Potpourri 2 Flashcards
Hypertension
Each 20/10 mmHg rise in BP doubles the risk of CVD
Isolated systolic HTN (ISH) - common form HTN in elderly from atrial blood volume and arterial stiffness
-nonreversible and usually asx
Elvate for CV risk, end organ damage, r/o secondary cause
HTN pathology association and causative drugs
Associated w/ MI, CVA, PVD, CHF, Renal failure
Dementia/cognitive impairment more common w/ HTN
-reduced progression w/ effective anti-HTN therapy
Drug-induced HTN: NSAIDs, steroids, OCP
HTN End Organ Damage
Heart, CVD, Renal disease, PAD, Retinopathy, Left ventricular hypertrophy (LVH)
Long-standing HTN most common cause diastolic dysfunction
HTN Treatment
Thiazide diuretic/Lisinopril 1st line - start slowly
Start 2 agents if BP >20/10 - one should be thiazide
HTN Treatment and Alternative Considerations
Thiazides - osteopenia/osteoporosis
BB - atrial tachycardia, migraine, thyrotoxicosis, essential tremor
-decrease mortality post op, prevent a-fib
CCB - useful w/ Raynaud’s
Alpha Blockers - useful w/ BPH
Hypertensive Urgency
Marked BP elevation but not acute target organ damage
No hospitalization, does require immediate combination/oral anti-HTN therapy
Hypertensive Emergency
Marked BP elevation with acute target organ damage
Encephalopathy, TIA/CVA, papilledema, MI, unstable angina, pulmonary edema, life-threatening arterial bleed, AAA, renal failure
Requires hospitalization and parenteral drug therapy
Anterior Circulation Occlusion
Face-hand-arm-leg contralateral hemiparesis
Aphasia
Dysarthria
Anterior Cerebral Artery Occlusion
Leg weakness and sensory loss - contralateral
Arm (proximal weakness) and sensory loss - contralateral
Urinary incontinence
Middle Cerebral Artery Occlusion
Contralateral hemiplegia in face-arm-leg
Homonymous hemianopia - visual field defect in each eye, always on same side
Left side: aphasia, Wernicke’s (receptive) or Broca’s (expressive)
Right side: confusion, spatial disorientation, sensory/emotional neglect
Apraxia
Posterior Circulation Artery Occlusion
Structures that rely on posterior circulation blood supply
Brainstem
Thalamus
Hippocampus
Cerebellum
Visual Cortex
Temporal and Occipital lobes
Subarachnoid hemorrhage
Artery rupture in brain
Primary cause: Aneurysm, AVM
Worst HA ever radiating from face to neck w/ phono/photophobia
Intracerebral Hemorrhage
Bleeding into brain parenchyma
Primary cause: HTN, amyloid angiopathy
Looks like hemorrhagic stroke - always get a CT to r/o hemorrhage before giving TPA
Polymyalgia Rheumatica
AI disease affecting medium vessels - possible RSV antibodies
Aching, bilateral pain and morning stiffness of shoulder, neck, pelvic girdle
Looks like asymmetric peripheral arthritis +/- carpal tunnel and edema of hands/wrist/ankle/feet
More common in women
Labs: ESR most useful, normochromic normocytic anemia
Treatment: IV Prednisone TOC, Bisphosphonates/Calcium and Vitamin D supplements
Parkinson’s Disease
Dopamine deficiency from substantia nigra
Chronic progressive disease, may develop dementia
Treatment: Sinemet 1st line - tardive dyskinesia
