Syncope And Hypertension - Dr. Miller Flashcards
Neurally mediated syncope
TRANSIENT
- Vasovagal (normal passing out)
- Carotid sinus syndrome
- Situational syncope (refex)
Cardiac syncope
low CO from arrythmia
Orthostatic hypotension syncope
CHRONIC, from standing up
episode for syncope happen in what age pattern
20, 60, 80
sharp increase after 70
who can leave and who needs to stay in hospital from syncope (how to make this decision)
San Francisco Syncope Ratio C : CHF H : Hct lower 30% E : EKG abnormal S : SOB S : Systolic BP under 90
Neurally mediated syncope examples
passing out form locking knees or seeing blood
Neurally mediated syncope sx
= dizzy, pass out and then can wake up and tell you what happened
= autonomic activation
= N, palpitations, sweat, pallor, hyperventilation
= dilated pupils, rare urinary incontinence
= Slow pulse *
orthostatic hypotension is what
= systolic lower by 20 and/ or diastolic lower by 10 (after 3min standing from laying down)
= usually preceded by warning sx
cardiac syncope
sudden loss of consciousness, usually from exertion
= no warning collapse (like hypertrophic cardiomyopathy)
= few warning sx preceding
5-15 % of syncope cases are due to what
medications
syncope PE things
vital signs and BP (orthostatic included)
= if focal Neurologic findings DO Carotid artery imaging + CT/MRI head
syncope and DX
= EKG : esp past ekg from pt
= CBC + electrolytes
= troponin (if you think its cardiac)
neurogenic syncope refer to
autonomic evaluation
reflex syncope refer them to
Tilt-table testing
cardiovascular syncope refer them to
- implantable cardiac monitor
- ambulatory external cardiac monitor
- stress testing
- MRI/CT
tilt table testing
not recomended as much
= neurologic mediated syncope from reflex
= unclear dx, delayed orthostatic hypo
= BP and HR as you tilt someone to see how autonomic function **
the only type of syncope that pt does not have to stay in hospital for observation
neurally mediated syncope
what can help pt with neurally mediated syncope episodes
= gripping hands and arm tensing
= crossing legs
= medications also (vasoconstrictors)
= avoid triggers
orthostatic hypotension tx
= remove reversible causes like drugs = slow moving from laying down = compression stockings = increase dietary salt and fluid = MEDS : midodrine or fludrocortisine
cardiac syncope tx
= EPS (electric physiology study)
= Brady : pacer
= tachy : ablation, antiarryhtics, defibrillators
Hypertension risks modifiable
smoking, DM, obesity, diet unhealthy, low Physical activity
HTN fixed risks
= CKD = FH = age = socioeconomic status = male = sleep apnea = stress psychosocial
HTN effects what 4 organs
- Heart
- Brain : dementia, CVA, HTN encephalopathy
- Kidney : segmental glomerular sclerosis
- Peripheral Arteries
secondary htn
from another disorder
htn urgency is what
over 180/110 + no end organ damage
htn emergency is what
over 180/110 with end organ damage
endothelin 1 function
Th 1 function
Treg function
ON BP
endothelin 1 = increase BP
Th1 = increase BP
Tregs = decrease BP
htn dx doe by what
2017 ACC/AHA guidelines
HTN is normal
elevated
stage 1
stage 2
normal : under 120/80
elevated : 120-129/ under80
stage 1 : 130-139/ 80-89
stage 2: 140/90 or more
HTN in children
is over 95% percentile at there age and sex
pre-htn (90%-95%)
HTN in pregnant women is what
140/90 or higher
primary htn causes
job changes, alcohol, diet,
gradual increase
dx htn what to order
CBC, lipid panel, CMP, TSH, UA, EGK, fasting blood glucose
stage 1 htn how to tx
- non- pharmacologic : no ASCVD or 10year CVD risk over 10%
- non-pharmacologic + BP meds : if CVD 10year risk over 10%*
(ORRR *DM, *CKD, *over 65yo)
elevated htn tx
non-pharm (reassess in 3mo-6mo)
stage 2 htn tx
non-pharm + 2 BP meds (different classes)
stage 1 htn pt needed BP meds what should I do
assess electrolytes and renal function 2-4 weeks after starting tx
2017 ACC/ AHA want what BP
under 130/80`
what is 1 thing that can lower BP more then anything
DASH diet SERVINGS:
- (6-8 whole grains)
- 4-5 veggies
- 4-5 fruits
- 2-3 dairy
- 2-3 fat/oil
- lean meat, poultry, fish (2-3)
- nuts, seeds, legumes (4-5 per week)
- candy + added sugar (less then 5 per week)
exercise that lowers BP
aerobic (-5 to 8 mmHg)
static isometric (-5mmHg)
Dynamic (-4mmHg)
First line meds for HTN management
- RAAS inhibitor (renin, angiotensin, aldosterone, system)
- CCBs
- thiazide
Blacks respond to what htn drug
CCBs and diuretics
White respond to what htn drug
ACE-I and ARBs
HTN medication for :
DM2
ACE-I or ARBs
HTN medication for :
CHD or CHF
ACE-I, ARBs, BB
HTN medication for : BPH (benign prostatic hypertrophy
a-blocker
HTN medication for : A fib
CCB or BB
ACE-1
lisinopril
benazepril
ramipril
ARBs
candesartansm irbesartan, losertan, telmisartan
Thiazide-like diuretics
chlirthalidone, indapamide (not HCTZ as much)
CCB
amlodipine, isradapine, nifedipine
BB
atenolol, bisorpolol, carvedilol, metoprolol
Hypertensive urgency other name
(Asymptomatic severe htn)
= over 180/110
= lower to like 160/100
= lower slowly** over days - weeks
HTN emergency sx
- agitation, delirium, eye problems, , weakness, numbness, hemorrhage, CP, SOB, Cerebral Infarct, PE
- acute back pain (aortic dissection)
HTN Emergency tx
- lower 10-20% 1st hour
2. 5-15% next 24hr
htn em tx for kidney
fenoldapam
htn em tx for vascular
BB esmolol
htn em tx for heart
vasodilator + BB
htn em tx for brain
clevidipine, nicardipine, fenoldampam (CCB)
meow
:)
