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Cardiovascular - Coggle Diagram
Cardiovascular
Primary prevention
Blood pressure
Physical activity
Type II diabetes
Diet
Tobacco
Cholesterol
Aspirin use in high risk population
Guidelines
JNC 8
<140/<90 mmHg
60yo
<150/<90mmHg
AHA/ACC
<130/<80 mmHg
First line treatment
Non-black
CCB
ACE inhibitor/ARB
Thiazide
Black adults:
Thiazide diuretic
CCB
With CKD
ACE inhibitor
ARB
HTN
Target Organ Damage
Brain
Stroke
Vascular (mult-infarct) dementia
Cardiovascular system
atherosclerosis
MI
Left ventricular hypertrophy
Heart failure
kidney
Hypertensive nephropathy
renal failure
Eye
Hypertensive retinopathy w/risk of blindness
Low grade
Common long standing poorly controlled HTN;
reversible when treated
Grade 1
Grade 2
Arterioles
2 more items...
Narrowing on terminal arteriolar branches
No vision change or permanent findings
High grade
HTN emergency
Grade 4
DBP >130mmHg
Papilledema (Swelling of optic disk)
Grade 3
DBP>110 mmHg
Flame-shaped hemorrhages
potential visual changes
potential permanent retinal findings
Medications
Priority
Lower PVR
Diuretic (thiazine) Preferred
Ca sparing
Preferred for women with risk of fractures
Na, K, Mg depleting
Acts on angiotensin system
Angiotensin receptor blockers (ARB) -sartan
Losartan (Cozaar)
Telmisartan )Micardis)
Angiotensin-converting enzyme inhibitor (ACEi) -Pril
Enalapril (Vasotec)
Lisinopril (Prinivil, Zestril)
caution
induces cough
switch to ARB
Angioedema
African
Latino
History NSAID use
adverse effects
K+ sparing
hyperkalemia risk in patients with
inadequate fluid intake
overdiuresis
renal impairment
when used with aldosterone agent
Priority med with DM
Pregnancy category D
CCB
Dihydropyridine (HDP)
Amlodipine (Norvasc)
NonDHP CCB example
Diltiazem (Cardizem LA)
adverse effects
Ankle edema
caution
heart failure
renal impairment
hepatic impairment
Secondary (Not first line)
Beta-adrenergic antagonist -lol
Types
Atenolol (Tenoretic)
Metoprolol (Toprol, Lopressor)
Propranolol (Inderal LA)
adverse effects
Not first line
decreased BP-lowering effect in select populations
avoid non-cardioselective beta blockers
in lower airway disease (asthma COPD)
Propanolol
nadolol
lower-dose cardioselective beta blocke therapy (metoprolol) usually accepted in lower airwat disease if otherwise indicated (HF, uncontrolled HTN)
Lowers heart rate and stroke volume
Aldosterone antagonist
Types
Spironolactone (Aldactone)
potassium sparing
Eplerenone (Inspra)
adverse effects
Hyperkalemia risk esp. w/use of
ACEi
ARBS
volume depletion
excessive diuresis
gynecomastia, prolonged use
not first line
adverse effects profile
New HTN Screening
Secondary causes HTN
Fasting blood glucose
DM
CBC
Anemia
Lipid Profile
Dyslipidemia
Serum creatineine (CR) w eGFR
Renal function
Serum sodium, Potassium, calcium
Electrolyte disorder
TSH
Thyroid disorder
UA
Proteinuria (HTN neuropathy)
EKG
Arrythmia, infarction, cardiac chamber sizw