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2 - CPR (cardio) > Syncope and Hypertension > Flashcards

Syncope and Hypertension Flashcards

1
Q

What is Syncope?

A

Transient, self-limited loss of consciousness due to cerebral hypoperfusion

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2
Q

What are the 3 categories of Syncope?

A
  1. Neurally mediated
  2. Cardiac
  3. Orthostatic Hypotension
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3
Q

What is the tri-modal incidence of 1st episode ages for Syncope?

A

20, 60, or 80

– sharp increase after 70

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4
Q

What are some Syncope mimics that are NOT true Syncope?

A
  • Seizures, sleep disturbances, psych issues

- Trauma, metabolic/toxic disorders

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5
Q

Transient, self limited loss of consciousness due to cerebral hypoperfusion

A

Syncope

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6
Q

What are the symptoms of Neurally Mediated Syncope?

A

Dizziness, lightheadedness, fatigue, sweating, abdominal pain and nausea

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7
Q

Dizziness, lightheaded, diaphoresis, nausea and abdominal pain characterizes what type of Syncope?

A

Neurally mediated

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8
Q

With Neurally Mediated Syncope, describe the eyes and urinary things that can happen

A

Eyes may remain open, deviate up or move with dilated pupils

– Urinary incontinence may occur but is rare

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9
Q

For Neurally Mediated Syncope, what is the followup type?

A

Outpatient

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10
Q

Cardiac Syncope warning symptoms?

A

FEW or NONE

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11
Q

When does Cardiac Syncope usually occur and if any symptoms are there, what would they be?

A

Occurs while supine or with exertion

– chest pain, palpitations, etc.

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12
Q

For Cardiac Syncope that involves cardiac issues, what is the followup types?

A

Observation or Admission

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13
Q

What defines Orthostatic Hypotension?

A

REDUCTION in:
systolic BP > 20mmHg OR
diastolic BP > 10mmHg
= WITHIN 3 minutes of standing up

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14
Q

Orthostatic Hypotension episode warning symptoms?

A

YES usually preceded by them

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15
Q

Orthostatic Hypotension symptoms?

A

SUDDEN POSTURAL CHANGE

–> lightheaded, dizzy, fainting, etc.

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16
Q

What can suggest the diagnosis in half of Syncope patients?

A

HISTORY

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17
Q

Besides history, what else is commonly to blame for Syncope (especially orthostatic hypotension)?

A

MEDS

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18
Q

The physical exam for Syncope patients is usually NORMAL. What should you take a look at?

A

Vitals (Orthostatic vitals too), cardiac and neuro

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19
Q

Treatment for Neurally Mediated Syncope?

A
  • Reassurance, avoid triggers, increase plasma volume
  • Physical counterpressure maneuvers
    ex. leg crossing, arm tensing
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20
Q

Treatment for Cardiac Syncope?

A

Treat underlying disorder

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21
Q

Treatment for Orthostatic Hypotension?

A

Remove reversible causes!

- Staged movements from supine to upright, compression stockings, possible drugs

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22
Q

Hypertension is usually ______

A

ASYMPTOMATIC - measure it

23
Q

In what race/ethnic group is hypertension usually more severe with an earlier onset and mortality?

A

Black people

24
Q

Hypertension doubles your risk of?

A

Cardiovascular disease

25
Q

What are some modifiable risk factors for Hypertension?

A
  • Elevated cholesterol

- Obesity, diabetes, smoking

26
Q

What are some relatively fixed risk factors for Hypertension?

A
  • Increasing male age
  • Chronic Kidney disease
  • Obstructive sleep apnea
  • Stress
27
Q

On what 4 organ/systems are the pathologic consequences of Hypertension seen?

A

HEART - most common cause of death
BRAIN
Kidney
Peripheral arteries

28
Q

Elevated blood pressure WITHOUT an underlying disorder

A

Primary (essential) hypertension

29
Q

Elevated blood pressure WITH a specific underlying disorder

A

Secondary hypertension

30
Q

In order to classify severe hypertension/emergency, the blood pressure has to be greater than or equal to?

A

180/110

31
Q

BP > 180/110 WITHOUT end organ damage symptoms

A

Asymptomatic Severe Hypertension

32
Q

BP > 180/110 WITH end organ damage symptoms

A

Hypertensive emergency

33
Q

Normal BP level

A

< 120/80

34
Q

Elevated BP level

A

120-129/<80

35
Q

Stage 1 HTN BP level

A

130-139/80-89

36
Q

Stage 2 HTN BP level

A

> 140/90

37
Q

For children, what classifies HTN?

A

Systolic BP > 95th percentile for age, ht, wt

38
Q

For pregnant women, what classifies HTN?

A

Systolic BP >140 OR

Diastolic BP > 90

39
Q

What labs should be ordered in the diagnosis of hypertension?

A

CBC, CMP, lipid panel, TSH, UA, EKG

40
Q

Normal BP treatment

A

Lifestyle modifications

41
Q

Elevated BP treatment

A

Non-pharmacologic therapy

120-129/<80

42
Q

If a patient has Stage 1 hypertension, what should be calculated?

A

ASCVD or 10 year CVD risk > 10%?

43
Q

Treatment for Stage 1 HTN with no CVD risk?

A

Non-pharmacologic therapy

44
Q

Treatment for Stage 1 HTN with ASCVD or a 10 year CVD risk > 10%?

A

BP lowering medication

45
Q

In what 3 conditions are patients directly placed into a high risk category and started on medication for Stage 1 HTN?

A
  • Age > 65
  • Diabetes
  • Chronic Kidney Disease
46
Q

Treatment for Stage 2 HTN?

A

BP lowering medication

47
Q

Medication for HTN involves?

A

2 agents of different classes

- assess electrolytes and renal function a few weeks after starting

48
Q

What is the BP goal when treating hypertension?

A

BP < 130/80

49
Q

What lifestyle modifications can be made to alter hypertension?

A
  • exercise and weight reduction
  • decrease alcohol and salt intake
  • DASH diet – high in fruits/veggies
50
Q

Treatment for Asymptomatic Severe HTN?

A

Gradually lower BP over several days to weeks and intensify therapy every 2-4 weeks

51
Q

What are the most common manifestations of an Hypertensive Emergency?

A

Cerebral infarction and pulmonary edema

– neuro/eye disturbances, dyspnea, chest pain

52
Q

Treatment for a Hypertensive Emergency?

A
  • Lower MAP gradually in first 24 hours

- Treat organ specific manifestations

53
Q

To treat vascular manifestations of a Hypertensive Emergency, what should be done?

A

Give IV beta blocker to RAPIDLY lower bp

54
Q

To treat kidney manifestations of a Hypertensive Emergency, what should be given?

A

Fenoldapam

2 - CPR (cardio) (44 decks)

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