Syncope And Hypertension - Dr. Miller

Question 1

Neurally mediated syncope

Answer 1

TRANSIENT

1. Vasovagal (normal passing out)
2. Carotid sinus syndrome
3. Situational syncope (refex)

Question 2

Cardiac syncope

Answer 2

low CO from arrythmia

Question 3

Orthostatic hypotension syncope

Answer 3

CHRONIC, from standing up

Question 4

episode for syncope happen in what age pattern

Answer 4

20, 60, 80

sharp increase after 70

Question 5

who can leave and who needs to stay in hospital from syncope (how to make this decision)

Answer 5

San Francisco Syncope Ratio 
C : CHF
H : Hct lower 30%
E : EKG abnormal
S : SOB
S : Systolic BP under 90

Question 6

Neurally mediated syncope examples

Answer 6

passing out form locking knees or seeing blood

Question 7

Neurally mediated syncope sx

Answer 7

= dizzy, pass out and then can wake up and tell you what happened
= autonomic activation
= N, palpitations, sweat, pallor, hyperventilation
= dilated pupils, rare urinary incontinence
= Slow pulse *

Question 8

orthostatic hypotension is what

Answer 8

= systolic lower by 20 and/ or diastolic lower by 10 (after 3min standing from laying down)
= usually preceded by warning sx

Question 9

cardiac syncope

Answer 9

sudden loss of consciousness, usually from exertion
= no warning collapse (like hypertrophic cardiomyopathy)
= few warning sx preceding

Question 10

5-15 % of syncope cases are due to what

Answer 10

medications

Question 11

syncope PE things

Answer 11

vital signs and BP (orthostatic included)

= if focal Neurologic findings DO Carotid artery imaging + CT/MRI head

Question 12

syncope and DX

Answer 12

= EKG : esp past ekg from pt
= CBC + electrolytes
= troponin (if you think its cardiac)

Question 13

neurogenic syncope refer to

Answer 13

autonomic evaluation

Question 14

reflex syncope refer them to

Answer 14

Tilt-table testing

Question 15

cardiovascular syncope refer them to

Answer 15

• implantable cardiac monitor
• ambulatory external cardiac monitor
• stress testing
• MRI/CT

Question 16

tilt table testing

Answer 16

not recomended as much
= neurologic mediated syncope from reflex
= unclear dx, delayed orthostatic hypo
= BP and HR as you tilt someone to see how autonomic function **

Question 17

the only type of syncope that pt does not have to stay in hospital for observation

Answer 17

neurally mediated syncope

Question 18

what can help pt with neurally mediated syncope episodes

Answer 18

= gripping hands and arm tensing
= crossing legs
= medications also (vasoconstrictors)
= avoid triggers

Question 19

orthostatic hypotension tx

Answer 19

= remove reversible causes like drugs
= slow moving from laying down
= compression stockings 
= increase dietary salt and fluid
= MEDS : midodrine or fludrocortisine

Question 20

cardiac syncope tx

Answer 20

= EPS (electric physiology study)
= Brady : pacer
= tachy : ablation, antiarryhtics, defibrillators

Question 21

Hypertension risks modifiable

Answer 21

smoking, DM, obesity, diet unhealthy, low Physical activity

Question 22

HTN fixed risks

Answer 22

= CKD
= FH
= age
= socioeconomic status
= male
= sleep apnea
= stress psychosocial

Question 23

HTN effects what 4 organs

Answer 23

1. Heart
2. Brain : dementia, CVA, HTN encephalopathy
3. Kidney : segmental glomerular sclerosis
4. Peripheral Arteries

Question 24

secondary htn

Answer 24

from another disorder

Question 25

htn urgency is what

Answer 25

over 180/110 + no end organ damage

Question 26

htn emergency is what

Answer 26

over 180/110 with end organ damage

Question 27

endothelin 1 function Th 1 function Treg function ON BP

Answer 27

endothelin 1 = increase BP Th1 = increase BP Tregs = decrease BP

Question 28

htn dx doe by what

Answer 28

2017 ACC/AHA guidelines

Question 29

HTN is normal elevated stage 1 stage 2

Answer 29

normal : under 120/80 elevated : 120-129/ under80 stage 1 : 130-139/ 80-89 stage 2: 140/90 or more

Question 30

HTN in children

Answer 30

is over 95% percentile at there age and sex | pre-htn (90%-95%)

Question 31

HTN in pregnant women is what

Answer 31

140/90 or higher

Question 32

primary htn causes

Answer 32

job changes, alcohol, diet, | gradual increase

Question 33

dx htn what to order

Answer 33

CBC, lipid panel, CMP, TSH, UA, EGK, fasting blood glucose

Question 34

stage 1 htn how to tx

Answer 34

1. non- pharmacologic : no ASCVD or 10year CVD risk over 10% 2. non-pharmacologic + BP meds : if CVD 10year risk over 10%* (ORRR *DM, *CKD, *over 65yo)

Question 35

elevated htn tx

Answer 35

non-pharm (reassess in 3mo-6mo)

Question 36

stage 2 htn tx

Answer 36

non-pharm + 2 BP meds (different classes)

Question 37

stage 1 htn pt needed BP meds what should I do

Answer 37

assess electrolytes and renal function 2-4 weeks after starting tx

Question 38

2017 ACC/ AHA want what BP

Answer 38

under 130/80`

Question 39

what is 1 thing that can lower BP more then anything

Answer 39

DASH diet SERVINGS: 1. (6-8 whole grains) 2. 4-5 veggies 3. 4-5 fruits 4. 2-3 dairy 5. 2-3 fat/oil 6. lean meat, poultry, fish (2-3) 7. nuts, seeds, legumes (4-5 per week) 8. candy + added sugar (less then 5 per week)

Question 40

exercise that lowers BP

Answer 40

aerobic (-5 to 8 mmHg) static isometric (-5mmHg) Dynamic (-4mmHg)

Question 41

First line meds for HTN management

Answer 41

1. RAAS inhibitor (renin, angiotensin, aldosterone, system) 2. CCBs 3. thiazide

Question 42

Blacks respond to what htn drug

Answer 42

CCBs and diuretics

Question 43

White respond to what htn drug

Answer 43

ACE-I and ARBs

Question 44

HTN medication for : | DM2

Answer 44

ACE-I or ARBs

Question 45

HTN medication for : | CHD or CHF

Answer 45

ACE-I, ARBs, BB

Question 46

HTN medication for : BPH (benign prostatic hypertrophy

Answer 46

a-blocker

Question 47

HTN medication for : A fib

Answer 47

CCB or BB

Question 48

ACE-1

Answer 48

lisinopril benazepril ramipril

Question 49

ARBs

Answer 49

candesartansm irbesartan, losertan, telmisartan

Question 50

Thiazide-like diuretics

Answer 50

chlirthalidone, indapamide (not HCTZ as much)

Question 51

CCB

Answer 51

amlodipine, isradapine, nifedipine

Question 52

BB

Answer 52

atenolol, bisorpolol, carvedilol, metoprolol

Question 53

Hypertensive urgency other name

Answer 53

(Asymptomatic severe htn) = over 180/110 = lower to like 160/100 = lower slowly**** over days - weeks

Question 54

HTN emergency sx

Answer 54

1. agitation, delirium, eye problems, , weakness, numbness, hemorrhage, CP, SOB, Cerebral Infarct, PE 2. acute back pain (aortic dissection)

Question 55

HTN Emergency tx

Answer 55

1. lower 10-20% 1st hour | 2. 5-15% next 24hr

Question 56

htn em tx for kidney

Answer 56

fenoldapam

Question 57

htn em tx for vascular

Answer 57

BB esmolol

Question 58

htn em tx for heart

Answer 58

vasodilator + BB

Question 59

htn em tx for brain

Answer 59

clevidipine, nicardipine, fenoldampam (CCB)

Question 60

meow

Answer 60

:)