N530 Cardiovascular Problems Exam Study Set
dx of HTN - ANSWER normal: SBP <120 and DBP <80
elevated: SBP 120-129 and DBP < 80
stage 1 HTN: SBP 130-139 or DBP 80-889
stage 2 HTN: SBP > or equal to 140 or DBP > or equal to 90
-based on at least 2 BP readings on at least 2 separate occasions
-children > 3yo should have BP every office visit
primary (essential) HTN - ANSWER -chronic elevation of BP w/ no ID cause
-90 -95% of all HTN cases
-due to constitutional and environmental factors
r/f:
-family hx
-race
-age
-lifestyle
2ndary HTN - ANSWER -elevation of BP d/t another disorder
causes:
•Kidney disease (chronic glomerulonephritis)
•Cushing's syndrome
•Primary hyperaldosteronism
•Pheochromocytoma (tumor of chromaffin cells in the adrenal medulla which secrete epi
caus incr HR, contractility, and peripheral vascular resistance)
•Coarctation of the aorta (congenital condition with narrowing/constriction of the aorta)
•Oral contraceptives
•Cocaine, amphetamines
•Decongestants (e.g. Sudafed)
,HTN complications - ANSWER -if severe and chronic, can affect other organs: chronic
renal dz, CHF, CAD, arrhythmia, eyes (retinopathy, peripheral vasc dz
-hypertensive crisis: SBP > 180 or DBP > 120
-hypertensive urgency: Markedly elevated blood pressure without damaging organs
-hypertensive emergency: Markedly elevated blood pressure that does cause end-organ
damage (mental status change, intracranial hemorrhage, retinopathy, aortic dissection,
cardiac ischemia, congestive heart failure, or acute renal failure)
HTN tx - ANSWER goal: improve control and prevent rise of BP w/ aging
initial treatment:
-lifestyle modification 1st (weight lost, DASH diet, decr alc and sodium reduction, stop
smoking)
-stepped therapy: set BP goal, titrate BP meds no more frequently than q4-6 wks (more
slowly for geriatric pts d/t fall and ortho hypo), may need to prescribe multiple anti-HTN
meds (choose med w/ diff MOA and adverse drug effects- adding more med reduces BP
better than maxing dose for 1 med)
-monitor at onset and at least yearly for end organ damage: electrolyte, CBC, renal fxn,
BG, UA, lipid, EKG
-meds for HF & HTN: BB, ACEi/ARBc, aldosterone antagonist, diuretics
-MI &HTN: BB, ACEi/ARB, aldosterone antagonist
-angina &HTN: BB, Calcium channel blocker
-DM & HTN: ACEi/ARB
-CKD & HTN: ACEi/ARB
-african americans: diuretics, isosorbide dintrate/hydralazine (bidil) & ca channel
blocker (reduced monotherapy for BB, ACEI, ARB unless compless w/ diuretic)
HTN during pregnancy - ANSWER -drugs of choice: methyldopa and labetalol
-avoid during pregnancy ACEI, ARBs, direct renin inhibitor
-chronic: HTN developed < 30 wks gestation
-gestational HTN: developed @ 20 wks or more
-preeclampsia: SBP > or equal to 140 or DBP > or equal to 90 AND proteniuria (> or
equal to 300 mg/24 h) develops after 20 wks
-eclampsia: preeclampsia + seizures
, hyperlipidemia/dyslipidemia - ANSWER -high lipids/lipoprotein
-primary: genetics
-2ndary: d/t other dz (DM, obesity, alc, renal, meds)
s/s: cholesterol plaques that deposit in various tissue:
-arteries (atheromas)
-skin and tendon (xanthomas)
-eyelids (xanthelasma)
iris (corneal arcus)
dx: fasting lipid panel (fast for at least 8 hrs)
r/f for coronary heart disease (CHD) - ANSWER age: male > or equal to 45, female > or
equal to 55
fam hx: premature CHD (MI or sudden death < 55 yr in father/ other male 1st degree
relative or < 65 yr in mother/ female 1st degree relative)
cigarrette smoking
HTN: BP > or equal to 140/90 or on any HTN med
HDL: < or equal to 40
DM
-lifestyles changes and lipid lowering therapy for those with no CV risk or 10-year risk
that is less than 7.5%
•If 10-year cardiac risk >7.5%, recommend statin (adverse effect: elevated liver
enzymes)
coronary artery disease - ANSWER -heart disease caused by impaired coronary blood
flow
-most common cause: atherosclerosis
acute coronary syndrome: spectrum of acute ischemic heart disease:
•Unstable angina (UA)
•Non-ST segment elevation MI (NSTEMI)
•ST-segment elevation MI (STEMI)
unstable angina - ANSWER -persistent and severe chest pain
dx of HTN - ANSWER normal: SBP <120 and DBP <80
elevated: SBP 120-129 and DBP < 80
stage 1 HTN: SBP 130-139 or DBP 80-889
stage 2 HTN: SBP > or equal to 140 or DBP > or equal to 90
-based on at least 2 BP readings on at least 2 separate occasions
-children > 3yo should have BP every office visit
primary (essential) HTN - ANSWER -chronic elevation of BP w/ no ID cause
-90 -95% of all HTN cases
-due to constitutional and environmental factors
r/f:
-family hx
-race
-age
-lifestyle
2ndary HTN - ANSWER -elevation of BP d/t another disorder
causes:
•Kidney disease (chronic glomerulonephritis)
•Cushing's syndrome
•Primary hyperaldosteronism
•Pheochromocytoma (tumor of chromaffin cells in the adrenal medulla which secrete epi
caus incr HR, contractility, and peripheral vascular resistance)
•Coarctation of the aorta (congenital condition with narrowing/constriction of the aorta)
•Oral contraceptives
•Cocaine, amphetamines
•Decongestants (e.g. Sudafed)
,HTN complications - ANSWER -if severe and chronic, can affect other organs: chronic
renal dz, CHF, CAD, arrhythmia, eyes (retinopathy, peripheral vasc dz
-hypertensive crisis: SBP > 180 or DBP > 120
-hypertensive urgency: Markedly elevated blood pressure without damaging organs
-hypertensive emergency: Markedly elevated blood pressure that does cause end-organ
damage (mental status change, intracranial hemorrhage, retinopathy, aortic dissection,
cardiac ischemia, congestive heart failure, or acute renal failure)
HTN tx - ANSWER goal: improve control and prevent rise of BP w/ aging
initial treatment:
-lifestyle modification 1st (weight lost, DASH diet, decr alc and sodium reduction, stop
smoking)
-stepped therapy: set BP goal, titrate BP meds no more frequently than q4-6 wks (more
slowly for geriatric pts d/t fall and ortho hypo), may need to prescribe multiple anti-HTN
meds (choose med w/ diff MOA and adverse drug effects- adding more med reduces BP
better than maxing dose for 1 med)
-monitor at onset and at least yearly for end organ damage: electrolyte, CBC, renal fxn,
BG, UA, lipid, EKG
-meds for HF & HTN: BB, ACEi/ARBc, aldosterone antagonist, diuretics
-MI &HTN: BB, ACEi/ARB, aldosterone antagonist
-angina &HTN: BB, Calcium channel blocker
-DM & HTN: ACEi/ARB
-CKD & HTN: ACEi/ARB
-african americans: diuretics, isosorbide dintrate/hydralazine (bidil) & ca channel
blocker (reduced monotherapy for BB, ACEI, ARB unless compless w/ diuretic)
HTN during pregnancy - ANSWER -drugs of choice: methyldopa and labetalol
-avoid during pregnancy ACEI, ARBs, direct renin inhibitor
-chronic: HTN developed < 30 wks gestation
-gestational HTN: developed @ 20 wks or more
-preeclampsia: SBP > or equal to 140 or DBP > or equal to 90 AND proteniuria (> or
equal to 300 mg/24 h) develops after 20 wks
-eclampsia: preeclampsia + seizures
, hyperlipidemia/dyslipidemia - ANSWER -high lipids/lipoprotein
-primary: genetics
-2ndary: d/t other dz (DM, obesity, alc, renal, meds)
s/s: cholesterol plaques that deposit in various tissue:
-arteries (atheromas)
-skin and tendon (xanthomas)
-eyelids (xanthelasma)
iris (corneal arcus)
dx: fasting lipid panel (fast for at least 8 hrs)
r/f for coronary heart disease (CHD) - ANSWER age: male > or equal to 45, female > or
equal to 55
fam hx: premature CHD (MI or sudden death < 55 yr in father/ other male 1st degree
relative or < 65 yr in mother/ female 1st degree relative)
cigarrette smoking
HTN: BP > or equal to 140/90 or on any HTN med
HDL: < or equal to 40
DM
-lifestyles changes and lipid lowering therapy for those with no CV risk or 10-year risk
that is less than 7.5%
•If 10-year cardiac risk >7.5%, recommend statin (adverse effect: elevated liver
enzymes)
coronary artery disease - ANSWER -heart disease caused by impaired coronary blood
flow
-most common cause: atherosclerosis
acute coronary syndrome: spectrum of acute ischemic heart disease:
•Unstable angina (UA)
•Non-ST segment elevation MI (NSTEMI)
•ST-segment elevation MI (STEMI)
unstable angina - ANSWER -persistent and severe chest pain
