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Cardiology | Medicine (MD/DO) School Study Aid


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Hypertension & Dyslipidemias
30 Picmonics to Learn | 1 hr 15 mins

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Hypertensive Emergency Diagnosis and Management
Diagnosis
Laboratory Tests
Chest X-ray
Management
Decrease Blood Pressure Carefully
Antihypertensives
Monitor Vital Signs
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2 mins
Hypertensive Emergency Characteristics and Presentation
Characteristics
Acute Increase in Blood Pressure
≥ 180/120
End-Organ Dysfunction
Clinical Features
Stroke
Hypertensive Retinopathy
Acute Heart Failure
Myocardial Infarction
Acute Kidney Injury
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2 mins
Hyperlipoproteinemia (Type V Dyslipidemia)
Pathophysiology
Increased Cholesterol
Increased VLDL
Increased Chylomicrons
Increased Triglycerides
Increased Risk of Cardiovascular Disease
Clinical Features
Xanthomas
Acute Pancreatitis
Diagnosis
Lipid Panel
Management
Lifestyle Changes
Statins
Fibrates
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2 mins
Primary Hypertension Risk Factors
Excessive Alcohol Consumption
High Sodium Diet
Dyslipidemia
Obesity
African American
Advanced Age
Vitamin D Deficiency
Reduced Nephron number
Diabetes
Lack of Physical Activity
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1 min
Hypertension Assessment
Mechanism
Essential Hypertension
Secondary Hypertension
Assessment
Headache
Vision Changes
Nosebleed (Epistaxis)
Chest Pain
Syncope (Fainting)
Diagnosis
Average 2 Sets, 2 Minutes Apart
After 2 or More Visits
Nursing Considerations
Take BP Both Arms
Common in African Americans
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2 mins
Blood Pressure Classification (JNC 7)
Classifications
Normal
Systolic (< 120)
Diastolic (< 80)
Prehypertension
Systolic +20 (120-139)
Diastolic +10 (80-89)
Stage 1 Hypertension
Systolic +20 (140-159)
Diastolic +10 (90-99)
Stage 2 Hypertension
Systolic + > 20 (160)
Diastolic + > 10 (100)
Hypertensive Crisis
Systolic > 180
Diastolic > 110
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4 mins
Blood Pressure Classification (ACC/AHA 2017)
Classifications
Normal
Systolic Less than 120
Diastolic Less than 80
Elevated
Systolic +10 (120-129)
Diastolic Less than 80
Stage 1 Hypertension
Systolic +10 (130-139)
Diastolic +10 (80-89)
Stage 2 Hypertension
Systolic +40 (140-179)
Diastolic +30 (90-119)
Hypertensive Crisis
Systolic greater than or equal to 180
Diastolic greater than or equal to 120
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5 mins
Hypertension Management (JNC-8)
Goal of Treatment
Age Over 60 years (and Healthy)
150/90
Age Under 60 years (and Healthy)
Any Age with Diabetes or CKD
140/90
Treatment
ARB/ACE-I/Thiazide/CCB (Primary or Combo)
CKD (w/wo Diabetes)
ARB or ACE-I Primary
African American
Thiazide or CCB Primary
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3 mins
Hypercholesterolemia Disease
Risk Factors
Diabetes
Smoking
Family History
Hypertension
HDL < 40
Men Older than 45 Years of Age
Women Older than 55 Years of Age
Signs and Symptoms
Atheromas
Plaques in Blood Vessel Walls
Tissue Ischemia
Xanthomas
Lipemia Retinalis
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2 mins
Hypercholesterolemia Risk Stratification
0 - 1 Risk Factors
< 160 mg/dl LDL goal
greater or equal to 2 Risk Factors and 10-year Risk ≤ 20%
< 130 mg/dL LDL Goal
Coronary Heart Disease OR >/= to 2 Risk Factors AND 10-Year Risk > 20%
< 100 mg/dL LDL Goal
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2 mins
Hypercholesterolemia Treatment
Lifestyle Modifications (Diet, Exercise, Smoking Cessation)
Statins
Niacin
Ezetimibe
Fibrates
Bile Acid Resins
Screening
Men greater or equal to 35 Years Old (20-35 if at increased risk)
Women greater or equal to 45 Years Old (20-45 if at increased risk)
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2 mins
Metabolic Syndrome
Assessment
Dyslipidemia
Central Obesity
Insulin Resistance
Hypertension
Increased C-Reactive Protein (CRP)
Increased Fibrinogen
Considerations
Increased Risk Cardiovascular Disease
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1 min
Peripheral Artery Disease (PAD)
Mechanism
Atherosclerosis
Assessment
Intermittent Claudication
Pain with Exercise
Paresthesias
Arterial Ulcers
Critical Limb Ischemia
Amputation
Consideration
Ankle-Brachial Index (ABI)
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1 min
Abdominal Aortic Aneurysm (AAA) Assessment
Mechanism
Atherosclerosis
Assessment
Bruit
Pulsation in Abdomen
Abdominal or Lower Back Pain
Tearing Pain
Diagnosis
Ultrasound
Considerations
Rupture
Shock
Surgical Repair
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1 min
Gestational Hypertension
New-Onset Hypertension
> 20 Weeks Gestation
Risk Factors
Nulliparity
Obesity
African American Females
> 35 years Old
Multiple Gestations
Family History of Gestational HTN (or Preeclampsia)
Complications
IUGR
Prematurity
Abruptio Placentae
Management
Fetal Monitoring
Alpha-Methyldopa
Beta-Blockers (Labetalol)
Calcium Channel Blockers
Hydralazine
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4 mins
Subarachnoid Hemorrhage
Bleeding into Subarachnoid Space
Mechanisms
Trauma
Aneurysm Rupture
AVM Rupture
Vasospasm causes Ischemia
Signs & Symptoms
"Worst Headache Of My Life"
Diagnosis
Noncontrast Head CT
Lumbar Puncture
Angiography
Considerations
Surgery
Blood Pressure Control
Intracranial Pressure Control
Nimodipine for Vasospasm Prophylaxis
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3 mins
Abdominal Aortic Aneurysm
Screening
Screen Males 65-75 Who've Ever Smoked
Diagnosis
Ultrasound
Treatment
Observation
Asymptomatic and < 5 cm in Size
Surgical Repair
> 5.5 cm in Abdomen
Emergent Surgery
Ruptured or Symptomatic
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2 mins
Cardiac Tamponade
Mechanism
Fluid in the Pericardial Sac
Pericarditis
Decreased Cardiac Output
Signs/Symptoms
Beck's Triad
Hypotension
Jugular Venous Distention (JVD)
Distant Heart Sounds
Pulsus Paradoxus
Electrical Alternans
Treatment
Pericardiocentesis
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1 min
Dysbetalipoproteinemia (Type III Familial Dyslipidemia)
INHERITANCE
Autosomal Recessive
PATHOGENESIS
Defective Apolipoprotein E (Apo E)
Lab Findings
Increased Chylomicrons
Increased VLDL
Symptoms/Findings
Premature atherosclerosis
Tuberoeruptive xanthomas
Palmar xanthomas
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3 mins
Hypertriglyceridemia (Type IV Familial Dyslipidemia)
INHERITANCE
Autosomal Dominant
pathogenesis
Hepatic Overproduction of VLDL
Related to Insulin Resistance
Lab Findings
Increased VLDL
Increased Triglycerides (> 1000 mg/dL)
Symptoms/Findings
Acute Pancreatitis
Eruptive Xanthomas
Increased Risk for Coronary Artery Disease (CAD)
Increased Risk of Peripheral Vascular Disease
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3 mins
Hyperchylomicronemia (Type I Familial Dyslipidemia)
INHERITANCE
Autosomal Recessive
PATHOGENESIS
Lipoprotein Lipase Deficiency (LPL)
Altered Apolipoprotein C-II (Apo C-II)
Lab Findings
Increased Chylomicrons
Increased Cholesterol
Increased Triglycerides
Symptoms/Findings
Pancreatitis
Hepatosplenomegaly
No Increased Risk for Atherosclerosis
Eruptive/Pruritic Xanthomas
Milky White Appearance of Blood When Drawn
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3 mins
Familial Hypercholesterolemia (Type IIa Familial Dyslipidemia)
INHERITANCE
Autosomal Dominant
PATHOGENESIS
Defective or Absent LDL Receptors
Defective Apolipoprotein B-100 (ApoB-100)
Lab Findings
Increased LDL
Decreased HDL
Type IIb also has Increased VLDL
Symptoms/Findings
Accelerated Atherosclerosis
Achilles Tendon Xanthomas
Xanthelasma
Corneal Arcus
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4 mins
Abetalipoproteinemia
Pathophysiology
Autosomal Recessive
Deficiency of Apolipoproteins B-48 and B-100
MTTP Gene Mutation
Clinical Features
Malabsorption
Steatorrhea
Failure to Thrive
Ataxia
Retinitis Pigmentosa
Spinocerebellar Degeneration
Diagnosis
Lipid-Laden Enterocytes
Acanthocytes
Decreased Cholesterol and LDL
Treatment
Vitamin E (Alpha-Tocopherol)
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4 mins
Arteriolosclerosis
Characteristics
Small Arteries and Arterioles
Thickening of Arteriole Wall
Hyperplastic Arteriolosclerosis
Hyperplastic
Smooth Muscle Cell Hyperplasia
"Onion Skin" Appearance
Malignant Hypertension
Hyaline Arteriolosclerosis
Hyaline
Subendothelial Protein Deposits
Chronic Hypertension
Diabetes Mellitus
Aging
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2 mins
Central Retinal Artery Occlusion
Etiology
Atherosclerosis
Atrial Fibrillation
Giant Cell (Temporal) Arteritis
Clinical Features
Sudden Painless Monocular Vision Loss
Descending Curtain
Fundoscopic Findings
Retinal Plaques
Grayish Retinal Discoloration
Cherry Red Spot on Macula
Diagnosis
Ultrasound
Interventions
Ocular Massage
Reduce Intraocular Pressure
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3 mins
Thoracic Aortic Aneurysm
Characteristics
Elderly Men
Above the Diaphragm
Usually Asymptomatic
Risk Factors
Hypertension
Smoking
Connective Tissue Disorders
Vasculitis
Diagnosis
Chest X-Ray
Chest CT Angiography
Management
Manage Risk Factors
Surgery if Rupture or Dissection
Observation if Asymptomatic
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4 mins
Hypertensive Retinopathy
Etiology
Chronic Hypertension
Fundoscopic Findings
Flame Hemorrhages
Arteriovenous Nicking
Retinal Microaneurysms
Cotton Wool Spots
Macular Star
Papilledema
Treatment
Lower Blood Pressure
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2 mins
Abdominal Aortic Aneurysm Rupture
Clinical Features
Acute Tearing Pain
Pulsatile Abdominal Mass
Grey Turner Sign
Cullen Sign
Hypovolemic Shock
Diagnosis
Diagnosis by Clinical Impression
Treatment
Emergent Surgical Intervention
Considerations
Poor Prognosis
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3 mins
Aortic Dissection
Characteristics
Tear in Aortic Intima
Stanford Classification
Type A: Tear of Ascending Aorta
Type B: Tear of Descending Aorta
Risk Factors
Hypertension
Aortic Aneurysm
Marfan Syndrome
Signs/Symptoms
Chest Pain
Blood Pressure Difference Between Arms
Mediastinal Widening
Treatment
Surgery for Type A
Beta Blockers for Type B
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2 mins
Central Retinal Vein Occlusion
Etiologies
Hypercoagulability
Hypertension
Diabetes Mellitus
Clinical Features
Non-Ischemic
Mild to Moderate Vision Loss
Sparse Dot-blot and Flame Hemorrhages
Ischemic
Sudden, Painful Vision Loss
"Blood and Thunder" Appearance
Cotton Wool Spots
Papilledema
Interventions
Observation if Non-Ischemic
Laser Photocoagulation
VEGF Inhibitors
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3 mins

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