Syncope and HTN Flashcards
What are the Criteria in the San Francisco Syncope Rule?
CHESS
CHF history
Hematocrit <30%
ECK abnormal
SOB
Systolic BO <90mmHg
What is the prodrome for neurally mediated syncope?
Abdominal pain, nausea
Vision changes, dizziness
Slow pulse
What is orthostatic hypotension?
What are the characteristic symptoms?
reduction in SBP >20 or diastolic >10 within 3 min of standing
Dizziness and presyncope with sudden postural changes
What is the prodrome for cardiac syncope?
Often none
chest pain, palpitations
often while supine or with exertion
What is the most important feature in dignosing syncope?
What are some key elements to ascertain?
History
LOC
Hx of CV disease
Clinical features to suggest specific cause?
what are some recommended studies for diagnosing syncope?
Stress test-exertional syncope
TTE-structural heart dz
EPS-suspected arrhythmia
MRI/CT-only specific circumstances
What are some cardiac monitors for evaluating syncope?
Holter-sx that recur within 24-72 hrs
Event-Pt activated, sx recur in 2-6wks
External loop-Continuous activated or auto, sx recur in 2-6wks
Internal-SubQ, 2-3yrs, for infrequent syncope
What kind of syncope pt would you dispo as “observation”
over 50 with h/o cardiac disease
functioning cardiac device
abnormal EKG
Fh of sudden cardiac death
sx do not point to neurally mediated
What kind of syncope patient would be admitted?
major arrhythmia
serious CV condition
noncardiac condition like trauma or severe anemia
How is neurally mediated syncope managed?
reassurance, avoid triggers
expand plasma volume with fluid/salt
physical counterpressure maneuvers of limbs to reduce syncope by 39%
What is the management of orthostatic hypotension?
Remove reversible causes
nonpharm interventions (education)
pharm-midodrine
What is the management for cardiac syncope?
EPS in patients with suspected arrhythmic etiology only
Treat underlying cardiac disorder
What are the main pathological consequences of HTN?
heart maladaptations
brain-CVA, dementia, encephalopathy
Kidney injury
peripheral artery disease
What is normal BP?
What is elevated BP?
What is stage 1 HTN?
What is stage 2 HTN?
What is pregnancy HTN?
<120/80
120-129/<80
130-139/80-89
>140/90
>140/>90
What diagnostic tests should always be ordered on HTN patients?
CBC
CMP
Lipids
TSH
UA
EKG
According to ASCVD criteria, which patients are automatically placed in the high risk category in regards to HTN?
Patients with DM, CKD, or over 65
Patients with stage 2 HTN are treated with how many HTN agents?
Two ant-HTN agents of different classes
2-4 weeks after initiation of RAAS inhibitors or diuretics, what should be checked?
Electrolytes and renal function
What is the goal BP for HTN management?
<130/80
What are the modifiable risk factors for HTN?
smoking
DM
HLD
weight
low fitness/poor diet
What diet is recommended for lowering BP?
DASH diet
(-11.2mmHg change in BP)
What is the first line drug class for HTN management?
RAASi
CCBs
thiazide diuretics
What is the anti-HTN of choice in Black patients?
What about for white patients?
CCB or Diuretics in Black patients
ACEi or ARBs in white patients
What drugs should go together for these comorbidities?
DM2 and HTN
CHD or CHF with HTN
BPH and HTN
Afib and HTN
ACEi or ARBs
ACEi or ARBs, B-blockers
a-blockers
CCBs or B blockers
What are the general rules to follow in choosing anti-HTN?
Choose generics
once-day dosing
no food related/timing issues
cheap cost
consider 2 in 1 combinations
What to consider with reassessment in HTN treatment
monitor for orthostasis
ID white coat effect
document adherance
monitor response
reinforce importance of treatment
What is HTN urgency
How should it be treated?
BP over 180/110
lower gradually but not acutely over several days to weeks. Increase therapy every 2-4 weeks
How to recognize HTN Emergency?
neuro deficits, visual changes , chest pain, back pain, dyspnea
need EKG, CXR, UA, electrolyte and crt measurement
How to treat HTN emergency
Lower MAP gradually
differentiate stroke/trauma from HTN encephalopathy
check/tx for acute HF, ACS
can rapidly lower BP with IV b blockers (esmolol) if concerned for stroke?
can treat kidneys with fenoldapam
