Cardiology Flashcards Preview

Merck Manual (Common Medical Topics) > Cardiology > Flashcards

Flashcards in Cardiology Deck (43)
Loading flashcards...
1

definition of HTN

sustained elevation of resting systolic BP (≥ 140 mmHg), diastolic BP (≥ 90 mmHg), or both

2

etiology of HTN

- primary (unknown cause; 85-95% of cases)
- secondary

3

probably MCC of secondary HTN

primary aldosteronism

4

pathophysiology of HTN must involve what 2 mechanisms?

1. increased CO
2. increased TPR

5

what are the possible pathophysiological causes of HTN?

- abnormal sodium transport
- sympathetic nervous system
- renin-angiotensin-aldosterone system
- vasodilator deficiency

6

4 mechanisms controlled renin secretion

1. afferent arteriolar wall tension
2. macula densa receptor
3. circulating angiotensin (negative feedback)
4. sympathetic nervous system (stimulates secretion)

7

do pathologic changes occur early in HTN?

no

8

what are the risks of severe or prolonged HTN?

- CAD and MI
- HF
- stroke (particularly hemorrhagic)
- renal failure
- death

9

what is the mechanism resulting in HTN's complications?

arteriolosclerosis and atherogenesis

10

sxs of HTN

usually asymptomatic until complications develop

11

sxs of complicated HTN

- dizziness
- flushed facies
- HA
- fatigue
- epistaxis
- nervousness

12

what are the cardiovascular, neurologic, renal, and retinal symptoms caused by severe HTN (hypertensive emergencies)?

- symptomatic coronary atherosclerosis
- HF
- hypertensive encephalopathy
- renal failure
- hypertensive retinopathy

13

what is one of the earliest signs of hypertensive heart disease?

4th heart sound

14

what are the retinal changes seen in hypertensive pts based on the 4 groups of the Keith, Wagener, and Barker classification?

- grade 1: constriction of arterioles only
- grade 2: constriction and SCLEROSIS of arterioles
- grade 3: hemorrhages and exudates (in addition to vascular changes)
- grade 4: PAPILLEDEMA

15

diagnosis of HTN

> 2 readings on 2 or more visits

16

testing for evaluation of hypertensive pt

- BMP
- FLP
- UA and spot urine albumin:creatinine ratio
- TSH
- ECG

17

if UA detects albuminuria, cylindruria, or microhematuria, or if serum creatinine is elevated (1.4 mg/dL or more in men, and 1.2 mg/dL or more in women), what test should be done next?

renal US to evaluate kidney size

18

if pt is hypokalemic unrelated to diuretic use, what should the pt be evaluated for?

primary aldosteronism and high salt intake

19

on ECG, a broad, notched P-wave indicates what, and why is it significant?

- atrial hypertrophy
- may be one of the earliest signs of hypertensive heart disease

20

which signs of hypertensive heart disease may occur later and indicate what?

- sustained apical thrust and elevated QRS voltage w/ or w/o evidence of ischemia
- LVH

21

pts w/ what signs and sxs should be screened for pheochromocytoma?

- labile, significantly elevated BP
- HA
- palpitations
- tachycardia
- excessive perspiration
- tremor
- pallor

22

pts screened for pheochromocytoma, should also be screened for what and how?

- sleep d/o
- sleep study

23

does systolic or diastolic BP better predict fatal and nonfatal cardiovascular events?

systolic

24

w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, and hemorrhage (grade 3 retinopathy)?

< 10%

25

w/o tx, what is the 1-yr survival for pts w/ retinal sclerosis, cotton-wool exudates, arteriolar narrowing, hemorrhage, and papilledema (grade 4 retinopathy)?

< 5%

26

what is the MCC of death among TREATED hypertensive pts?

CAD

27

what is the MCC of death among INADEQUATELY treated hypertensive pts?

ischemic or hemorrhagic stroke

28

does effective control of HTN prevent most complications and prolong life?

yes

29

initial tx for HTN

- weight loss and exercise
- smoking cessation
- diet; increased fruits and vegetables, decreased salt, limited alcohol

30

when is medication started for HTN?

initial BP > 160/100, or unresponsive to lifestyle modifications