase physical activity
  • limit alcohol consumption
  • BP meds
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36
Q

What is the 1st line tx of mild HTN 140-149 / 90-99 in the US?

A

-Diuretics are 1st line tx and are effective 50% of the time

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37
Q

What is the mechanism of action of diuretics?

A

-they decrease Na+ resorbtion at the distal convoluted tubule of the kidney by inhibiting the Na+/Cl transporter. This results in a loss of NaCl and fluid.

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38
Q

Why do diuretics work?

A
  • initially lowers plasma volume

- Long term, they lower peripheral vascular resisance

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39
Q

What types of patients are diuretics used on?

A
  • HTN
  • heart failure
  • Kidney stones with idiopathic hypercalcemia
  • Nephrogenic diabetes insipidous
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40
Q

List 2 diuretics and their dosage.

A
  • hydochlorothiazide HCTZ, 12.5 or 25 mg po per day

- chlortalidone, 12.5 or 25m po per day

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41
Q

What are the side effects of diuretics?

A
  • decrease in serum K
  • decrease in serum Na
  • decrease in serum Mg
  • decrease in serum Ca
  • increase Uric acid, CAN CAUSE GOUT
  • increase glucose (caution with diabetics)
42
Q

Describe Loop Diuretics.

A

-powerful diuretics that only last a few hours in the body

43
Q

What is the mechanism of action of Loop Diruetics?

A

-act on the ascending loop of Henle inhibiting the Na+/K/+2Cl transporter. This is the site where most of the Na is reabsorbed making these medications very powerful.

44
Q

When do you use Loop Diuretics?

A
  • Important for pulmonary edema
  • other conditions with severe edema
  • Hyperkalemia
  • Acute renal failure
  • Anion overdose
45
Q

List 2 Loop Diuretics?

A
  • Furosemide- Lasix

- Ethacrynic acid

46
Q

What are the side effects of Loop Diuretics?

A
  • Hypokalemia
  • Ototoxicity (reversible)
  • Hyperruicemia (GOUT)
  • Hypotension
47
Q

How do Potassium Sparing Diuretics work?

A

-they block the production of a key protein for the sodium potassium exchange transporter in the collection tube of the kidney

48
Q

When do you use Potassium Sparing Diuretics?

A

-used as a 2nd drug for tx of HTN which may lower K+

49
Q

Name 2 Potassium Sparing Diuretics?

A
  • Amiloride

- Spironolactone

50
Q

What are the side effects of Potassium Sparing Diuretics?

A
  • Hyperkalemia
  • Ototoxicity (reversible)
  • Hyperuricemia (GOUT)
  • Decrease Mg
51
Q

How do Beta Blockers work?

A

-beta blockers compete with catecholamines to bind to the Beta receptors. Once a receptor is occupied by a beta receptor antagonist that receptor is blocked and cannot be used by a catecholamine. This prevents sympathetic cardiac stimulation.

52
Q

What are Beta Blockers used for?

A
  • HTN
  • Angina
  • CHF
  • MI
53
Q

What are some Beta Blockers?

A
  • metoprolol
  • carvedilol
  • atenolol
  • propranolol
  • labetalol
54
Q

What are the common side effects of Beta Blockers?

A

-asthma exacerbation–a B2 blockade results in an increase in airway resistance. (metoprolol and atenolol are better for asthmatics as they have a higher affinity for B1 receptors and not B2 receptors)

  • bradycardia
  • hypoglycemia
  • nausea and vomiting
55
Q

What do catacholamines stimulate at B1 receptors?

A
  • increase HR
  • increase contractility of the heart
  • increase the in which the heart pumps
  • cause vasoconstriction (which increases BP)
56
Q

What do catacholamines stimulate at B2 receptors?

A
  • relax smooth muscle
  • increase insulin secretion
  • relax the bronchiols
  • increase renin secretion
57
Q

When are beta blockers used?

A
  • HTN
  • Angina
  • CHF
  • MI
58
Q

How do alpha blockers work?

A

-alpha blockers compete with catecholamines and prevent sympathetic vasocontriction

59
Q

When are alpha blockers used?

A
  • HTN as a second medication

- Tx of benign prostatic hyperplasia

60
Q

What are the common side effects of alpha blockers?

A

-postural hypotension especially when beginning therapy

61
Q

How do renin inhibitors work?

A

-inhibits the activity of renin

62
Q

Describe the Renin system in the kidney.

A
  • Juxtaglomerular cells secrete renin in response to low blood volume
  • angiotensinogen + renin = angiotension I
  • Angiotension I + angiotensin converting enzyme = angiotensiion II
  • Angiotension II causes vasocnontriction and stimulates aldosterone secretion causing the kidneys to reabsorb more Na+ and water
63
Q

When are Renin Inhibitors used?

A

-HTN is second medication

64
Q

Name a Renin Inhibitor medication?

A

-Aliskiren

65
Q

What are the side effectos of Renin Inhibitors?

66
Q

How do ACE inhibitors work?

A
  • inhibit angiotension converting enzyme thereby slowing the production of angiotension II
  • reduce vasoconstriction
  • reduce aldosterone secretion
67
Q

When do you use ACE inhibitors?

A
  • HTN
  • CHF
  • DM (may lower risk of end stage renal disease as well as MI
68
Q

Name 3 ACE inhibitors?

A
  • captopril
  • enalapril
  • ramipril
69
Q

What are the side effects of ACE inhibitors?

A
  • cough
  • hyperkalemia
  • teratogenic
70
Q

How do Angiotensin Receptor Blockers (ARBs) work?

A
  • block the angiotension receptor
  • reduce vasoconstriction
  • reduce aldsosterone secretion
71
Q

When do you use (ARBs)?

72
Q

Name one ARB ?

A
  • Losartan

- valsartan

73
Q

What are the side effects of ARBs ?

A
  • cough but less than ACE inhibitors
  • hyperkalemia
  • teratogenic
74
Q

How do Calcium Channel Blockers (CCBs) work?

A
  • CCBs block the voltage gated by calcium channels in blood vessels and cardiac muscle
  • this reduction in intracellular Ca+ leads to a decrease in muscle tone and therefore vasodilation and a decrease in cardiac contractility
  • reduce AV node conduction
  • decreases HR
75
Q

When do you use CCB’s ?

A
  • HTN
  • Angina
  • Arrhrythmia (supraventricular tachyarrhythmias)
76
Q

Name 3 CCB’s?

A
  • verapamil
  • dilitazem
  • amlodipine (works more on perif vasc system, not heart)
  • nifedipene (works more on perif vasc system, not heart)
77
Q

What are the side effects of CCB’s ?

A
  • HA
  • peripheral edema
  • bradycardia
78
Q

How do Central Sympatholytic Action drugs work?

A
  • centrally working alpha 2 adrenergic agonis
  • decreases HR
  • decreases renal vasc resistance
79
Q

When do you use Central Sympatholytic Action drugs?

A
  • HTN

- other noncardiac uses

80
Q

Name 2 Central Sympatholytic Action drugs?

A
  • clonidine

- methyldopa

81
Q

What are the side effects of Central Sympatholytic Action medications?

A
  • dry mouth
  • sedation
  • huge list for methyldopa
82
Q

How do Arteriolar dilators work?

A
  • directly affect smooth muscle of the arteries
  • Hydralazline = works by releasing nitric oxide
  • Nitroprusside = works by releasing nitric oxide
  • Minoxidil = works by opening K channels creating hyperpolarization of smooth muscle
83
Q

When do you use Arteriolar Dilators?

A
  • hypertensive emergencies

- minoxidil is also used for tx of hair loss

84
Q

What are the side effects of Arteriolar Dilators?

A
  • angina
  • tachycardia
  • hypotensin
85
Q

How do beta blockers work?

A

-blocking the effects of norepinephrine and epinepherine (adrenaline), reduce heart rate, reduce blood pressure by dilating blood vessels, and may constrict air passages by stimulating the muscles that surround the air passages to contract (a side effect)

86
Q

Where are beta 1 receptors found?

A

-heart, eye and kidneys

87
Q

Where are bets 2 receptors located?

A

-lungs, blood vessels, GI tract, liver, uterus, skeletal muscles

88
Q

Which beta blockers primarily block B1 receptors and mostly affect the heart and not the air passages?

A
  • metoprolol (Lopressor, Toprol XL)

- so may be used with asthma

89
Q

Which beta blocker is nonselective and not used in asthma patients?

A

-propranolol (Inderol) blocks B1 and B2 receptors, so don’t use with asthma

90
Q

What types of patients may have an MI without chest pain?

A

-33 % of women and diabetics

91
Q

Describe the heart’s Mitral Valve?

A
  • it is bicuspid
  • sits between the left ventricle and left atrium
  • (think of the L in mitral for Left side of the heart)
92
Q

What is Mitral Stenosis?

A
  • where the Mitral Valve does not open sufficiently

- presumed due to Rheumatic Fever

93
Q

25 y.o. male presents with c/o exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea secondary to pulmonary congestion. PE shows heart sounds of “opening snap followed by S2” and a low pitched murmur at the apex. Lungs sounds include rales.

A

-Mitral Valve Stenosis is the Dx

-EKG will likely show Afib
-Echo with dopler is Dx**
-Tx : tx the Afib
pulmonary congestion tx with diuretics and vasodilators

    - percutaneous balloon valvuplasty
    - valve replacement
94
Q

What’s the important physiology of Mitral Valve Stenosis?

A

-the mitral valve is not opening enough so blood pressure and volume goes up in the left atrium, the atrium can dilate and also fluid backs up into the lungs

95
Q

What is the important physiology of Mitral Valve Regurgitgation?

A

-here, when the left ventricle contracts blood leaks back into the left atrium. This causes an increase in preload resulting in an increased ejection fraction. Eventually this wears/strains the heart and you get an enlarged left ventricle and a decreased ejection fraction. Eventually this leads to pulmonary congestion.

96
Q

What valve condition is more common in thin females?

A
  • mitral valve prolapse

- PE shows them to have a midsytolic click

97
Q

Guy comes in with exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. He has a Pansystolic blowing murmur at the apex and radiating to the axilla. A brisk carotid upstroke is noted, and lungs sounds include rales. Whats the dx and tx?

A

-mitral valve regurgitation

  • EKG shows Afib and left ventricular hypertrophy
  • Echo with dopler shows severity of regurgitation
  • Tx : -tx Afib with warfarin or cardiover
    - pulmonary congestion tx with diuretics and vasodilators
    - Surgery for valve repair or valve replacement
98
Q

What are the possible reasons patients get Aortic Stenosis?

A
  • bicuspid aortic valve, normally it is tricuspid (found in middle aged people)
  • degenerative or calcific aortic stenosis (atherosclerosis)
99
Q

A middle aged guy presents with c/o exertional dyspnea, syncope, and angina (secondary to poor perfusion of the coronary arteries). Heart sounds include a Harsh crescendo-decrescendo murmur along the right sternal border (may radiate to carotids).

A

-Aortic Stenosis

  • EKG show LV hypertrophy
  • CXR show a calcified aortic valve

echo with doppler is Dx

100
Q

What is the tx for Aortic Stenosis?

A
  • Aortic Valve Replacement
    • prosthetic last longer but need anticoagulation
    • pericardial and porcine have shorter lifespan
  • Ross procedure, replace aortic valve with patient’s pulmonary valve and a cadaver valve replaces the pulmonary valve
  • balloon valvuloplasty not effective long term.

1, Cardiology (11 decks)

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