Syncope and Hypertension Flashcards
What is Syncope?
Transient, self-limited loss of consciousness due to cerebral hypoperfusion
What are the 3 categories of Syncope?
- Neurally mediated
- Cardiac
- Orthostatic Hypotension
What is the tri-modal incidence of 1st episode ages for Syncope?
20, 60, or 80
– sharp increase after 70
What are some Syncope mimics that are NOT true Syncope?
- Seizures, sleep disturbances, psych issues
- Trauma, metabolic/toxic disorders
Transient, self limited loss of consciousness due to cerebral hypoperfusion
Syncope
What are the symptoms of Neurally Mediated Syncope?
Dizziness, lightheadedness, fatigue, sweating, abdominal pain and nausea
Dizziness, lightheaded, diaphoresis, nausea and abdominal pain characterizes what type of Syncope?
Neurally mediated
With Neurally Mediated Syncope, describe the eyes and urinary things that can happen
Eyes may remain open, deviate up or move with dilated pupils
– Urinary incontinence may occur but is rare
For Neurally Mediated Syncope, what is the followup type?
Outpatient
Cardiac Syncope warning symptoms?
FEW or NONE
When does Cardiac Syncope usually occur and if any symptoms are there, what would they be?
Occurs while supine or with exertion
– chest pain, palpitations, etc.
For Cardiac Syncope that involves cardiac issues, what is the followup types?
Observation or Admission
What defines Orthostatic Hypotension?
REDUCTION in:
systolic BP > 20mmHg OR
diastolic BP > 10mmHg
= WITHIN 3 minutes of standing up
Orthostatic Hypotension episode warning symptoms?
YES usually preceded by them
Orthostatic Hypotension symptoms?
SUDDEN POSTURAL CHANGE
–> lightheaded, dizzy, fainting, etc.
What can suggest the diagnosis in half of Syncope patients?
HISTORY
Besides history, what else is commonly to blame for Syncope (especially orthostatic hypotension)?
MEDS
The physical exam for Syncope patients is usually NORMAL. What should you take a look at?
Vitals (Orthostatic vitals too), cardiac and neuro
Treatment for Neurally Mediated Syncope?
- Reassurance, avoid triggers, increase plasma volume
- Physical counterpressure maneuvers
ex. leg crossing, arm tensing
Treatment for Cardiac Syncope?
Treat underlying disorder
Treatment for Orthostatic Hypotension?
Remove reversible causes!
- Staged movements from supine to upright, compression stockings, possible drugs
Hypertension is usually ______
ASYMPTOMATIC - measure it
In what race/ethnic group is hypertension usually more severe with an earlier onset and mortality?
Black people
Hypertension doubles your risk of?
Cardiovascular disease
What are some modifiable risk factors for Hypertension?
- Elevated cholesterol
- Obesity, diabetes, smoking
What are some relatively fixed risk factors for Hypertension?
- Increasing male age
- Chronic Kidney disease
- Obstructive sleep apnea
- Stress
On what 4 organ/systems are the pathologic consequences of Hypertension seen?
HEART - most common cause of death
BRAIN
Kidney
Peripheral arteries
Elevated blood pressure WITHOUT an underlying disorder
Primary (essential) hypertension
Elevated blood pressure WITH a specific underlying disorder
Secondary hypertension
In order to classify severe hypertension/emergency, the blood pressure has to be greater than or equal to?
180/110
BP > 180/110 WITHOUT end organ damage symptoms
Asymptomatic Severe Hypertension
BP > 180/110 WITH end organ damage symptoms
Hypertensive emergency
Normal BP level
< 120/80
Elevated BP level
120-129/<80
Stage 1 HTN BP level
130-139/80-89
Stage 2 HTN BP level
> 140/90
For children, what classifies HTN?
Systolic BP > 95th percentile for age, ht, wt
For pregnant women, what classifies HTN?
Systolic BP >140 OR
Diastolic BP > 90
What labs should be ordered in the diagnosis of hypertension?
CBC, CMP, lipid panel, TSH, UA, EKG
Normal BP treatment
Lifestyle modifications
Elevated BP treatment
Non-pharmacologic therapy
120-129/<80
If a patient has Stage 1 hypertension, what should be calculated?
ASCVD or 10 year CVD risk > 10%?
Treatment for Stage 1 HTN with no CVD risk?
Non-pharmacologic therapy
Treatment for Stage 1 HTN with ASCVD or a 10 year CVD risk > 10%?
BP lowering medication
In what 3 conditions are patients directly placed into a high risk category and started on medication for Stage 1 HTN?
- Age > 65
- Diabetes
- Chronic Kidney Disease
Treatment for Stage 2 HTN?
BP lowering medication
Medication for HTN involves?
2 agents of different classes
- assess electrolytes and renal function a few weeks after starting
What is the BP goal when treating hypertension?
BP < 130/80
What lifestyle modifications can be made to alter hypertension?
- exercise and weight reduction
- decrease alcohol and salt intake
- DASH diet – high in fruits/veggies
Treatment for Asymptomatic Severe HTN?
Gradually lower BP over several days to weeks and intensify therapy every 2-4 weeks
What are the most common manifestations of an Hypertensive Emergency?
Cerebral infarction and pulmonary edema
– neuro/eye disturbances, dyspnea, chest pain
Treatment for a Hypertensive Emergency?
- Lower MAP gradually in first 24 hours
- Treat organ specific manifestations
To treat vascular manifestations of a Hypertensive Emergency, what should be done?
Give IV beta blocker to RAPIDLY lower bp
To treat kidney manifestations of a Hypertensive Emergency, what should be given?
Fenoldapam
