Topic 4 Cardio Part 1

• Blood pressure is force exerted by blood against walls of blood vessels.
• Cardiac output is stroke volume times heart rate.
• Blood pressure is cardiac output times systemic vascular resistance.
• What is primary hypertension?

  Essential or idiopathic: hypertension without an identified cause.
• What is secondary hypertension?

  Hypertension with a specific cause that can be identified and corrected.
• What is normal blood pressure range?

  Systolic: Less than 120

  Diastolic: Less than 80
• What is elevated blood pressure range?

  Systolic: 120 - 129

  Diastolic: Less than 80
• What is hypertension stage 1?

  Systolic: 130 - 139

  Diastolic: 80 - 89
• What is hypertension stage 2?

  Systolic: 140 or higher

  Diastolic: 90 or higher
• What is a hypertensive crisis blood pressure?

  Systolic: Higher than 180

  Diastolic: Higher than 120
• What are symptoms of hypertension?

  Dizziness, palpitations, angina, dyspnea.
• Who has the highest prevalence of hypertension in the world?

  Blacks
• Who has the highest death rate from hypertension?

  Blacks.
• Hispanics are less likely to get treatment for hypertension, have the lowest rates of blood pressure control and have the lowest level of awareness of hypertension and treatment.
• Hypertension is more common in men.
• Hypertension is 2 - 3 times more common in women who take oral contraceptives.
• After age 64, hypertension is more common in women.
• What labs can help diagnose hypertension?

  Basic metabolic panel (BMP), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), complete blood count (CBC), lipid profile.
• What drugs can be used for hypertension?

  Thiazide diuretics: Hydrochlorothiazide (HCTZ)

  Calcium channel blockers: Diltiazem (Cardizem LA)

  ACE inhibitors: Lisinopril (Zestril)

  ARB: Losartan (Cozaar)
• Hypertension is usually asymptomatic until target organ damage occurs.
• Aspirin and NSAIDs may decrease effectiveness of ACE inhibitors.
• Cough is a common symptoms of ACE inhibitors.
• ARBs increase sodium and water excretion.
• ARBs do not give full effect on blood pressure for 3 - 6 weeks.
• Patients with kidney disease should not use ACE inhibitors and ARBs together.
• ACE inhibitors should not be used with potassium sparing diuretics even if diuretics enhance the effect.
• Calcium channel blockers decrease heart rate.
• CCBs should be used with caution for patients with heart failure.
• Grapefruit juice can increase serum concentrations and toxicity of CCBs.
• CCBs are used for SVTs and tachydysrhythmias.
• Avoid CCB use for patients with second or third degree AV block or left ventricular systolic dysfunction.
• Coronary artery disease (CAD) is a type of atherosclerosis or hardening of the arteries.
• Atherosclerosis is when fats harden with age in the blood vessels.
• Fatty streaks are the earliest lesions of atherosclerosis and lowering LDLs can slow the process. Appears by age 20.
• Fibrous plaque is the beginning of progressive changes in the endothelium of the arterial wall. Appears by age 30 and increases with age.
• Complicated lesions are the most dangerous stage of atherosclerosis where fibrous plaque grows with inflammation that causes plaque instability, ulceration, and rupture.
• Middle aged men have the highest incidence of CAD.
• Women are more likely to get CAD than women.
• Blacks have the highest risk of getting CAD.
• What kind of nutrition should be given to manage or slow down CAD?

  Decrease saturated fats and increase complex carbohydrates and fiber.