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CPR2 Exam 1 > Syncope And Hypertension - Dr. Miller > Flashcards

Syncope And Hypertension - Dr. Miller Flashcards

1
Q

Neurally mediated syncope

A

TRANSIENT

  1. Vasovagal (normal passing out)
  2. Carotid sinus syndrome
  3. Situational syncope (refex)
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2
Q

Cardiac syncope

A

low CO from arrythmia

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3
Q

Orthostatic hypotension syncope

A

CHRONIC, from standing up

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4
Q

episode for syncope happen in what age pattern

A

20, 60, 80

sharp increase after 70

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5
Q

who can leave and who needs to stay in hospital from syncope (how to make this decision)

A 
San Francisco Syncope Ratio 
C : CHF
H : Hct lower 30%
E : EKG abnormal
S : SOB
S : Systolic BP under 90
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6
Q

Neurally mediated syncope examples

A

passing out form locking knees or seeing blood

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7
Q

Neurally mediated syncope sx

A

= 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 *

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8
Q

orthostatic hypotension is what

A

= systolic lower by 20 and/ or diastolic lower by 10 (after 3min standing from laying down)
= usually preceded by warning sx

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9
Q

cardiac syncope

A

sudden loss of consciousness, usually from exertion
= no warning collapse (like hypertrophic cardiomyopathy)
= few warning sx preceding

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10
Q

5-15 % of syncope cases are due to what

A

medications

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11
Q

syncope PE things

A

vital signs and BP (orthostatic included)

= if focal Neurologic findings DO Carotid artery imaging + CT/MRI head

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12
Q

syncope and DX

A

= EKG : esp past ekg from pt
= CBC + electrolytes
= troponin (if you think its cardiac)

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13
Q

neurogenic syncope refer to

A

autonomic evaluation

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14
Q

reflex syncope refer them to

A

Tilt-table testing

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15
Q

cardiovascular syncope refer them to

A
  • implantable cardiac monitor
  • ambulatory external cardiac monitor
  • stress testing
  • MRI/CT
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16
Q

tilt table testing

A

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 **

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17
Q

the only type of syncope that pt does not have to stay in hospital for observation

A

neurally mediated syncope

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18
Q

what can help pt with neurally mediated syncope episodes

A

= gripping hands and arm tensing
= crossing legs
= medications also (vasoconstrictors)
= avoid triggers

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19
Q

orthostatic hypotension tx

A 
= remove reversible causes like drugs
= slow moving from laying down
= compression stockings 
= increase dietary salt and fluid
= MEDS : midodrine or fludrocortisine
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20
Q

cardiac syncope tx

A

= EPS (electric physiology study)
= Brady : pacer
= tachy : ablation, antiarryhtics, defibrillators

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21
Q

Hypertension risks modifiable

A

smoking, DM, obesity, diet unhealthy, low Physical activity

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22
Q

HTN fixed risks

A 
= CKD
= FH
= age
= socioeconomic status
= male
= sleep apnea
= stress psychosocial
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23
Q

HTN effects what 4 organs

A
  1. Heart
  2. Brain : dementia, CVA, HTN encephalopathy
  3. Kidney : segmental glomerular sclerosis
  4. Peripheral Arteries
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24
Q

secondary htn

A

from another disorder

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25
Q

htn urgency is what

A

over 180/110 + no end organ damage

26
Q

htn emergency is what

A

over 180/110 with end organ damage

27
Q

endothelin 1 function
Th 1 function
Treg function
ON BP

A

endothelin 1 = increase BP
Th1 = increase BP
Tregs = decrease BP

28
Q

htn dx doe by what

A

2017 ACC/AHA guidelines

29
Q

HTN is normal
elevated
stage 1
stage 2

A

normal : under 120/80
elevated : 120-129/ under80
stage 1 : 130-139/ 80-89
stage 2: 140/90 or more

30
Q

HTN in children

A

is over 95% percentile at there age and sex

pre-htn (90%-95%)

31
Q

HTN in pregnant women is what

A

140/90 or higher

32
Q

primary htn causes

A

job changes, alcohol, diet,

gradual increase

33
Q

dx htn what to order

A

CBC, lipid panel, CMP, TSH, UA, EGK, fasting blood glucose

34
Q

stage 1 htn how to tx

A
  1. non- pharmacologic : no ASCVD or 10year CVD risk over 10%
  2. non-pharmacologic + BP meds : if CVD 10year risk over 10%*
    (ORRR *DM, *CKD, *over 65yo)
35
Q

elevated htn tx

A

non-pharm (reassess in 3mo-6mo)

36
Q

stage 2 htn tx

A

non-pharm + 2 BP meds (different classes)

37
Q

stage 1 htn pt needed BP meds what should I do

A

assess electrolytes and renal function 2-4 weeks after starting tx

38
Q

2017 ACC/ AHA want what BP

A

under 130/80`

39
Q

what is 1 thing that can lower BP more then anything

A

DASH diet SERVINGS:

  1. (6-8 whole grains)
  2. 4-5 veggies
  3. 4-5 fruits
  4. 2-3 dairy
  5. 2-3 fat/oil
  6. lean meat, poultry, fish (2-3)
  7. nuts, seeds, legumes (4-5 per week)
  8. candy + added sugar (less then 5 per week)
40
Q

exercise that lowers BP

A

aerobic (-5 to 8 mmHg)
static isometric (-5mmHg)
Dynamic (-4mmHg)

41
Q

First line meds for HTN management

A
  1. RAAS inhibitor (renin, angiotensin, aldosterone, system)
  2. CCBs
  3. thiazide
42
Q

Blacks respond to what htn drug

A

CCBs and diuretics

43
Q

White respond to what htn drug

A

ACE-I and ARBs

44
Q

HTN medication for :

DM2

A

ACE-I or ARBs

45
Q

HTN medication for :

CHD or CHF

A

ACE-I, ARBs, BB

46
Q

HTN medication for : BPH (benign prostatic hypertrophy

A

a-blocker

47
Q

HTN medication for : A fib

A

CCB or BB

48
Q

ACE-1

A

lisinopril
benazepril
ramipril

49
Q

ARBs

A

candesartansm irbesartan, losertan, telmisartan

50
Q

Thiazide-like diuretics

A

chlirthalidone, indapamide (not HCTZ as much)

51
Q

CCB

A

amlodipine, isradapine, nifedipine

52
Q

BB

A

atenolol, bisorpolol, carvedilol, metoprolol

53
Q

Hypertensive urgency other name

A

(Asymptomatic severe htn)
= over 180/110
= lower to like 160/100
= lower slowly** over days - weeks

54
Q

HTN emergency sx

A
  1. agitation, delirium, eye problems, , weakness, numbness, hemorrhage, CP, SOB, Cerebral Infarct, PE
  2. acute back pain (aortic dissection)
55
Q

HTN Emergency tx

A
  1. lower 10-20% 1st hour

2. 5-15% next 24hr

56
Q

htn em tx for kidney

A

fenoldapam

57
Q

htn em tx for vascular

A

BB esmolol

58
Q

htn em tx for heart

A

vasodilator + BB

59
Q

htn em tx for brain

A

clevidipine, nicardipine, fenoldampam (CCB)

60
Q

meow

A

:)

CPR2 Exam 1 (19 decks)

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