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CV <3 > Lecture 3: Hypotension > Flashcards

Lecture 3: Hypotension Flashcards

1
Q

What typically is referred to as hypotension?

A

< 90/60

Always treat the patient, not the number.

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2
Q

What is the main concern with regards to hypotension?

A

Hypoperfusion of organs, causing cellular damage.

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3
Q

What 3 things determine arterial BP?

A
  1. CO
  2. Venous pressure
  3. SVR
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4
Q

What general etiologies typically result in hypotension?

A
  1. Cardiogenic shock
  2. Hypovolemia
  3. Orthostatic Hypotension
  4. Sepsis/septic shock
  5. Endocrinology
  6. Vascular changes
  7. Drug-induced
  8. Neurogenic shock
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5
Q

What skin signs are typical of someone with hypotension?

A
  • Cool
  • Clammy
  • Diaphoretic
  • Pallor
  • Delayed cap refill
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6
Q

What is the general treatment for a hypotensive patient? What etiology would not use the general treatment?

A

Fluid resuscitation via IV NS bolus.

However, we should avoid fluids in people in HF.

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7
Q

Define orthostatic hypotension/postural hypotension.

A

Drop in BP upon standing, leading to actual symptoms of hypotension.

  • 20 mm SBP drop
  • 10 mm DBP drop

Change from standing to lying.

Due to either autonomic reflex dysfunction or volume depletion in general.

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8
Q

What happens to venous return and CO upon standing?

A

Decreases in both.

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9
Q

How does our body typically prevent orthostatic hypotension?

A
  • Increased HR
  • Increased SVR
  • Results in increased CO to prevent SBP drop

Sympathetic stimulation

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10
Q

What are the classic symptoms of orthostatic hypotension?

A
  • Generalized weakness
  • Dizziness or lightheadedness
  • Blurry vision or darkening of visual fields
  • Syncope

Should only occur when changing positions to standing.

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11
Q

What are the atypical symptoms of orthostatic hypotension?

A
  • Fatigue
  • Cognitive slowing
  • Nausea
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12
Q

What are the two typical evaluation methods for orthostatic hypotension?

A
  • Bedside tilt test/orthostatic BP measurement
  • Formal tilt table test
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13
Q

Describe a tilt table test and the medications typically used.

A
  • Strapped to a table, start laying flat then standing for 45 mins.
  • If no response, NTG is administered while flat again.
  • Tilted upright again to test for symptoms.
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14
Q

What is the primary cause of acute orthostasis?

A

Volume depletion, treated via IV fluids.

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15
Q

What two medications have evidence for use in orthostasis?

A
  • Fludrocortisone
  • Midodrine
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16
Q

What is a common complication of treating orthostasis with medication?

A

Supine hypertension

17
Q

What class is fludrocortisone and its MOA?

A

It is a mineralcorticoid with high glucocorticoid activity.

It promotes potassium excretion and sodium reabsorption.

Preferred over midodrine

18
Q

What are the main SEs of fludrocortisone?

A
  • Edema
  • Hypokalemia
  • Supine/sitting HTN
19
Q

What class is midodrine and its MOA?

A

It is an a1 selective adrenergic agonist.

Increases SVR, increasing SBP and DBP without crossing BBB.

Main consideration: short half-life, requiring TID.

20
Q

What is POTS?

A

Postural orthostatic tachycardia syndrome

A variation of orthostasis primarily characterized by tachycardia.

21
Q

What is the diagnostic criteria for POTS?

A
  1. Hx of orthostatic symptoms w or w/o systemic symptoms.
  2. Sustained increase in HR by at least 30bpm (40 for pts < 20yo) within 10 minutes without orthostatic hypotension.
  3. Autonomic testing to confirm.
22
Q

What is the gold standard test to diagnose POTS?

A

Formal tilt table test showing 30 BPM increase or > 120 BPM within 10 mins WITHOUT hypotension.

23
Q

What are nonpharmacological treatments for POTS?

A
  • Avoid exacerbating factors
  • Drink more water (2-3L)
  • Eat more salt (3-5g)
  • Exercise + compression stockings.
24
Q

What medications are used for POTS?

A
  • Fludrocortisone
  • Midodrine
  • BBs (Propranolol)
  • SSRI/SNRI (rarely used)
25
Q

What is the prognosis for POTS?

A

Good. People generally grow out of it within 1-2 years.

26
Q

What are the 4 types of shock?

A
  • Distributive
  • Cardiogenic
  • Hypovolemic
  • Obstructive
27
Q

What characterizes cardiogenic shock and the MCC?

A

Inability of the heart to pump properly, resulting in inadequate CO.

MCC: acute MI and its complications.

28
Q

What defines shock?

A

Hypotension with evidence of end-organ hypoperfusion.

29
Q

What is the classic presentation of a patient with cardiogenic shock?

A
  • Peripheral vasoconstriction (cool, moist skin)
  • Tachycardia
30
Q

For a patient presenting with cardiogenic shock, what would suggest recent or acute MI?

A

Cardiac enzyme elevation (trop, CK-MB)

31
Q

For a patient presenting with cardiogenic shock, what would suggest renal and hepatic hypoperfusion?

A
  • Elevated serum creatinine
  • Elevated AST and ALT
32
Q

For a patient with cardiogenic shock, what would suggest hepatic congestion or hypoperfusion?

A
  • Coagulation abnormalities
  • Anion gap acidosis
  • Serum Lactate

CV <3 (25 decks)

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