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83 Cards in this Set
- Front
- Back
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Is the most common cause of HTN primary or secondary?
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Primary (95%)
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What is considered a normal BP?
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Under 120 systolic AND
Under 80 diastolic |
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What is pre-HTN?
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Systolic 120-139 OR
Diastolic 80-89 |
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What is Stage I HTN?
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Systolic 140-159 OR
Diastolic 90-99 |
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What is Stage II HTN?
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Systolic 160+ OR
Diastolic 100+ |
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What is HTN urgency?
What is HTN emergency? |
Urgency: Diastolic 130+ and no target organ damage
Emergency: Diastolic 130+ and target organ damage |
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What organs are affected by hypertensive emergencies (target organ damage) (5)?
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Eyes
Heart Kidney Brain Peripheral vascular |
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What will be seen on physical exam in the case of hypertensive retinopathy (5)?
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A/V nicking (arteriole causes crossing venule to bulge -- hourglass)
Papilledema (optic disc margin blurring) Cotton wool spots (white spots on retina) Hemorrhages (red spots on retina) Exudates (yellow spots on retina) |
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Non-pharm treatment for HTN (5)?
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Physical activity
DASH diet Low sodium diet Weight reduction Alcohol in moderation |
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What is the BP goal in uncomplicated HTN?
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Systolic <140 AND
Diastolic <90 (get back to pre-HTN) |
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What is the pharm treatment for uncomplicated Stage I HTN?
What is the pharm treatment for uncomplicated Stage II HTN? |
Diuretic or (ACEI or ARB or CCB)
Diuretic + (ACEI or ARB or CCB) |
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What pharm HTN treatment should be avoided in African Americans? Why?
Which pharm HTN treatments have been shown to be more effective in African Americans (2)? |
Avoid ACEI in African Americans due to angioedema
Diuretics and CCBs have been shown to be effective in African Americans |
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What is the BP goal for HTN with compelling indications?
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< 130/80
Consider < 120/80 in CHF Compelling indications: DM Renal ds CAD/PAD AAA Framingham > 10% CHF |
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What is the pharm treatment for HTN with DM or chronic kidney ds (CKD)?
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ACEI
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What is the pharm treatment for HTN with CAD or history of MI?
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Start with BB
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What is the pharm treatment for HTN with recurrent stroke or left ventricular dysfunction?
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Diuretic + ACEI
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How do you treat HTN urgency?
How do you treat HTN emergency? |
Reduce BP to < 100 systolic within 24 hours using po agents
Reduce BP < 110 systolic within 30 minutes and to < 100 systolic within 24 hours using IV agents |
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What drug class ends with -dipine?
Name some adverse effects |
CCBs
AE: HA, edema, dizziness |
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Two CCBs that affect heart rate
What are some adverse effects? |
Diltiazem
Verapamil Bradycardia, HOTN, HA, edema, HA |
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What drug class ends with -sartan?
Name some adverse effects |
ARB
AE: Hyperkalemia, HOTN, angioedema Titrate up CI in 2nd/3rd trimester pg |
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What drug class ends with -pril?
Name some adverse effects |
ACEI
AE: Hyperkalemia, cough, HOTN, angioedema, rash Titrate up CI in 2nd/3rd trimester pg |
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What drug class ends with -olol?
Name some adverse effects |
BB
AE: Depression, bradycardia, ED Need to taper Avoid using non-selective BB in asthma |
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Which BBs are cardioselective?
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Atenolol
Metoprolol |
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What are three classes of diuretics?
Name one drug from each class Name some adverse effects |
Thiazide, K+ sparing, loop
HCTZ, spiranolactone, furosemide AE: hypokalemia, hypomagnesemia, hyperglycemia, hyperuricemia |
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What is the most common cause of death in the United States?
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CAD
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What are the risk factors for CAD (6)?
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Smoking
HTN or taking HTN meds HDL < 40 Family hx (M < 55, F < 65) Age (M > 45, F > 55) HDL > 60 (neg risk) Some Hippos Have Families At Home |
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What are the CAD risk equivalents (5)?
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Framingham > 20%
Symptomatic CAD AAA DM PAD Fucking Sad About Dead Puppies |
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Normal values for:
Total cholesterol Triglycerides HDL LDL |
TC: < 200
Tri: < 150 HDL: 40 - 60 LDL: < 100 |
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What constitutes a high risk of CHD?
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CHD or risk equivalent
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For a high risk of CHD:
LDL Goal? Start TLC at what LDL? Consider pharm at what LDL? |
LDL Goal: < 100
TLC at 100+ LDL Pharm at 100+ LDL |
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For a moderate-high risk of CHD:
LDL Goal? Start TLC at what LDL? Consider pharm at what LDL? |
LDL Goal: < 130
TLC at 130+ LDL Pharm at 130+ LDL |
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For a moderate risk of CHD:
LDL Goal? Start TLC at what LDL? Consider pharm at what LDL? |
LDL Goal: < 130
TLC at 130+ LDL Pharm at 160+ LDL |
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For a low risk of CHD:
LDL Goal? Start TLC at what LDL? Consider pharm at what LDL? |
LDL Goal: < 160
TLC at 160+ LDL Pharm at 190+ LDL |
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What constitutes a moderate-high risk of CHD?
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At least two risks or a Framingham score of 10%-20%
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What constitutes a moderate risk of CHD?
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At least 2 risks and less than 10% Framingham score
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What constitutes a low risk of CHD?
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0 - 1 risks
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What is the non-pharm treatment for CAD (3)?
How long should this be done before starting pharm tx? |
TLC:
Good diet Exercise Decrease weight This should be done of six weeks prior to pharm treatment unless pharm is indicated immediately |
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What do statins do?
What do fibric acids do? What does nicotinic acid do? What do bile acid resins do? What does 2-azetidione do? |
Statins: Decrease LDL (gold standard, inhibits enzyme that makes cholesterol [HmgCoA)
FA: Decrease triglycerides (secrete cholesterol in bile) NA: Increase HDL (block VLDL --> LDL) BAR: Good for young people, bind bile acids to excrete in stool and prevents fat absorption 2AZ: Inhibits absorption of cholesterol, usually added to statin |
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What drug class ends with -statin?
Name some adverse effects (3) |
Statins
AE: hepatotoxicity, myopathy, neuropathy Don't use in pg, lots of drug interactions. |
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What drug class is gemfibrozil (Lopid) in?
Name some adverse effects (2) |
Fibric acid
AE: GI complaints, bile stones Avoid statins |
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Name some adverse effects of nicotinic acid (Niacor
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Niaspan) (3)
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What drug class is cholestyramine (Questran)?
Name some adverse effects (3) |
Bile acid resin
AE: GI complaints, increase triglycerides, constipation |
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Name some adverse effects of ezetimibe (Zetia) (4)?
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Fatigue, abd pain, diarrhea, joint pain
Do not use in conjunction with statins in liver ds |
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Chest pain that comes on with stress or exercise.
What relieves it? What will cardiac enzymes show? What will EKG show? What is the treatment? |
Stable angina
Rest or nitro Normal enzymes ST depression Correct risk factors, nitrates, BB, CCB (dilt/verapamil), ASA |
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Chest pain that comes on at the same time everyday, regardless of stress or exercise.
What relieves it? What will cardiac enzymes show? What will EKG show? What is the treatment? |
Prinzmetal's angina
Nitro Normal enzymes ST elevation CCB prophylaxis |
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Chest pain that comes on with stress or exercise, worsening over time. May eventually come on at rest.
What relieves it? What will cardiac enzymes show? What will EKG show? What is the treatment? |
Unstable angina
Nitro (increasing doses) Enzymes normal to mildly elevated ST depression persists for hours Admit to hospital MONAHB + clopidogrel, glycoprotein 2b/3a (morphine, oxygen, nitro, aspirin, heparin, bb) |
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What are the criteria needed for an MI diagnosis?
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EKG (ST elevation >= 1 small box in 2 contiguous leads) or new Q-wave formation or LBBB
Cardiac enzymes (serial troponin, CK-MB, myoglobin) H&P consistent with MI (Need two of the above three to dx) |
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What is the gold standard for diagnosing MI?
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Angiogram
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Which artery is occluded in an anterior MI?
Which leads would this appear on? |
Left anterior descending (LAD)
V1-V4 |
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Which artery is occluded in an lateral MI?
Which leads would this appear on? |
Left circumflex
I, aVL, V5-V6 |
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Which artery is occluded in an inferior MI?
Which leads would this appear on? |
Right coronary artery
II, III, aVF |
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Which artery is occluded in an posterior MI?
Which leads would this appear on? |
Right coronary artery
V1-V3 depression |
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What is the treatment for an acute MI?
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MONAHB
(w/ glycoprotein 2b/3a for PCI) Thrombolytics within 3 hours if no cath lab available Morphine Oxygen Nitrates Aspirin (324mg crushed/chewed) Heparin BB |
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Primary cause of death resulting from an MI
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Arrhythmia
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1. What are the sx of CHF?
2. What system is activated in CHF? |
1. dyspnea/fatigue
2. RAAS (renin/angiotensin = vasoconstrict, aldosterone = Na retention) |
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1. Pathophysiology of CHF? 2. How does CHF change cardiac output?
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1. myocardial damage 2. preload (fill of ventricles), afterload (tension/stress in LV during ejection), contractility, ↓ HR
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1. Where does R sided HF back up to? 2. Left sided heart failure?
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1. backs up to periphery (distensed neck veins, hepatomegaly, edema) 2. lungs (rales/crackles)
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1. Signs of CHF
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1. cyanosis, tachycardia, JVD, S3/4, edema, ascites, ↓urine, BNP >100 (left ventriculal EDV)
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1. Causative agents of CHF
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1. negative inotropes (BB, CCB, anti-arrhythmics), cardiotoxic (EtOH, amphetamines, chemo), Na/H2O retainers (NSAIDs, estrogens, glucocoricoids)
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What are the AHA Stages of HF
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A = @ risk; B = asymptomatic; C = mild-mod dz; D = severe dz
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What are the NYHA Functional Classes of CHF?
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I = no sx, II = slight limitation, III = marked limitation, IV = no activity
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What does a chest XR show with CHF?
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Kerly B lines (short, parallel linear opacities), cardiomegaly, interstitial/pulmonary edema
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Tx Options of CHF
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1. BB = reverse remodel (cardioprotective) 2. Diuretic (↓ preload) 3. ACEi = prevents remodeling (↓ afterload) 4. Digitalis (↑ contractility)
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1. What are the types of cardiomyopathies? 2. MC?
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1. dilated, hypertrophic, restrictive 2. dilated = MC
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Dilated Cardiomypathy 1. Causes 2. Features 3. Labs 4. Tx
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1. ↓ strength of contraction dt idiopathic, EtOH, chemo, endocrine 2. signs of CHF 3. CXR like CHF, Echo (dilation, ↓CO), EKG 4. no EtOH, tx underlying dz
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Hypertrophic Cardiomyopathy 1. Causes 2. Features 3. Labs 4. Tx
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1. hypertrophy of septum/LV - can't fill = GENETIC (athletes) 2. dyspnea/angina/syncope w/ exercise, S4 gallop, stong PMI 3. CXR (prominent LV), EKG = LVH, Echo = hypertrophy 4. BB or CCB
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Restrictive Cardiomyopathy 1. Causes 2. Features 3. Labs 4. Tx
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1. LV small/nl w/ ↓ fx dt Fibrosis/Collagen defect dz 2.↓ exercise tolerance - R sided HF 3. CXR (cardiomegaly), EKG (A. fib), Echo (↓ LV fx) 4. diuretics, steroids, antiarrhythmics
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Types of Carditis (3)
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Pericarditis, Myocarditis, Endocarditis
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Pericarditis 1. Describe/Cause 2. S/S 3. Labs 4. Tx
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1. inflammed pericardium dt virus (MC), bacteria, tumor, post-MI 2. sharp CP, positional (:( laying),pleuritic, FRICTION RUB (heard best leaning forward) 3. diffuse ST elevation, all other tests nl (Echo, cardiac enzymes, CXR) 4. NSAIDS
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Endocarditis
1. Describe/cause 2. S/S 3. Labs 4. Tx |
1. infection of valve leaflets, MCC = RHD, MC valve = mitral
2. anemia, fever, new murmur 3. CXR (P-edema/cardiomegaly), EKG = tachycardia, Echo = use TTE, enzymes = nl 4. IV Abx |
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MC type of Murmur?
Is it Systolic/Diastolic? |
Aortic Stenosis
systolic |
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Aortic Stenosis
1. Cause 2. Heard 3. Labs 4. Tx |
1. degenerative (MCC)
2. systole, @ R 2nd ICS, radiates to neck/LSB, heard best sitting/squatting/leaning forward 3. EKG = LVH, left axis dev, atrial hypertrophy 4. Tx = sx - replace |
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What occurs during the following:
S1 sound? S2 Sound? Systole? Diastole? Stenosis? Regurg? |
S1 = mitral/tri closing, S2 = aortic/pulm closing, systole = b/t S1 & S2, diastole = after S2 before S1; Stenosis = can't open; Regurg/Insufficiency = can't close
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Mitral Stenosis 1. Cause 2. Heard 3. Labs/Tx
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1. 2nd MC type, MCC = rheumatic fever 2. diastole (opening snap), @ apex, little/no radiation, heard best left lateral position 3. Dx w/ A. fib in elderly (severe cases)
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Mitral Valve Prolapse 1. Cause 2. Heard
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1. young/healthy 2. systolic, SYSTOLIC CLICK, @ mitral valve area (apex), heard best w/ valsalva, whoop/honk = pathognomonic
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Peripheral Arterial Disease (PAD) 1. Info 2. S/S 3. Dx 4. Tx
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1. chronic = atherosclerosis; acute = thrombus/embolus; usu LE (MC: femoral), ↑ risk MI (7x) 2. asx, pain, cludication, hair loss, dec. pulses/color/cap refill 3. Allen's ABI (close to 0 = bad), US, CT, angiography 4. Surgery, decrease risk factors
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AAA 1. Info 2. S/S 3. Dx 4. Tx
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1. usu below renal arteries, MCC = degenerative, Risks: male, HTN, smoke, age, Marfan's 2. back pain (deep/boring) 3. PE = pulsatile mass in abdomen, Dx = spiral CT 4. screen male >65 qyr, surgery >4-5cm
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Temporal Arteritis 1. Info 2. S/S 3. Dx 4. Tx
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1. inflammatory dz of large bvessels, MC = cranial 2, unilateral, HA, change in vision, pain 3, ESR/CRP, temporal artery biopsy 4. Tx = prednisone
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Raynaud's Dz/Phenomenon 1. info 2, S/S 3. Dx 4. Tx
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1. vasospastic, MC = F, phenomenon = secondary to other dz 2. red, white, blue, numbness 3. Allens = (-) in dz, (+) in phenomenon 4. CCB (avoid smoke, ergots, BB)
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DVT 1. info 2. S/S 3. Dx 4. Tx
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1. clot in legs, Risks = >40, smoke, Wells Score (CA, immobile, PMHx…) 2. none, tender, skin color change, warmth 3. Homan's sign (+), US 4 anticoagulate, compression socks, caval filter, surgery
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What makes up the 3 parts of Virchow's Triad?
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venous stasis, tissue injury, increased coagulopathy
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Superficial Venous Thrombosis 1. Info 2. S/S 3. Dx 4. Tx
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1. same as DVT in superficial sx 2. pain, tender, warm 3. Pexam = palpate cord, leg = pain, pulses in foot = nl 4. self-limiting (1-2wks), NSAIDs, warm compress
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Varicose Veins 1. Info 2. S/S 3. Dx 4. Tx
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1. dilated veins in legs, Risk Factors = FHx, Female, obese, caucasian 2. worse w/ menstruation, achy, fatigue, better w/ rest 3. palpate on exam 4. incurable, compression socks, severe = injection therapy
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