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Hyper and hypotension Flashcards

1
Q

How many people over 65 hae hypertension

A

over 1/2

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2
Q

what is the most common risk factor for MI and stroke

A

uncontrolled hypertension

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3
Q

What race and ethnicity is htn seen more in

A

Men, african americans

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4
Q

Is there a genetic component to hypertension

A

yes

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5
Q

Different types of hypertension

A

Essential (Primary), Secondary, malignant

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6
Q

What percentage of people have essential hypertension

A

95%

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7
Q

Pre-hypertension

A

120-139mmHg / 80-90mmHg

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8
Q

Stage 1 hypertension

A

140-159mmHg/90-99mmHg

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9
Q

Stage 2 hypertension

A

> 160mmHg/ >100mmHg

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10
Q

How do you diagnose essential hypertension

A

2 or more readings during 2 or more visits with a mean BP of 140/90

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11
Q

When can you diagnose htn with just one reading

A

End organ damage

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12
Q

Is diastolic or systolic a greater predictor of risk in patients over 50?

A

Systolic

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13
Q

Is diastolic or systolic a greater predictor of mortality in patients under 50?

A

diastolic

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14
Q

What percentage of people get “white coat” syndrome

A

20-25%

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15
Q

Screening for individuals with normal bp

A

every 2 years

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16
Q

BP check for people with prehypertension

A

every year

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17
Q

Name some risk factors of primary hypertension

A 
Excess sodium intake
Excess alcohol intake
Obesity & weight gain
Physical Inactivity
Dyslipidemia
Type A personality
Vitamin D deficiency
OTC meds (NSAIDs, Decongestants, etc)
Family Hx
Ethnicity (African American) 
Age of onset/length of time
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18
Q

Symptoms in htn

A

Asymptomatic!

HA, dizziness, CP, palpitations, buzzing noise, fatigue, visual changes

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19
Q

PE findings for a person with Htn

A

retinopathy, papilledema, bruits, edema, CHF, weakness or confusion

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20
Q

What is some routine lab testing for Primary hypertension

A

electrolytes, BUN, creatinine, glucose, GFR, fasting lipid profile, TSH, UA,

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21
Q

What are some routine testing for primary hypertension

A

EKG, CXR and echo

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22
Q

Treatment of essential hypertension

A

Lifestyle modifications- weight loss, exercise, sodium restriction, stop smoking, increase potassium – for 6-12 months

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23
Q

How much does loosing 10kg decrease your blood pressure

A

5-20mmHg

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24
Q

How much can exercising 30min/day decrease your blood pressure

A

4-9mmHg

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25
When do you start medication for hypertension
when lifestyle modifications fail
26
Diuretics
Stop Na from reabsorbing thus increasing the Na and water excretion
27
What do you need to monitor with loop diuretics
K- hypokalemia Na- hyponatremia Glucose- hyperglycemia Uric acid- hyperuricemia
28
What are potassium sparing diuretics
Spironolactone
29
Beta blockers
decrease HR and cardiac output, decrease PVR, reduce renin activity
30
Cardioselective beta blockers
Inhibit beta 1 receptors | Metoprol, atenalol
31
Non cardioselective
Inhibit beta 1 and beta 2 | Propanolol, labetalol
32
Side effect of beta blockers
bradyardia, fatigue/lethargy, impotence, hyperglycemia, masks signs of hypoglycemia
33
CCB
Cause peripheral vasodilation
34
Dihydropyridines
amlodipine, nifedipine
35
NonDihydropyridines
Slows conduction at the AV node | Verapamil, diltiazem
36
Side effects of CCB
Peripheral edema, constipation, HA, bradycardia (nondyhydropyridines)
37
ACE Inhibitors
Inhibit conversion of angiotensin 1 to angiotensin 2, and reduced aldosterone secretion
38
ARB
Directly inhibits angiotensin 2
39
Side effects of ACE and ARB
hyperkalemia, dizziness, angioedema and cough
40
are ACE's and ARB's indicated in pregnancy
NO they are contraindicated
41
What to ACE and ARB combined increase the risk of
Cancer
42
Alpha blockers
inhibits alpha1 receptors resulting in vasodilation of veins and arterioles. TX for BPH
43
Side effects of alpha blockers
Orthostatic hypotension, HA, dizziness
44
Central alpha-adrenergics
alpha 2 agonist redicing the sympathetic outflow from CNS producing a decrease in peripheral resistance - methyldopa
45
Side effects of Gentral alpha adrenergics
peripheral edema, drowsiness, dry mouth
46
Arteriolar dilators
RElax smooth muscles and produce peripheral dilation - hydralyzine and minoxidil (Rogaine)
47
Side effects of hydralazine
fluid/sodium retention, lupus like syndrome, T wave changes and excess hair growth
48
Does hydralyzine have a short or long half life
short- frequent dosing- 3X day
49
Direct renin inhibitors
Block the conversion of angiotensin to angiotensin 1'Aliskiren
50
ARD of renin inhibitors
increase BUN/CR, hyperkalemia if used with ACE
51
what is Prinzide
lisinopril +HCTZ
52
What is lotrel
Benazepril + amlodipine
53
Exforge HCT
Amlodipine +Valsartan + HCTZ
54
For an african american what blood pressure medications work best
CCB & diuretics
55
Forr a diabetes patient what blood pressure medications work best
ACE/ARB
56
For CHF patient what BP meds work best
BB, diuretics, ACE
57
For CAD what BP meds work best
BB, CCB
58
For CKD what BP meds work best
ACE/ARB
59
What is malignant htn
EMERGENCY- associated with end organ damage | BP >180/120
60
What is end organ damage
retinal hemorrhages, renal failure encephalopathy, MI
61
How do you treat malignant hypertension
Nitroprusside- can be titrated | Labetalol- IV bolus or continuous infusion
62
How fast should you lower BP in malifnant Htn
no more than 25% initially
63
Causes of secondary hypertension
1) Renovascular HTN - RAS 2. Primary Renal Dz. - due to glomerulonephritis, pyelo, ASHD 3. Primary Aldosteronism 4. Pheochromocytoma 5. Cushing’s Syndrome 6. Coarctation of the Aorta 7. Obstructive Sleep Apnea Syndrome 8. Hypothyroidism or Hyperparathyroidism 9. Drugs - cocaine
64
What is the most common correctable cause of secondary hypertension?
Renovascular hypertension (renal artery stenosis)
65
How does renal artery stenosis (RAS) cause hypertensoin
impairs blood flow to kiney, which increases renin and starts the cascade
66
How do you diagnose RAS
Renal arteriography- gold standard MRA/CTA Renal US with duplex imaging
67
Treatment of RAS
medication therapy or angioplast with stent
68
If I have bilateral RAS are ACE and ARBs good choices
NO- can lead to worsening renal function
69
I have unexplained hypokalemia and hypertension, why?
Primary aldosteronism
70
What is the main cause of primary aldosteronism
aldosterone producing adenoma or bilateral adreanal hyperplasia
71
What are the diagnostic features of secondary hypertension
Low -Plasma renin activity High - plasma aldosterone concentration CT adrenals
72
Treatment of primary aldosteronism
Adenoma- adrenalectomy | No adenoma- medical therapy with aldosterone antagonist (spiranolactone)
73
Phenochromocytoma symptoms
Epospdic eadache, sweating and tachycardia, sustained paroxysmal htn
74
diagnosis of phenochromocytoma
1) 24 hour urine catecholamines and metanephrines 2) plasma fractionated metanephrines 3) CT or MRI of abdomen/pelvis
75
What percentage of phenochromocytomas are in the abdomen
95%
76
Treatment of phenochromocytoma
adrenalectomy
77
Other causes of secondary hypertension
Cushings | Coactation
78
symptoms of coarctation of aorta
hypertension in both upper extremitis and low on unobtainable in LE. may have CP or claudication
79
Diagnosis of Coarctation
MRA, echocardiogram
80
Treatment of coarctation
Surgical correction, balloon angioplasty with stent
81
types of hypotension
cardiogenic shock | Orthostatic hypostions
82
Cardiac output and normal value
the volume of blood pumped by the heart in a unit of time. Normal:5L/min
83
Cardiac index and normal value
cardiac output corrected for body size Normal: 2.6- 4.2
84
Stroke volume and normal values
VOlume of blood in each beat/contraction. Normal: 70 ml/beat
85
Preload
the degree of ventricular filling during diastole
86
afterload
impedance of the ejection of blood from the ventricle
87
Ejection Fraction
The percent of the total blood volume in the ventricle at the end of diastole that is ejected during systole. Normal: 55-65%
88
Pulmonary Wedge pressure
Left atrial pressure measurement - measures preload in left ventricle. Normal = 12mmHg
89
What do you use to measure pulomnary wedge pressure
swan-ganz catheter
90
Chardiogenic shock
Inadequate tissue perfusion due to cardiac dysfunctio/decreased cardiac output Caused by severe reduction in cardiac index and elevation of SVR Hypotension <80-90 and MAP 30mmHg lower than basline
91
What is the most common cause of cardiogenic shock?
MI With LV dysfunction
92
Other causes of cardiogenic shock
``` Acute MR due to papillary muscle or chordae tendinae rupture Ventricular free wall rupture Pericardial tamponade Myocarditis End-stage cardiomyopathy ```
93
Clinical manifestations of cardiogenic shock
``` Hypotension Cool extremities/Pallor appearance Altered mental status Decreased or absent urine output/ARF Respiratory distress from CHF ```
94
Diagnosis of Cardiogenic shock
Echocardiogram (mainy | (TEE), Hemodynamic Monitoring, Cardiac catheterization
95
Normal pressure of the Right atrium
2-8 mmHg
96
Normal pressure of the Right Ventricle
systolic- 15-20/ diastolic 8-15
97
Normal pulmonary artery ressures
systolic 15-25/diatolic 8-15
98
Normal Pulmonary artery wedge pressure
6-12
99
Normal left ventricular end-diastolic pressure
6-12
100
If PCWP high or low in cardiogenic shock
High
101
Is PCWP high or low in septic shock
low
102
treatment of cardiogenic shock
1) reprofuse 2) intraaoritc baloon pump- decreased myocardial o2 consumption 3) meds- inotropes or vasopressors
103
Name some inotropes
Dopamine | Dobutamine
104
Dopamine causes and dose
increases contractility and vasoconstriction | Dose: 5-50 mcg/kg/min
105
Dobutamine causes and dose
increases contractility and cardiac output | Dose:5-40 mcg/kg/min
106
Name some Vasopressors
Norepi | Epi
107
What does norepi do and dose
vasoconstricts and increases contractility Dose: 1-30 mcg/min
108
What does epi do and dose
increases cardiac output and decreases SVR | Dose: 7-35 mcg/min
109
Orthostatic hypotension
symptomatic falls in bp after standing form a seated or supine position- may or may not have syncope
110
Who is orthostatic hypotension more common in
elderly and diabetics
111
what is the compensatory mechanism in which regulates bp
baroreceptors
112
What is a normal change in SBP
5-10 drop
113
What is a normal change in DBP
5-10 increase
114
What is a normal change in HR
10-25 bpm increase with standing
115
Causes of orthostatic hypotensio
volume depletion, autonomic dysfunction, medications, postprandial
116
symptoms of Orthostatic hypotension
Dizziness, Lightheadedness, Blurred vision, Confusion, Near syncope/syncope
117
Diagnosis of orthostatic hypotension
Check BP supine, sitting and standing 3 mins apart
118
Labs that could be helpful in diagnosing orthostatic hypotension
BUN/Creatinine levels, anemia
119
Treatment of rthostatic hypotension
increase salt and water intake, compression stockings,remove offending medications
120
What medications can be used for orthostatic hypotension
Fludrocortisone | Midodrine
121
Other name for orthostatic hypotension
postural hypotension

Cardiology (8 decks)

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