hypertension & CAD Flashcards
(60 cards)
1
Q
modifiable risk factors for CAD
A
- dislipidemia
- smoking
- hypertension
- diabetes
- obesity
- thrombogenic factors
- sedentary lifestyle
2
Q
non-modifiable risk factors for CAD
A
- family history of CAD
- age
- sex
3
Q
levels of risk associated with CAD
A
- smoking
- hypertension (DBP >90 mmHg)
- serum total cholesterol level (>240 mg/dL)
4
Q
high blood pressure puts you at risk for what?
A
heart disease and stroke
5
Q
hypertension increases RR by 2-4 fold for what
A
- CAD, stroke, HF, PAD, AF, CKD
- dementia: vascular, Alzheimer’s
- mild cognitive deficits
6
Q
attributable risk for HTN
A
- stroke (62%)
- CKD (56%)
- HF (49%)
7
Q
who gets hypertension?
A
- males > females up to age 64
- females > males after age 65
8
Q
HTN is more common and severe in what race?
A
African Americans
9
Q
other risk factors for HTN?
A
- positive family history
- obesity
- diabetics
10
Q
SBP or DBP more important as a CAD risk factor for persons over 50?
A
SBP
11
Q
hypertension fact/statistic
A
persons who are normotensive at age 55 have a 90% lifetime risk of developing HTN
12
Q
cerebral perfusion autoregulation
A
persons with chronic hypertension have a higher MAP
13
Q
CNS damage conditions
A
- hypertensive encephalopathy
- hemorrhagic stroke
- ischemic stroke
14
Q
renal system damage conditions
A
acute renal failure
15
Q
cardiopulmonary system damage conditions
A
- acute decompensated HF
- acute coronary syndrome (including MI)
- acute pulmonary edema
- dissecting aortic aneurysm
16
Q
ophthalmologic damage conditions
A
- exudates
- papilledema
- retinal hemorrhages
17
Q
what is blood pressure?
A
- pressure exerted by circulating blood upon the walls of blood vessels
- refers to the pressure in the systemic circulation
18
Q
blood pressure varies with what?
A
- strength of heartbeat
- elasticity of arterial walls
- volume and viscosity of blood
- health, age, and physical condition of person
- location of measurement
19
Q
what is hypertension?
A
- systemic arterial blood pressure is elevated
- based on the average of 2 or more readings taken at 2 or more visits
20
Q
primary hypertension
A
- aka essential HTN
- accounts for 95% cases of HTN
- no established cause
21
Q
secondary hypertension
A
- 5% of HTN cases
- secondary to other potentially rectifiable causes
22
Q
identifiable causes of secondary HTN
A
- sleep apnea
- drug induced or related causes
- CKD
- primary aldosteronism
- renovascular disease
- chronic steroid therapy or Cushings syndrome
- pheochromocytoma
- coarctation of the aorta
- thyroid or parathyroid disease
23
Q
HTN pathophysiology
A
- ANS
- intravascular fluid volume = aldosterone stimulation
- vascular autoregulation
- renin-angiotensin aldosterone system (RAAS)
24
Q
RAAS picture
A
look at notes
25
HTN symptoms
- headache
- dizziness
- blurred vision
- shortness of breath (especially with exertion)
- chest pain
- rapid pulse, palpitations
- malaise and fatigue
- OFTEN NO SYMPTOMS AT ALL
26
normal BP numbers
SBP = <120/<80 mmHg
27
elevated BP numbers
SBP= 120-129 mmHg
DBP= <80 mmHg
treatment: life style modifications
28
stage 1 HTN BP numbers
SBP= 130-139 mmHg
DBP= 80-89 mmHg
treatment: life style modifications (+ meds for those with CVD)
29
stage 2 HTN BP numbers
SBP= >140 mmHg
DBP= >90 mmHg
treatment: life style modifications and meds
30
BP goals for general >60 years
< 150/90 mmHg
31
BP goals for <60 years
< 140/90 mmHg
32
BP goals for black americans (any age; with or without DM)
< 140/90 mmHg
33
BP goals for adults with DM who are not black
< 140/90 mmHg
34
BP goals for adults with CKD
< 140/90 mmHg
35
weight reduction leads to reduction in SBP....
5-20 mmHg/10kg weight loss
36
adopting DASh eating plan leads to reduction in SBP of
8-14 mmHg
37
reducing dietary sodium leads to reduction of SBP of
2-8 mmHg
38
physical activity leads to reduction in SBP of
4-9 mmHg
39
moderation of alcohol reduction leads to reduction of SBP of
2-4 mmHg
40
thiazide type diuretics
- Hydrochlorothiazide
- Chlorthalidone (acts on distal convoluted tubule and inhibits Na and Cl transport) (also has longer mechanism of action and more potent
41
how do ACE inhibitors work?
block Angiotensin I from converting into Angiotensin II
42
how do Angiotensin Receptor Blockers (ARB) work?
block the effects of Angiotensin II receptors
43
what do calcium channel blockers do?
slow HR and lower BP
44
acute coronary syndromes (ACS)?
- unstable angina
- MI
- non ST elevation MI (NSTEMI)
- ST elevation MI (STEMI)
45
pathogenesis of acute coronary syndromes
plaque rupture > platelet adhesion > platelet activation > partially occlusive arterial thrombosis & unstable angina > microembolization & NSTEMI > totally occlusive arterial thrombosis & STEMI
46
spectrum of acute coronary syndromes
look at notes
47
what is angina?
- occurs with activity and stress
- pain is described as pressure, squeezing, heaviness and may be associated with diaphoresis, nausea or vomiting and/or shortness of breath
- relieved with rest or nitroglycerin
48
cardiac markers
picture in notes
49
anti-ischemic treatment for NSTEMI
- bed rest
- nitroglycerin
- oxygen
- morphine
- beta blocker (metoprolol)
- possibly calcium channel blocker (verapamil)
- ACE inhibitor for decrease LV function
50
anti-platelet/anti-thrombotic treatment
- aspirin
- heparin
- add platelet GP IIb/IIIa receptor antagonist
51
early invasive strategy (aggressive?)
cath lab
52
early conservative medical management
look at notes
53
STEMI criteria
- elevated serial enzymes
| - ST elevation in 2 or more leads
54
hospital discharge care
```
A: aspirin & anticoagulants
B: beta blockers & BP
C : cholesterol & cigs
D: diet & diabetes
E: education & exercise
```
55
candidates for cardiac cath
- MI
- known CAD
- positive stress test
- not reach target HR on stress test
- possible HF
- structural deformities
- identify bacterial infection
56
goal of cardiac cath (left system)
- identify location of CAD for PCA or CABG
- measure LV ejection fraction
- if needed, measure aortic valve
57
risks of cardiac cath procedure
- very rare, death, MI, stroke, renal failure
- bleeding 2-5% (biggest risk)
- allergic reaction to dye
58
patient population for percutaneous transluminal coronary artery (PTCA/stent)
- blockage greater than 70%
| - Patient is a candidate for CABG (left main disease, proximal LAD, triple vessel disease)
59
intra-procedure
- receives heparin
- GP IIb/IIIa inhibitor
- nitroglycerin
60
PTCA/stent patient directions
- stay in bed for 4-6 hrs after procedure
- may resume regular activities in 4-5 days
- discharged from hospital in 1 day
- if received stent, discharged on anticoagulant
