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Family Med EOR > Conduction Disorders, CHF, HTN, & Orthostatic Hypotension > Flashcards

Conduction Disorders, CHF, HTN, & Orthostatic Hypotension Flashcards

1
Q

What are characteristics of atrial fibrillation?

A

Narrow QRS

No P waves

May cause thrombi to form –> embolization –> ischemic strokes

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2
Q

What are causes of Afib?

A 
Cardiac disease 
Ischemia 
Pulmonary disease
Infection
CMs
Electrolyte imbalances
Endocrine or neurological disorders 
Increasing age, genetics
Meds, drugs, alcohol
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3
Q

Describe the 4 types of Afib

A
  1. Paroxysmal: self terminating within 7 days
  2. Persistent: Lasts > 7 days. Requires termination
  3. Permanent: persistent Afib > 1 yr (refractory to DCCV)
  4. Lone: paroxysmal, persistent or permanent w/out evidence of heart disease
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4
Q

How do you treat Afib?

A

Rate control: BBs (metoprolol), CCBs (diltiazem), digoxin (preferred in pts w/ hypotension or CHF)

Rhythm control: DCC, pharmacologic, ablation

Anticoag: assess CHADS2 score, determine benefits vs risks

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5
Q

What is the CHADS-VASC Criteria?

A 
CHF 
HTN 
Age ≥75
DM
S2 (stroke, TIA, thrombus) 
Vascular disease (prior MI, PAD)
Age 65-74
Sex (female)
  • ≥ 2 points = mod-high risk & anticoag recommended
  • 1 = clinical judgement
  • 0 = no anticoag
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6
Q

What is the CHADS2 Criteria?

A 
CHF 
HTN 
Age ≥ 75 
DM 
S2
  • ≥ 2 = warfarin
  • 1 = warfarin or ASA
  • 0 = none or ASA
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7
Q

What anticoag agents can be used to treat Afib?

A

NOACs (preferred): dabigatran, rivaroxaban, apixaban, edoxaban

Warfarin: INR goal 2-3

Dual antiplatelet therapy (ASA + clopidogrel)

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8
Q

What are characteristics of PSVT?

A

HR > 100 bpm
Rhythm usually regular w/ narrow QRS
P waves hard to discern

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9
Q

Describe the 2 main types of PSVT

A
  1. AVNRT: 2 pathways (both within the AV node) MC type

2. AVRT: 1 pathway within AV node & a 2nd accessory pathway outside AV node (Ex. WPW)

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10
Q

What 2 conduction patterns are seen in PSVT?

A
  1. Orthodromic (95%): narrow complex tachy

2. Antidromic: wide complex tachy

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11
Q

How do you treat SVT?

A
  1. Stable w/ narrow complex –> adenosine 1st line, AV nodal blockers
  2. Stable w/ wide complex –> antiarrhythmics (amiodarone, procainamide if WPW)
  3. Unstable –> DCCV
  4. Definitive tx = ablation
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12
Q

What are characteristics of a LBBB? (4)

A

Wide QRS > .12s
Broad, slurred R in V5,6
Deep S wave in V1
ST elevation V1-V3

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13
Q

What are characteristics of a RBBB? (3)

A

Wide QRS > .12s
RsR’ in V1,2
Wide S wave in V6

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14
Q

What are CXR findings in CHF?

A

Cephalization of flow: Increased vascular flow due to increased pulmonary venous pressure

Kerley B lines –> batwing/butterfly appearance –> pulmonary edema

Cardiomegaly

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15
Q

How do you treat CHF?

A 
"LMNOP": 
Lasix 
Morphine (reduces preload) 
Nitrates (reduce preload & afterload)
O2 
Position (place upright to decrease VR)
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16
Q

Describe the 2 types of HTN

A
  1. Primary: idiopathic
  2. Secondary: Renovascular MC cause. Renal artery stenosis: fibromuscular dysplasia MC cause in young pts, atherosclerosis in elderly
17
Q

What signifies an advanced stage of malignant HTN?

A

Papilledema

*More prognostic than an isolated BP measurement

18
Q

What lifestyle changes are used to treat HTN? (4)

A

Wt loss
Dash Diet
Exercise
Limited alcohol

19
Q

What pharmacological agents are used to treat HTN? (6)

A
  1. Diuretics: TOC, initial therapy, cardioprotective
  2. ACEI: cardioprotective when used w/ thiazides, renoprotective, post-MI
  3. ARB: consider if unable to tolerate ACEI/BBs
  4. CCBs
  5. BBs: good if hx of MI, but not usually 1st line
  6. Alpha1 Blockers: good for those w/ BPH
20
Q

What pharmacological agents are best for African American patients w/ HTN?

A

Thiazides & CCBs

21
Q

Which pharmacological agents are best for DM patients w/ HTN?

A

ACEI or ARB

22
Q

What pharmacologic agents should be used in a hypertensive pt w/ hx of gout?

A 
CCBs 
Losartan (only ARB that doesn't cause hyperuricemia)
23
Q

What causes orthostatic hypotension?

A

Meds: antihypertensives, vasodilators, diuretics, narcotics, antipsychotics, antidepressants, Etoh

Neurologic: diabetic neuropathy, Parkinson, Guillain-Barre

24
Q

What are s/s of orthostatic hypotension?

A

Dizziness, weakness, lightheadedness, syncope
Change in mental status
+/- weak pulse, cool extremities, tachy, tachypnea

25
Q

How do you diagnose orthostatic hypotension?

A

Within 2-5 mins of standing:

  1. Systolic BP falls ≥ 20 &/or
  2. Diastolic BP falls ≥ 10

If secondary to hypovolemia, may be accompanied by an increase of pulse rate > 15 bpm

26
Q

What is the workup for orthostatic hypotension?

A

BMP, CBC

ECG

27
Q

How do you treat orthostatic hypotension?

A

Remove offending meds
Increase salt, caffeine, & fluid intake

Fludrocortisone, midodrine

Family Med EOR (15 decks)

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