Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2014 - CM Cardio > Hyper/Hypotension (Cardio 1) > Flashcards

Hyper/Hypotension (Cardio 1) Flashcards

1
Q

What is the prevalence of HTN in adults?

A

30%, 58-65 million people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What co-morbidities are associated with HTN?

A
  • coronary artery dz
  • left ventricular hypertrophy
  • ischemic stroke
  • chronic kidney dz
  • DM
  • peripheral artery dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Patient Barriers to Effective HTN Tx

A
  • lack of health insurance or regular provider
  • nonadherence to therapy: medication cost, complicated regimen, side effects, lack of support, poor physician communication
  • advanced age or obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Systole

A

phase of cardiac cycle when ventricles contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diastole

A

phase of cardiac cycle when ventricles relax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Systolic Pressure

A

maximum arterial pressure during ventricular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diastolic Pressure

A

point of lowest arterial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What 2 things determine arterial pressure?

A
  • cardiac output

- peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cardiac Output

A

CO = HR + stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What determines/influences peripheral resistance?

A
  • vascular structure

- vascular function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal BP

A

less than 120/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pre-HTN

A

systolic 120-139

diastolic 80-89

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HTN:

  1. Stage 1
  2. Stage 2
A
  1. systolic 140-159, diastolic 90-99

2. sys 160+, dias 100+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

JNC 8 Goal BP Levels

A
  1. age 60+: goal < 150/90 (if you’re 60, you can have 150)

2. less than 60 yo: goal < 140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pheochromocytoma

A
  • 5 Ps: pressure, pain, perspiration, palpitation, pallor
  • 2% of people with secondary HTN
  • paroxysmal secretion of epinephrine, norepi by adrenal or remote tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some secondary causes of HTN?

A
  • ENDOCRINE: Cushing’s, primary aldosteronism, congenital adrenal hyperplasia, hyper or hypothyroid
  • RENAL: renovascular dz, pre-eclampsia
  • MECHANICAL: coarctation of aorta, A/V fistula
  • MEDICINE: stimulants, corticosteroids, SSRIs, oral contraceptives
17
Q

White Coat HTN

A
  • falsely elevated BP in clinical setting

- 20-25% of pts will have false, mild elevation of pressure

18
Q

Malignant HTN

A
  • SBP > 180, DBP > 120
  • most often w/ long standing, uncontrolled HTN
  • multiple other causes
  • can lead to HTN encephalopathy
  • risk for seizures/coma if not treated
19
Q

Reversible/Modifiable Risk Factors for HTN

A
  • smoking
  • excessive ETOH intake
  • physical inactivity
  • renal dz
  • obesity (BMI >30)
  • dyslipidemia
  • DM
20
Q

Non-reversible Risk Factors for HTN

A
  • age
  • family hx: premature CVD in men <65
  • race
21
Q

Metabolic Syndrome

A

-abdominal obesity: waist >40 inches men, >35 women
-fasting glucose > 110
-BP > 130/85
-triglycerides > 150
-HDL < 40 in men, < 50 in women
++3 or more of these make dx –> increased risk of developing HTN, CVD

22
Q

Clinical Presentation HTN

A
  • often no specific sxs
  • neurological sxs: headache, dizziness, palpitations, fatigue, impotence
  • vascular sxs: epistaxis, hematuria, metrorrhagia, blurred vision, weakness, angina
23
Q

History Pertinent to HTN

A
  • onset and duration of sxs
  • past MHx: consider potential target organs affected
  • past surgical hx
  • family hx of HTN or CVD
  • social hx: alcohol, tobacco, caffeine, diet, drugs, exercise
24
Q

Pertinent Physical Exam Findings in HTN

A
  • Cushingoid appearance (moon face, hirsutism, abdominal/trunk obesity)
  • fundoscopy (eye vessels)
  • CV exam: displacement of PMI, S3 or S4, carotid bruits
  • ab: renal artery bruits, palpation for enlarged kidneys
  • peripheral vascular: equality of peripheral pulses, femoral artery bruits
25
Q

Lab Work Up for HTN

A
  • CBC: anemia, polycythemia
  • serum potassium: r/o hyperkalemia
  • BUN and creatinine: assess renal fx
  • calcium and phosphate (parathyroid dz)
  • fasting glucose: DM screen
  • fasting lipid profile: assess risk of arteriosclerosis
  • TSH
  • urinalysis with microscopic UA: protein, blood, glucose
  • chest x ray: cardiomegaly
  • EKG: evidence of MI, LVH, dysrhythmia
26
Q

HTN End Organ Damage: Brain

A
  • stoke

- TIA, reversible ischemic neurological deficit

27
Q

Papilledema

A

optic nerve swelling

28
Q

A/V Nicking

A

compression of retinal veins

29
Q

Cotton Wool Spots

A

ischemic regions of retina

30
Q

HTN End Organ Damage: Eye

A
  • retinopathy
  • papilledema: optic nerve swelling
  • A/V nicking: compression of retinal veins
  • hemorrhage
  • exudates: lipid deposits after hemorrhage
  • cotton wool spots: ischemic regions of retina
31
Q

HTN End Organ Damage: LVH

A
  • S4 heart sound = stiff ventricle
  • cardiomegaly
  • EKG changes: R wave of aVL > 11 mm; S wave of V1 or V2 + R wave of V5 or V6 > 35 mm
32
Q

HTN End Organ Damage: Kidney

A
  • proteinuria

- renal insufficiency

33
Q

Peripheral Arterial Dz

A
  • hair loss on legs
  • diminished peripheral pulses
  • cool extremities
  • sluggish cap refill (> 3 secs)
34
Q

Non-Pharmacological Management of HTN

A
  • lower BP, enhance efficacy of HTN meds
  • weight reduction (BMI 18-25)
  • diet: DASH (potassium, calcium, fruits, veggies) or low sodium diet (1600mg/day)
  • exercise: 30 mins/day
  • reduce EtOH intake (1-2 servings/day)
35
Q

Postural/Orthostatic Hypotension

A
  • significant drop in arterial BP with position change
  • represents a defect in vasomotor reflexes
  • frequent cause of syncope in elderly
  • prominent feature in many ANS disorders
36
Q

Autonomic NS Disorders that can Cause Orthostatic Hypotension

A
  • multiple sclerosis
  • Parkinson’s
  • peripheral neuropathy
  • Raynaud’s
  • reflex sympathetic dystrophy
37
Q

Causes of Orthostatic Hypotension

A
  • drugs (antihypertensives, antidepressants, vasodilators)
  • physical deconditioning
  • sympathectomy
  • decreased blood volume: GI bleed, dehydration, adrenal insufficiency
  • idiopathic/familial postural hypotension
  • advanced age
38
Q

Dx of Orthostatic Hypotension

A
  • measure BP and HR from supine to sitting to standing
  • wait 2 mins btw position changes
  • SUSTAINED drop of SBP > 20 or DBP > 10
  • absence of compensatory HR increase (15 bpm) suggests neurogenic etiology
  • compensatory HR increase suggests non-neurogenic
39
Q

Management of Orthostatic Hypotension

A
  • reduce/eliminate offending drugs
  • caution pt on position changes
  • elevate head of bed
  • compression stockings
  • some pts require high sodium diet
  • may require drug therapy

Fall 2014 - CM Cardio (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions