If a patient doesn't tolerate an ace inhibitor, you can next try them on an_______. This class of medication should NEVER be given in combination with an ACE inhibitor.
for people who don't tolerate ACE inhibitors
First line agents for HTN are:
SBP >180 or DBP>110 is hypertensive____
and is treated with ______
swelling of the optic disc with blurred margins
emergency, requires IV antiHTN and BP monitoring
What EKG changes are seen with classic anginal pain?
chest pain with exertion
goes away with NTG/rest
typically ST depression
tightness pain of chest
Printzmetals angina is caused by:
(NOT BY CAD, these people have a clean angio)
treated with calcium channel blockers
typically ST elevation on EKG
Levine's sign is more than 90% diagnostic of angina.
Levine's sign is when:
the patient has their hand clenched over their chest
What is normal total cholesterol?
What is normal triglycerides?
What is optimal LDL?
When is HDL high?
this is good bc it cancels the preHTN risk
Patients with angina should modify their diet by decreasing:
saturated and unsaturated fats
30% of patients with MI have no initial _____ changes
Which troponin is 100% cardio selective?
Per Barkley, the treatment for acute MI IN ORDER is:
(unblock the vessel before trying to get O2 to it)
What is the timeframe for cardiac fibrinolytics?
30 minutes of chest pain, within 6 hours of onset
Why do patients with claudication need to exercise?
To develop collateral circulation
What is first line therapy for dermatitis?
wet compress and hydrocortisone
What is the leading cause of heart failure in America?
What heart sound is heard suring systole and is the closing of the AV valves?
What heart sound is head during diastole and is the closing of the pulmonic and aortic valves?
Name three causes of S3?
Name three causes of S4?
stiff ventricular wall
Which heart sound sounds like Kentucky?
Which heart sound sounds like Tennessee?
What is the grading system for cariac murmurs 0-6/6?
1/6 very faint
4/6 AUDIBLE + THRILL you can feel
5/6 part of stethascope off
6/6 from the door
If you hear a low-pitched diaslotic murmur at the APEX, apical crescendo, what is it?
*remember APEX is the bottom = mitral
A systolic cardiac murmur at the 5th ICS MCL (apex), radiates to left axilla, blowing, musical.
*radiates to left axilla
systolic murmur, right 2nd ICS, radiates to the neck
diastolic murmur at 2nd left ICS (base)
According to Dr. Barkley, standard pharmacologic treatment for heart failure includes:
ace-inhibitors and thiazide diuretics
Beta blockers can cause what pulmonary side effect?
Name 3 Secondary causes of HTN
renal artery stenosis
NYHA functional classifications of heart failure
I: no limitations of physical activity
II: slight limitations of physical activity but comfortable at rest
III: marked limitations of funcitonal activity but comfortable at rest
IV: severe; inability to carry out any physical activity without discomfort, signs and symptoms while at rest
A patient with what NYHA classification will need pillows for orthopnea at night?
Class 4 because they have signs and symptoms while at rest
What differentiates NYHA HF class II from Class III?
both are comfortable at rest,
but class II has SLIGHT limitations of physical activity
and class III has MARKED limitation of physical activity
Name three signs/symptoms of HTN
S4 (r/t ventricular hypertrophy and stiff ventricular wall)
suboccopital pulsing HA
*often silent killer without any signs and symptoms
How does the use of NSAIDS exacerbate HTN?
bc they effect prostaglandins and the kidneys
A chest x-ray of a patient with HF may show what three things?
Kerley B lines
According to JNC 8 recommendations, pharmacologic treatment for HTN in African-Americans includes which two drugs first?
1st thiazide diuretics
2nd calcium channel blockers
According to JNC 8, goal BP for a patient 60 or older is:
According to JNC 8, goal DBP for any adult regardless of age is:
According to JNC 8, goal BP for patients less than 60 is
According to JNC 8, the goal BP for any adult with CKD or DM
According to JNC 8, what is the drug class of choice for the treatment of HTN for adults with CKD regardless of race or other medical conditions?
ARB if they don't tolerate ACE
*never ACE-I and ARB together
According to JNC 8, when do you refer a patient to a HTN specialist?
if 3 or more drugs are needed
How do Thiazide diuretics work to reduce morbidity and mortality and patients with HTN and what are their side effects?
Thiazide diuretics increase the exrection of sodium AND water
they may cause hyponatremia, hypokalemia, hypomangesemia, HYPERcalcemia and Hyperglycemia
ACE inhibitors (or ARBs if ACE not tolerated) are recommended 1st line for the treatment of HTN in patients with CKD despite age or ethnicity. What female condition and what electrolyte imbalance is an ACE-I/ARB contraindicated in?
ACE inhibitors are contraindicated in pregnancy
Do not initiate ACE-I if K>5.5
What anti-HTN drug class should be avoided in patients with asthma/COPD?
beta blockers because beta 2 stimulates bronchoconstriction and can cause wheezing
What antiHTN class is used for Printzmetal's angina and migraines?
calcium channel blockers
What central alpha-2 agonist is the drug of choice in pregnancy and can also be used in Parkinsons?
If you see a patient with BP >180/120 and fondoscopic changes which include flame-shaped retinal hemorrhages, soft exudates, and papilledema (swelling of the optic disk with blurred margins), what is the diagnosis and how long do you have to correct the BP?
hypertensive emergency/malignant HTN
within 1-2 hours redue BP by 25%
Satins are contraindicated in patients with
If you diagnose a patient with angina, what medication would you prescribe daily
ASA 81mg PO daily
When treating a patient with statin therapy, which level are you targeting?
the goal of statin therapy is to reduce the LDL by at least 50%
If you have a patient with liver problems who can't take statins, what is a cheap pharmacologic treatment option that decreases LDL and increases HDL?
HMG-CoA reductase inhibitors are:
Exam findings/signs of MI
low grade fever 48 hours
Troponin I elevate within 4-6 hours
leukocystosis 10-20 on the second day due to inflamation/damage of the necrotic tissue