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55 Cards in this Set

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  • Back
CHF is a clinical syndrome characterized by what (3)?
Dyspnea, Abnormal Retention of water and sodium
CHF results from a change of one or more of the following
Contractile ability of the heart muscle, preload, afterload, and HR
CHF adversely affects what 2
LA pressure and cardiac output
Clinical features of left sided heart failure
Exertional dyspnea, non-productive cough, fatigue, orthopnea, paroysmal nocturnal dyspnea, basilar rales, gallops, and exercise intolerance
Clinical features of right sided heart failure
JVD, tender or nontender hepatic congestion, nausea, pitting edema
What activity in CHF produces pallor and cold, clammy skin
Sympathetic activity
CHF electrolyte embalances
Hyperkalemia and hyponatremia
CHF CXR may show
cardiomegaly, bilateral or right-sided pulmonary effusions, perivascular or interstitial edema (Kerley B lines), venous dilation, and alveolar fluid
What lab values might be elevated in CHF?
BNP or N-terminal pro-BNP
How do we assess the severity of CHF?
Angiography, cardiac cath,
Older patients should have what other testing to rule out hemochromatosis?
Thyroid function tests, iron studies
What is the initial treatment in CHF?
Thiazide or loop diuretic and an ACEI
What are CCB (preferably amlodipine) used in CHF?
To treat angina or HTN
CCBs- Dihydropyridines (mechy of action, not used for what? which drugs are they?)
-Decrease resistance and arterial pressure. Not used to treat angina (except amlodopine) because vasodilation can lead to reflex tachycardia. All end in -pine
CCBs- Non-dihydropyridines (mechy of action? 2 examples?)
Myocardial selective. Reduces myocardial O2 demand and reserves coronary vasospasm. Causes less reflex tachycardia. Verapamil and Diltiazem.
HTN- causes
Genetic predisposition, increased age, african americans, excessive salt intake, obesity
Exacerbating factors of HTN
-Alcohol use, cigarette smoking, lack of exercise, polycythemia, use of NSAIDs, and low K intake
Metabolic Syndrome
Truncal obesity, hyperinsulinemia and insulin resistance, hypertriglyceridemia, HTN
Secondary Causes of HTN
-Sleep apnea, estrogen use, pheo, coarction of the aorta, pseudotumor cerebri, parenchymal renal disease, renal artery stenosis, chronic steroid therapy, Cushing'sm thyroid and parathyroid disease, primary hyperaldolsteronism, pregnancy
Having Metabolic Syndrome is associated with the development of:
Diabetes and increased risk of cardiovascular complications
Prehyperatension
120-139 (systolic) 80-89 (diastolic)
Stage 1 Hypertension
140-159 (systolic) 90-99 (diastolic)
Stage 2 Hypertension
>160 (systolic) or >100 (diastolic)
New York Heart Association Functional Classification of Heart Disease- Class I
No limitation of physical activity;
New York Heart Association Functional Classification of Heart Disease- Class II
Slight limitation of physical activity; ordinary physical activity results in symptoms
New York Heart Association Functional Classification of Heart Disease- Class III
Marked limitation of physical activity; comfortable at rest but less than ordinary activity causes symptoms
New York Heart Association Functional Classification of Heart Disease- Class IV
unable to engage in physical activity without discomfort; symptoms may be present even at rest
Hypertensive Urgencies- treatment?
Blood pressure must be reduced within hours
Hypertensive Emergenicies- treatment
Blood pressure must be reduced within 1 hour in order to prevent end-organ damage
Definition of Malignant Hypertension
Elevated blood pressure associated with papilledema adn either encephalopathy or nephropathy.
If malignant HTN goes untreated, what occurs?
Progressive renal failure
Essential diagnostic criteria for HTN
Systolic pressure >140 or a diastolic pressure >90 measured on three seperate occasions
Most commonly voiced symptom of HTN
nonspecific headache
End-organ damage in untreated HTN includes what?
Heart failure, renal failure, stroke, dementia, aortic dissection, atherosclerosis, and retinal hemorrhage
In hypertensive urgencies the systolic pressure is > ____ OR the diastoilc pressure is > ___
220 OR 125
In Hypertensive Emergencies the diastolic pressure is usually greater than what?
130
What lab is important for ascertaining the associated risk for atherosclerosis?
Lipid proflie
What is the first treatment for HTN?
D- dietary
A- approaches to
S- stop
H- hypertension
In pts with HTN-- when should loop diuretics be used?
Only in those with renal dysfunction and when close electrolyte monitoring is assured
Which type of diuretic is most consistently effective in pts with HTN?
Thiazide type
What might need to be taken when patients are on diuretics?
K supplements
B-adrenergic antagonists are used to do what?
Decrease heart rate and cardiac output. Are more effective in younger white patients.
Intial DOC for pts with HTN and diabetes?
ACEI
Mechy of action of ACEI
-Inhibit bradykinin degradation and stimulate synthesis of vasodilating prostaglandings.
Major side effect of ACEI
Cough
Mechy of action of ARBs
- Block the interaction of angiotension II on receptors.
Why do ARBs not cause a cough?
Because they do not increase bradykinins
What type of drug might be preferred in AA and elderly patients and is used for peripheral vasodilation
CCBs
What is the drug Aliskiren?
A renin inhibitor that was recently approved for mono or combo therapy in HTN.
What are the preferred agents for treating hypertensive emergencies and urgencies?
Nitroprusside
Nitroglycerine or a BB (if ischemia is present)
Oral agents for less severe hypertensive emergencies include what?
-Clonidine, captopril, and nifedipine
Causes of cardiogenic shock?
MI, dysrhythmias, heart failure, defects in the valves or septum, HTN, myocarditis, cardiac contusion, rupture of the ventricular septum, or myocardiopathies
Cause of postural hypotension:
Reduced cardiac output, paroxysmal cardiac dysrhythmias, low blood volume, medications, various endocrine and metabolic disorders.
What is a major cause of falls in the elderly that is reversible?
Orthostatic hypotension
What is the definition of orthostatic hypotension?
GReater than 20 drop in systoilc pressure between supine and sitting and or standing measurements