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CPR 2 Exam 1 > Miller Syncope & Htn > Flashcards

Miller Syncope & Htn Flashcards

1
Q

What is syncope?

A

Transient self limited loss of consciousness due to cerebral hypoperfusion

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2
Q

What is Neurally mediated syncope?

A
  • Vasovagal syncope
  • Carotid sinus syndrome
  • Situational

Most common type

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3
Q

What causes cardiac syncope?

A

Arrhythmias

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4
Q

What are the subtypes of orthostatic hypotension?

A
  • Initial
  • Classic
  • Delayed
  • Neurogenic
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5
Q

What can mimic syncope?

A
  • Siezures
  • Sleep disturbances such as cataplexy or narcolepsy
  • TBI
  • Metabolic disorder
  • Psychogenic
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6
Q

What is the tri modal incidence of the first syncopal episode?

A
  • 20 yrs
  • 60 yrs
  • 80 yrs old

Sharp increase after 70

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7
Q

What are risk factors for syncope?

A
  • aortic stenosis
  • Impaired renal function
  • BBB
  • Males
  • Underlying chronic disorders
  • A. fib
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8
Q

How does neural mediated syncope present?

A
  • Orthostatic intolerance sx:
    • dizzy, light headed, fatigue
  • Autonomic activations:
    • diaphoresis, pallor, palpitation, nausea
  • Confusion rare
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9
Q

What does it mean to say neural mediated syncope has a prodrome?

A

They had symptoms before the syncopal episode

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10
Q

what is orthostatic hypotension?

A
  • Reduction of 20mmHg systolic or 10mmHg disasolic w/n 3 min of standing.
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11
Q

what symptoms do patients have with orthostatic hypotnesion?

A
  • light headed
  • dizzy
  • presyncope
  • all with sudden posture changes
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12
Q

___ occurs suddenly with few warning symptoms.

A

Cardiac syncope

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13
Q

How do patients with cardiac syncope present?

A
  • Palpitations
  • Chest pain
  • Dizzy
  • OR no prodrome
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14
Q

What is tilt table testing potentially helpful for?

A
  • Suspected VVS
  • Suspected delayed OH
  • Distinguish between convulsive syncope and epilepsy
  • Establish diagnosis of psuedosyncope

Not recommended often anymore

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15
Q

In what senario can a patient be referred to outpatient with syncope?

A
  • Neural mediated syncope
  • Cardiac syncope BUT no serious medical condition
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16
Q

What senario will a patient with syncope need to be observed?

A
  • Age >50
  • hx of cardiac dz
  • functioning cardiac device
  • abnormal ECG
  • FH sudden cardiac death
  • If the symptoms don’t point to neural mediated syncope
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17
Q

In what senario do patients need to be admitted with syncope?

A
  • Major cardiac arrhythmia
  • Serious CV condition
  • Noncardiac conditions
    • severe anemia
    • major trauma
    • persistent abnormal vital signs
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18
Q

How do you manage neural mediated syncope?

A
  • Increase central blood volume and CO
    • reassure, avoid triggers, plasma volume expansion with fluids
    • Teach physical counterpressure maneuvers such as crossing legs or arm tensing
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19
Q

How do you manage/treat syncope due to OH?

A
  • Remove reversible causes
  • Educate about staged moving
  • Compression stockings and counterpressure maneuvers
  • Expand intravascular volume
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20
Q

How do you treat cardiac syncope?

A
  • Electrophysiology study (EPS) is helpful if you suspect cardiac syncope, but haven’t been able to record it on ECG
    • bradyarrhythmia: cardiac pace
    • tachyarrhythmia: ablation, drugs cardioverter defibrillator
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21
Q

What is the leading single contributor to all cause mortality and disability world wide?

22
Q

What are the pathological consequences of hypertension in the heart?

A
  • Structural/functional adaptations that lead to:
    • LVH
    • HF
    • Atherosclerotic CAD and microvascular dz
    • Arrhythmias
23
Q

What are the pathological consequences of hypertension in the brain?

A
  • CVA
  • Impaired cognition
  • HTN encephalopathy
24
Q

What are the pathological consequences of hypertension in the kidney and peripheral arteries?

A
  • Renal injury and ESRD
  • PAD
25
What is essential (primary) HTN?
Elevated BP with no underlying disorder
26
What is a hypertensive emergency?
* Severe BP elevation WITH sx of end organ damage
27
What is Asymptomatic severe HTN (hypertensive urgency)? q
* severe BP elevation WITHOUT sx of end organ damage
28
What is normal BP?
\< 120/80
29
What is considered elevated BP?
120-129/\<80
30
What is stage 1 htn?
130-139/80-89
31
What is stage 2 htn?
\>140/90
32
In kids what is considered htn?
* Systolic BP greater than the 95th percentile for age, sex, and height
33
In pregnant women what is considered hypertension?
* SBP \>140 or * DBP\>90
34
What can indicate primary htn?
* Gradual increase in BP * Weight gain, high sodium diet, decrease exercise * Fhx
35
What can indicate secondary hypertension?
* features of cushing syndrome * Pheochromocytoma * Polycystic kidney * Abdominal bruit * Precordial murmur
36
What labs do you want to order for primary htn?
* fasting blood glucose * serum creatine with eGFR * lipid panel * CBC/CMP * THS * UA * ECG
37
What is the treatment for someone with elevated BP?
Nonpharmacological therapy
38
What is the first step when you have a patient with stage 1 htn?
* Clinical ASCVD or estimated 10 yr risk CVD risk \>10% * if high risk use BP meds * If lower than 10% use non pharmacologic therapy and reassess
39
What is the treatment for someone with stage 2 htn?
* Non-pharmacologial therapy * also BP lowering medication * two anti HTN agents of different classes
40
When do you reassess someone with stage 2 htn after they begin their therapy?
* 1 month * If they are meeting BP goal reassess every 3-6 months * If not meeting goal look at adherence to meds and/or intensify therapy
41
What needs to be looked at once you start a RAS inhibitor or diuretic?
* assess electrolytes and renal function 2-4 weeks after starting
42
?You have a patient who is 68 yo with CKD and stage 1 hypertension, what do you do?
* Start them on BP lowering medication * because they have CKD (or diabetes) they are automatically placed into the high CVD risk category
43
What are the first line HTN medications\>
* RAAS inhibitors * CCB's * Thiazide diuretics * *African americans respond best to CCB's or diuretics* * *Whites respond best to ACE-Is or ARBS*
44
For a patient with DM2, CHD, BPH and A. fib, what class of HTN drugs would you use?
* A. fib → CCB * BPH → Alpha blocker * CHD → ACE-Is or ARBs or Beta blocker * DM2 → ACE-Is or ARBS
45
What are the ACE-Is?
* Benazepril * Fosinopril * Lisinopril * *the “pril's”*
46
What are examples of ARB's?
* Candesartan * Irbesartan * *The “artan's”*
47
Examples of thiazide like diuretics?
* Chlorthalidone * Indapamide * HCTZ
48
what symptoms do you see in a patient with BP \>180/110
* HA * Light headed * Dyspnea * Anxiety * Epistaxis * Palpatation
49
How do you treat Asymptomatic severe HTN (HTN urgency)
* Gradually lower BP and reassess in 2-4 weeks * NO evidence that acute inpatient tx of this improves outcomes
50
What will you see in a patient with HTN emergency?
Look for: * neuro sx * visual disturbance, exudates, papilledema * Chest discomfort, palpitation * acute severe back pain * dyspnea
51
How do you evaluate a patient with suspected HTN Emergency?
* EKG * CXR * UA * Serum electrolytes and creatine * potentially cardiac biomarkers or CT brain

CPR 2 Exam 1 (21 decks)

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