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Health Assessment > HTN > Flashcards

HTN Flashcards

1
Q
A
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1
Q

what is HTN (high blood pressure)

A
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2
Q

classification of BP in adults

A

normal <120/<80
elevated 120-129/<80
stage I HTN 130-139/80-89
Stage II HTN >140/>90

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3
Q

AHA defines HTN as

A

sustained SBP > 130 mmHg and DBP > 80 mmHg

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4
Q

HTN leads to an age related assocatiation to

A

ischemic heart disease, stroke, renal failure, retinopathy, PVD, and overall mortality

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5
Q

common risk for perioperative M&M shows ___ as a common risk factor if left untreated

A

HTN

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6
Q

in addition to SBP and DBP elevation, a widened pulse pressure is a risk factor for

A

CV remodeling as it correlates with vascular remodeling and stiffness

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7
Q

cause of primary HTN

A

SNS activity, dysregulation of RAAS, and deficency in endogenous vasodilators

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8
Q

genetic and lifestyle risk factors for HTN

A

obestity, alcholism and tobacco

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9
Q

secondary HTN causes in adults

A

hyperaldosteronism, thyroid dysfunction, OSA, Cushings, and pheochromocytoma

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10
Q

drugs that increase BP

A
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11
Q

secondary HTN causes for children birth to 12 years

A

coarction of aorta
renal parynchymal disease

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12
Q

secondary HTN in adolescence (12-18 years old)

A

coarction of aorta

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13
Q

secondary HTN causes of young adults

A

thyroid dysfunction
fibromuscular dyplasia
renal parychema

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14
Q

secondary causes of HTN in middle age adults (40-64)

A

hyperaldosteronism
cushing
pheo
OSA
thyroid dysfunction

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14
Q
A
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15
Q

secondary causes of HTN in older aldults >65 years

A

artherosclerotic renal artery stenosis
renal failure
hypothryoidism

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16
Q

chronic HTN leads to remodeling of

A

small and large arteries, endothelial dysfunction, and potentially irreversible end-organ damage

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17
Q

what can diagnose early vasculopathy

A

US of the common carotid intimal to medial thickness and arterial pulse wave velocity

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18
Q

cerebrovascular damage secondary to HTN

A

acute hypertensive encephalopathy
stroke
ICH
lacunar infarct
vascular dementia
retinopathy

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19
Q

heart disease secondary to HTN

A

LV hypertrophy
afib
coronary microangiopathy
CAD - MI
heart failure

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20
Q

neprhopathy secondary to HTN

A

albuminuria
proteinuria
chronic renal insufficency
renal failure

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21
Q

vasculopathy secondary to HTN

A

endothelial damage
remodeling
generalized atherosclerosis
arteriosclerotic stenosis
aortic aneursym

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22
Q

what is resistant HTN

A

above goal BP despite3+ antihypertensive drugs at max dose

usually increases a CCB, ACE-I or ARB, and diuretic

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23
Q

controlled resistant HTN

A

controlled BP requiring 4+ medications

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24
Q

refractory HTN

A

uncontrolled BP on 5+ drugs

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25
Q

psuedo-resistant HTN

A

intolerance to drugs can result from BP inaccuracies (white coat syndrome) and or medication noncompliance

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26
Q

lifestyle modifications to help manage HTN

A

weight loss, decrease ETOH, exercise, smoking cessation

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27
Q

T/F there is a continuous relationship between increased BMI and HTN

A

true! weight loss is an effective nonpharm intervention through direct BP reduction and syngergistic enhancement of drug efficacy

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28
Q

for every 1kg of weight loss what decrease in BP would there be

A

1 mmHg

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29
Q

excessive ETOH is associated with what and BP

A

increased HTN and resistance to antihypertensives

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30
Q

T/F dietary K+ and Ca++ intake are inversely related to HTN and cerebrovascualr disease

A

true

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31
Q

T/F salt restriction is not assocaited with small but consistent BP drops

A

false

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32
Q

According to ACC/AHA Guidelines

evidence supports treating which patients with BP meds if SBP > 130 mmHg

hint: theres 4

A

ischemic heart disease
cerebrovascular disease
CKD
artherosclerotic disease

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33
Q

According to ACC/AHA Guidelines

evidence supports treating which patients with nonpharm therapy if SBP > 130 mmHg or DBP>80

A

patients without CV or cerebrovascular disease

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34
Q

According to ACC/AHA Guidelines

effective antihypertensive medications for nonblack HTN patients

A

ACE-Is, ARBs, CCBS, thiazide diuretics

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35
Q

According to ACC/AHA Guidelines

in black patients with HTN without HF or CKD but including those with DM.. what is the initial therapy for HTN

A

CCB or thiazide diuretic

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36
Q

According to ACC/AHA Guidelines

antihypertensive therapy in those with CKD

A

ACE-Is, ARBs improve kidney outcomes

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37
Q

Beta blocker therapy is reserved for

A

patients with CAD or tachydysrhtymias
or multidrug treatment in resistant HTN

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38
Q

treatment for secondary HTN

A

surgical correction of renal stenosis, adrenal adenoma, pheochromocytoma

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39
Q

is renal artery repair is not possible BP management is through

A

ACE-Is alone or with a diuretic

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40
Q

when are ACE-I, ARBs, and direct renin inhibitors not recommended for renal artery stenosis

A

bilateral renal artery stenosis

as they accelerate renal failure

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41
Q

primary hyperaldosteronism is treated with

A

aldosterone antagonist such as spironolactone

42
Q

current guidelines state the diagnosis of HTN needs

A

multiple elevated BP readings over time

43
Q

if BP elevated

A

check the other arm (contralateral arm)

44
Q

T/F elevated BP is a direct prompt to delay surgery asymptomatic patients without risk factors

A

false
elevated BP is not a direct prompt

45
Q

when can a surgey be delayed due to transient HTN

A

extreme HTN (>180/110) or end organ injury that could be reversed with BP control

46
Q

name the secondary cause based on symtpoms

flushing, sweating, palpitations

A

pheochromocytoma

47
Q

name the secondary cause based on symtpoms

renal bruit

A

renal artery stenosis

48
Q

name the secondary cause based on symtpoms

A
49
Q

name the secondary cause based on symtpoms

hypokalemia

A

hyperaldosteronism

50
Q

stopping BB or clonidine can be assocaited with

A

rebound effects

51
Q

which BP meds are held prior to surgery

A

ACE-Is, ARBs

52
Q

stopping CCB preop are assocaited with

A

increased perioperative CV events

53
Q

perioperative HTN increases _____ _____ as well as what M&M event

A

blood loss and incidence of MI and CVA

54
Q

brief moments of HypoTN with chronic HTN patients are assocaited with

A

AKI, myocardial injury, and death

55
Q

HTN patients are hemodynamically vulnerable to induction of GA bc…

A

induction drugs produce HypoTN; DL and intubation elicit HTN and tachycardia

56
Q

pre-induction considerations of the HTN patient

A

Aline
multimodal induction including a Short acting BB (esmolol)

57
Q

poorly controlled HTN is often accompanied by

A

volume depletion; especially if the patient is on a diuretic

58
Q

when might modest volume loading prior to induction be counterproductive

A

LVH and diastolic dysfunction patients

59
Q

hypertensive crisis is categorized as either urgent or emergent based on

A

presence of progressive organ damage (MI/stroke/AKI)

60
Q

women with PIH (pregnancy induced HTN) may show evidence of end-organ dysfunction with what DBP

A

encephlopathy
DBP>100

61
Q

peripartum HTN recommends immediate intervention for

A

SBP>160
DBP > 110

62
Q

1 drug for peripartum HTN

A

labetolol

63
Q

for rapid arterial dilation _____ infusion is gold standard due to fast onset and easy titration

A

sodium nitroprusside

64
Q

Clevidipine, a 3rd gen dihyropyridine CCB, can be used for

A

selective arteriolar vasodilating properities
*short Duration of Action - 1 min 1/2 life

expensive

65
Q

what is nicardipine

A

2nd gen dihydropyridine CCB
half life 30 min

less titratable than clevidipine

66
Q

primary agents for encepholapathy and ICH

A

clevidipine, nitroprusside, labetalol, nicardipine

67
Q

primary agents for aortic dissection

A

clevidipine, esmolol, labetalol, nicardipine

68
Q

primary agents for AKI

A

clevidipine, nicardipine, labetolol

69
Q

primary agents for preeclampsia and eclampsia

A

labetolol, nicardipine

70
Q

primary agents for pheochromocytoma

A

phentolamine, phenoxybenzamine, propanolol. labetalol

71
Q

primary agents for cocaine intoxication

A

labetalol, dexmedetomidine, clevipine

72
Q

pulmonary HTN is defined as a MPAP

A

> 20 mmHg

73
Q

symptoms of pulmonary HTN

A

accenuated S2&S4 “gallop”, LE swelling

74
Q

precapillary PH

A

PVR > 3 wood units without elevated LAP or PAWP

PAWP < 15 mmHg = normal

75
Q

isolated postcapillary PH

A

result from incerased pulmonary venous pressure usually due to elevated LAP from LV dysfuntion

PAWP>15 mmHg with normal PVR

76
Q

combined pre and postcapillary PH

A

chronic pulmonary venous HTN with secondary pulmonary arterial vasoconstriction and remodeling

PAWP > 15 mmHg and PVR >3.0 WU

77
Q

high flow PH

A

occurs without elevation in PAWP or PVR and results in increased pulmonary blood flow caused by a systemic to pulmonary shunt or high cardiac output

78
Q

pulmonary artery HTN requires what for a diagnosis

A

right heart cath

79
Q

mPAP can be increased by what 4 mechanism

A
  1. elevated resistance to blood flow within arterial circulation
  2. increased pulmonary venous pressure from LV heart disease
  3. chronically increased pulmonary blood flow
  4. combo of these processes
80
Q

with pulmonary artery HTN; what will a TEE show

A

enlarged RV/RA and peaked tricuspid regurgitation velocity

81
Q

severity of PH through right heart cath

A

mild PH (mPAP = 20-30 mmHg)
moderate PH (mPAP = 31-40 mmHg)
severe PH ( mPAP > 40 mmHg)

82
Q

normal pulm circulation can accomodate a ________ increase in cardiac output without a marked change in mPAP

A

4-fold

83
Q

1 out of 8 PAH patients show improvements with which drug

A

CCBs

84
Q

prostanoids

A

mimic prostacyclin to produce vasdilation while inhibiting platelet aggregation. they also have anti-inflammatory effects and may reduce proliferation of vascular smooth muscles

85
Q

prostanoid examples

A

eprostenol (IV)
iloprost (inhaled)
treprostinil (SQ, IV, INH, PO)
peraprost (PO)

all provide improvement; eprostenol reduces mortality

86
Q
A
87
Q

endothilin receptor antagonists (ERAs)

A

vascular endothelial dysfunction assocaited with PAH involves an imbalance bertwen nitric oxide (dilator) and endothelin (constrictor) substances
ERAs improve hemodynamics and exercise capacity

88
Q

nitric oxide/guanylate cyclase

A

vasodilation by guanyl cyclase and cGMP formation in smooth muscle cells
transient bc nitric oxide binds to Hgb and degraded by PDE type 5

89
Q

PAH symptoms

A

nonspecific - fatigue, dyspnea, cough
more advanced include angina and syncope with can occur with exercise if coronary blood flow cannot meet demand due to RV hypertrophy

90
Q

physical exam findings of PAH

A

parasternal lift, accentuated S2,S3 and or S4 gallop, JVD, peripheral edema, hepatomegaly and ascites

91
Q

PAH preop consideration due to potential

A

venous embolism, elevations in venous and or airway pressue, hypoxic pulmonary vasoconstriction, reduction in pulmonary vascular volume, systemic inflammation

92
Q

rarely, dilated pulmoanry artery may leads to

A

recurrent laryngeal nerve damage and hoarseness

93
Q

history of PH should prompt what preop test/assessment

A

functional status, cardiac performance, PFTs

94
Q

pts with moderate or severe PH prior to moderate-high risk surgery need a

A

right heart cath

95
Q

perioperative complexities that can potentially serious consequences in PH patient

A

transient HypoTN
mechanical vent
modest hypercarbia
small bubbles inIV
trendelenburg
pneumoperitoneum
single lung ventilation

any intervention that affect RV preload, inotropy, afterload, oxygen supply/demand relationship

96
Q

what vent settings can effect RV afterload

A

addition of PEEP
hypoventilation
hypercarbia
acidosis
atelactasis

97
Q

t/f in contrast to LV, the RV is thin walled and is subject to greater wall tension for the same degree of increase in EDV - increasing RV myocardial O2 demand

A

true

98
Q

with PAH, the elevated RV pressure leads to

A

increased coronary flow during diastole - making the RV more vulnerable to systemic Hypotension

worsening O2 supply/demand can potentially case MI

99
Q

systemic HypoTN + RV ischemia + high afterload can result in

A

lethal combo of RV dilation, insufficient LV filling, reduced stroke volume, and further systemic hypotension

100
Q

CO2 pneumoperitoneum has an impact on

A

biventricular load and pump function
-both pneumoperitnoeum, head down increase inspiratory pressure affecting RV pressures and afterload

101
Q

there is an increase periop M&M in patients with PH undergoing which ortho surgery

A

hip and knee replacement

102
Q

3 features of lung collapse

A

some centers transiently pressurize the chest to induce atelectasis
potential for systemic hypoxia
HPV will further increase RV afterload

103
Q

what is recommended for PAH patients for single lung ventilation

A

inhaled pulmonary vasodilators

Health Assessment (16 decks)

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