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CPR II Exam 1 > Syncope and HTN > Flashcards

Syncope and HTN Flashcards

1
Q

What are the Criteria in the San Francisco Syncope Rule?

A

CHESS

CHF history

Hematocrit <30%

ECK abnormal

SOB

Systolic BO <90mmHg

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2
Q

What is the prodrome for neurally mediated syncope?

A

Abdominal pain, nausea

Vision changes, dizziness

Slow pulse

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3
Q

What is orthostatic hypotension?

What are the characteristic symptoms?

A

reduction in SBP >20 or diastolic >10 within 3 min of standing

Dizziness and presyncope with sudden postural changes

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4
Q

What is the prodrome for cardiac syncope?

A

Often none

chest pain, palpitations

often while supine or with exertion

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5
Q

What is the most important feature in dignosing syncope?

What are some key elements to ascertain?

A

History

LOC

Hx of CV disease

Clinical features to suggest specific cause?

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6
Q

what are some recommended studies for diagnosing syncope?

A

Stress test-exertional syncope

TTE-structural heart dz

EPS-suspected arrhythmia

MRI/CT-only specific circumstances

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7
Q

What are some cardiac monitors for evaluating syncope?

A

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

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8
Q

What kind of syncope pt would you dispo as “observation”

A

over 50 with h/o cardiac disease

functioning cardiac device

abnormal EKG

Fh of sudden cardiac death

sx do not point to neurally mediated

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9
Q

What kind of syncope patient would be admitted?

A

major arrhythmia

serious CV condition

noncardiac condition like trauma or severe anemia

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10
Q

How is neurally mediated syncope managed?

A

reassurance, avoid triggers

expand plasma volume with fluid/salt

physical counterpressure maneuvers of limbs to reduce syncope by 39%

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11
Q

What is the management of orthostatic hypotension?

A

Remove reversible causes

nonpharm interventions (education)

pharm-midodrine

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12
Q

What is the management for cardiac syncope?

A

EPS in patients with suspected arrhythmic etiology only

Treat underlying cardiac disorder

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13
Q

What are the main pathological consequences of HTN?

A

heart maladaptations

brain-CVA, dementia, encephalopathy

Kidney injury

peripheral artery disease

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14
Q

What is normal BP?

What is elevated BP?

What is stage 1 HTN?

What is stage 2 HTN?

What is pregnancy HTN?

A

<120/80

120-129/<80

130-139/80-89

>140/90

>140/>90

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15
Q

What diagnostic tests should always be ordered on HTN patients?

A

CBC

CMP

Lipids

TSH

UA

EKG

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16
Q

According to ASCVD criteria, which patients are automatically placed in the high risk category in regards to HTN?

A

Patients with DM, CKD, or over 65

17
Q

Patients with stage 2 HTN are treated with how many HTN agents?

A

Two ant-HTN agents of different classes

18
Q

2-4 weeks after initiation of RAAS inhibitors or diuretics, what should be checked?

A

Electrolytes and renal function

19
Q

What is the goal BP for HTN management?

A

<130/80

20
Q

What are the modifiable risk factors for HTN?

A

smoking

DM

HLD

weight

low fitness/poor diet

21
Q

What diet is recommended for lowering BP?

A

DASH diet

(-11.2mmHg change in BP)

22
Q

What is the first line drug class for HTN management?

A

RAASi

CCBs

thiazide diuretics

23
Q

What is the anti-HTN of choice in Black patients?

What about for white patients?

A

CCB or Diuretics in Black patients

ACEi or ARBs in white patients

24
Q

What drugs should go together for these comorbidities?

DM2 and HTN

CHD or CHF with HTN

BPH and HTN

Afib and HTN

A

ACEi or ARBs

ACEi or ARBs, B-blockers

a-blockers

CCBs or B blockers

25
Q

What are the general rules to follow in choosing anti-HTN?

A

Choose generics

once-day dosing

no food related/timing issues

cheap cost

consider 2 in 1 combinations

26
Q

What to consider with reassessment in HTN treatment

A

monitor for orthostasis

ID white coat effect

document adherance

monitor response

reinforce importance of treatment

27
Q

What is HTN urgency

How should it be treated?

A

BP over 180/110

lower gradually but not acutely over several days to weeks. Increase therapy every 2-4 weeks

28
Q

How to recognize HTN Emergency?

A

neuro deficits, visual changes , chest pain, back pain, dyspnea

need EKG, CXR, UA, electrolyte and crt measurement

29
Q

How to treat HTN emergency

A

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

30
Q
A

CPR II Exam 1 (25 decks)

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