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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?

A

HTN

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
Q

What is essential (primary) HTN?

A

Elevated BP with no underlying disorder

26
Q

What is a hypertensive emergency?

A
  • Severe BP elevation WITH sx of end organ damage
27
Q

What is Asymptomatic severe HTN (hypertensive urgency)?

q

A
  • severe BP elevation WITHOUT sx of end organ damage
28
Q

What is normal BP?

A

< 120/80

29
Q

What is considered elevated BP?

A

120-129/<80

30
Q

What is stage 1 htn?

A

130-139/80-89

31
Q

What is stage 2 htn?

A

>140/90

32
Q

In kids what is considered htn?

A
  • Systolic BP greater than the 95th percentile for age, sex, and height
33
Q

In pregnant women what is considered hypertension?

A
  • SBP >140 or
  • DBP>90
34
Q

What can indicate primary htn?

A
  • Gradual increase in BP
  • Weight gain, high sodium diet, decrease exercise
  • Fhx
35
Q

What can indicate secondary hypertension?

A
  • features of cushing syndrome
  • Pheochromocytoma
  • Polycystic kidney
  • Abdominal bruit
  • Precordial murmur
36
Q

What labs do you want to order for primary htn?

A
  • fasting blood glucose
  • serum creatine with eGFR
  • lipid panel
  • CBC/CMP
  • THS
  • UA
  • ECG
37
Q

What is the treatment for someone with elevated BP?

A

Nonpharmacological therapy

38
Q

What is the first step when you have a patient with stage 1 htn?

A
  • 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
Q

What is the treatment for someone with stage 2 htn?

A
  • Non-pharmacologial therapy
  • also BP lowering medication
    • two anti HTN agents of different classes
40
Q

When do you reassess someone with stage 2 htn after they begin their therapy?

A
  • 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
Q

What needs to be looked at once you start a RAS inhibitor or diuretic?

A
  • assess electrolytes and renal function 2-4 weeks after starting
42
Q

?You have a patient who is 68 yo with CKD and stage 1 hypertension, what do you do?

A
  • Start them on BP lowering medication
    • because they have CKD (or diabetes) they are automatically placed into the high CVD risk category
43
Q

What are the first line HTN medications>

A
  • RAAS inhibitors
  • CCB’s
  • Thiazide diuretics
  • African americans respond best to CCB’s or diuretics
  • Whites respond best to ACE-Is or ARBS
44
Q

For a patient with DM2, CHD, BPH and A. fib, what class of HTN drugs would you use?

A
  • A. fib → CCB
  • BPH → Alpha blocker
  • CHD → ACE-Is or ARBs or Beta blocker
  • DM2 → ACE-Is or ARBS
45
Q

What are the ACE-Is?

A
  • Benazepril
  • Fosinopril
  • Lisinopril
  • the “pril’s”
46
Q

What are examples of ARB’s?

A
  • Candesartan
  • Irbesartan
  • The “artan’s”
47
Q

Examples of thiazide like diuretics?

A
  • Chlorthalidone
  • Indapamide
  • HCTZ
48
Q

what symptoms do you see in a patient with BP >180/110

A
  • HA
  • Light headed
  • Dyspnea
  • Anxiety
  • Epistaxis
  • Palpatation
49
Q

How do you treat Asymptomatic severe HTN (HTN urgency)

A
  • Gradually lower BP and reassess in 2-4 weeks
  • NO evidence that acute inpatient tx of this improves outcomes
50
Q

What will you see in a patient with HTN emergency?

A

Look for:

  • neuro sx
  • visual disturbance, exudates, papilledema
  • Chest discomfort, palpitation
  • acute severe back pain
  • dyspnea
51
Q

How do you evaluate a patient with suspected HTN Emergency?

A
  • EKG
  • CXR
  • UA
  • Serum electrolytes and creatine
  • potentially cardiac biomarkers or CT brain

CPR 2 Exam 1 (21 decks)

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