Cardio-Pharm Exam Review: HTN, HF, Dyslipidemia, Arrhythmia & VTE (copy)

78 Question-and-Answer flashcards summarizing diagnostic criteria, risk factors, pathophysiology, classifications, and treatments for hypertension, heart failure, dyslipidemia, arrhythmia, and VTE as presented in the lecture notes.

What systolic and diastolic blood pressure values define hypertension per ACC/AHA 2017?

SBP ≥ 130 mmHg or DBP ≥ 80 mmHg

Why is hypertension often called the “silent killer”?

Because it is usually asymptomatic; persistently elevated BP may be the only physical finding.

How many elevated BP readings and encounters are required to diagnose hypertension?

At least two elevated readings at two separate clinical encounters.

Name four modifiable risk factors for hypertension.

Smoking, diabetes, dyslipidemia/ hypercholesterolemia, overweight/obesity (others: inactivity, unhealthy diet).

Give three relatively fixed (non-modifiable) hypertension risk factors.

Chronic kidney disease, family history, increasing age (others: male sex, low SES, OSA, psychosocial stress).

List three key non-pharmacologic interventions for primary hypertension prevention.

Weight management/DASH diet with sodium restriction, increased physical activity, smoking cessation.

Which four medication classes are first-line for uncomplicated hypertension?

Thiazide diuretics, ACE inhibitors, ARBs, calcium-channel blockers.

What is the recommended initial therapy for stage 1 HTN with ASCVD risk ≥ 10 %?

Non-pharm therapy plus one BP-lowering medication; reassess in 3–6 months.

How is stage 2 hypertension treated initially?

Lifestyle modification plus TWO antihypertensives from different classes; reassess monthly until goal reached.

Provide the formula for cardiac output.

CO = Heart Rate (HR) × Stroke Volume (SV).

According to Frank-Starling, how does increased preload affect stroke volume?

Increased sarcomere stretch → stronger contraction → increased stroke volume.

What is the most common etiology of HFrEF?

Coronary artery disease (myocardial infarction or ischemia).

Give two common causes of HFpEF.

Long-standing hypertension and increased ventricular stiffness (e.g., hypertrophic cardiomyopathy, amyloidosis).

List four major risk factors for developing heart failure.

Hypertension, coronary heart disease, diabetes, smoking (others: obesity, inactivity).

Define orthopnea.

Shortness of breath that occurs when lying flat; relieved by sitting or standing.

Which heart sound (extra gallop) is classically associated with heart failure?

An S3 gallop.

Describe NYHA Functional Class II.

Slight limitation of physical activity; comfortable at rest, ordinary activity causes symptoms.

What EF percentage defines HFrEF?

Left-ventricular ejection fraction ≤ 40 %.

What medication combination is core GDMT for Stage C HFrEF?

ARNI (or ACEi/ARB) + beta-blocker + MRA + SGLT2 inhibitor ± loop diuretic as needed.

When is hydralazine + isosorbide dinitrate specifically recommended in HFrEF?

For Black patients with persistent symptoms despite optimal therapy or those intolerant to ACEi/ARB/ARNI.

Which two drug classes should be avoided in LVEF < 50 %?

Thiazolidinediones (TZDs) and non-DHP calcium channel blockers (diltiazem/verapamil).

What lipid abnormality pattern defines hyperlipidemia?

Elevated total cholesterol, LDL, or triglycerides and/or low HDL.

Differentiate exogenous vs. endogenous cholesterol pathways.

Exogenous: dietary fats/cholesterol from gut to liver (post-prandial); Endogenous: cholesterol/triglycerides from liver to peripheral tissues and back (fasting state).

Name the four major plasma lipoprotein classes.

Chylomicrons, VLDL, IDL, LDL (plus HDL).

What are the four letters in VTE risk factor Virchow’s Triad?

Blood stasis, vascular injury, hypercoagulability (no fourth—triad).

Give two clinical signs of proximal DVT.

Unilateral leg swelling and pain/tenderness (plus warmth, redness, palpable cord).

Which imaging modality is gold standard for DVT diagnosis?

Contrast venography (invasive).

How many Wells Score points classify a DVT as unlikely?

0 points.

What lab finding supports VTE diagnosis but is nonspecific?

Elevated D-dimer (fibrin degradation product).

Define massive PE.

PE causing hemodynamic instability, cardiac or respiratory arrest, or acute right-ventricular failure.

State the minimum anticoagulation duration after an initial VTE event.

At least 3 months for all patients.

Name three non-pharmacologic VTE prevention devices.

Graduated compression stockings (GCS), intermittent pneumatic compression (IPC), sequential compression devices (SCD).

What is the mechanism of action of alteplase in massive PE?

Converts plasminogen to plasmin, dissolving fibrin clots and restoring perfusion.

Provide the standard alteplase dose for PE.

100 mg IV infused over 2 hours.

Which adverse drug reaction is most concerning with unfractionated heparin?

Heparin-induced thrombocytopenia (HIT).

List prophylactic dosing for enoxaparin in normal renal function.

40 mg SQ once daily or 30 mg SQ every 12 h.

What anti-Xa level monitoring situations might be needed for LMWH?

Pregnancy, obesity, low body weight, pediatrics, or renal insufficiency.

Which parenteral anticoagulant is preferred in patients with HIT?

Argatroban (direct thrombin inhibitor).

How does fondaparinux differ mechanistically from LMWH?

It selectively inhibits factor Xa only (no direct thrombin inhibition).

State a contraindication to fondaparinux use.

CrCl < 30 mL/min (or active major bleeding, bacterial endocarditis).

Name three oral factor Xa inhibitors.

Rivaroxaban, apixaban, edoxaban (also betrixaban).

What black-box warning is shared by all DOACs regarding neuraxial anesthesia?

Risk of spinal/epidural hematoma leading to paralysis.

Which antidote reverses rivaroxaban or apixaban overdose?

Andexanet alfa (Andexxa).

What is the mechanism of dabigatran?

Direct, reversible inhibition of thrombin (factor IIa).

Which clotting factors are depleted by warfarin therapy?

Factors II, VII, IX, X and proteins C & S.

What is the typical INR goal for most warfarin indications?

INR 2.0-3.0.

How long must parenteral anticoagulation overlap with warfarin when bridging?

At least 5 days AND until two therapeutic INRs ≥ 24 h apart.

List four common drug classes that raise bleeding risk when combined with warfarin.

NSAIDs, antiplatelets, other anticoagulants, SSRIs/SNRIs.

What genetic or acquired condition creates a hypercoagulable state and increases VTE risk?

Factor V Leiden mutation (others: antiphospholipid antibodies, protein C/S deficiency).

Which points on Simplified Wells Score assign 3 points each?

Clinical sign of DVT and PE more likely than alternate diagnosis.

State one classic metabolic cause of arrhythmias remembered by the acronym “MEDS.”

Metabolic derangements (others: Electrolyte disturbances, Drug toxicity, Structural abnormalities).

Name three reversible risk factors for atrial fibrillation.

Excess alcohol (withdrawal or binge), surgery, thyrotoxicosis (others: hypertension, intense exercise).

Why are anticoagulants central in atrial fibrillation management?

To prevent cardioembolic stroke resulting from atrial thrombus formation.

What is the goal of secondary hypertension prevention?

Prevent recurrent cardiovascular events (<10 % of HTN cases).

Which diet is specifically recommended for BP lowering?

DASH diet (Dietary Approaches to Stop Hypertension).

How does potassium intake influence blood pressure?

Higher dietary potassium can blunt sodium’s pressor effect, aiding BP reduction.

Name one beta-blocker proven to reduce mortality in HFrEF.

Carvedilol (others: metoprolol succinate, bisoprolol).

What SGLT2 inhibitors have HF outcome data?

Dapagliflozin and empagliflozin.

Define HFimpEF.

Initial LVEF ≤ 40 % with follow-up EF ≥ 50 % after therapy; continue GDMT to avoid relapse.

Which HF stage includes patients with structural heart disease but no symptoms?

Stage B (pre-HF).

What blood test helps identify congestion in heart failure but is not in notes?

Brain natriuretic peptide (BNP) or NT-proBNP.

Which lifestyle modification can improve both blood pressure and dyslipidemia?

Regular aerobic physical activity/exercise.

What is the primary prevention statin recommendation age per USPSTF 2022 (brief)?

Adults 40-75 with ≥ 1 CVD risk factor and 10-year risk ≥ 10 % (detailed algorithm beyond scope).

Explain why UFH requires a continuous IV infusion for VTE treatment.

It has a short half-life (30–90 min) and variable pharmacokinetics requiring steady plasma levels.

List two serious complications specifically associated with warfarin early therapy.

Skin necrosis/gangrene and purple toe syndrome.

Why must 15 mg and 20 mg rivaroxaban tablets be taken with food?

Food increases absorption and bioavailability at higher doses.

Describe the monitoring needed for DOAC efficacy.

Routine efficacy labs are unnecessary; monitor Hgb/Hct, SCr annually or if bleeding suspected.

Which heart failure medication stimulates soluble guanylate cyclase?

Vericiguat (for worsening symptomatic HFrEF).

Give one contraindication to alteplase use.

Active internal bleeding (others: recent stroke within 2 months, severe uncontrolled HTN).

How does obesity increase VTE risk via Virchow’s Triad?

It promotes venous stasis and hypercoagulability due to increased inflammatory mediators.

State the prophylactic fondaparinux dose for patients ≥ 50 kg.

2.5 mg SQ once daily (5–9 days, extend up to 35 days post-surgery).

Which laboratory value is falsely elevated by argatroban, complicating warfarin overlap?

INR (prothrombin time).

What are two key side effects of LMWH besides bleeding?

Thrombocytopenia and hyperkalemia (also ↑LFTs).

Outline the initial weight-based UFH bolus for VTE treatment.

80 units/kg IV bolus followed by 18 units/kg/hr infusion.

Explain the rationale for not expelling the air bubble from prefilled enoxaparin syringes.

The air bubble ensures complete drug delivery and prevents drug tracking into subcutaneous tissue.

What patient group is at highest risk for drug-induced dilated cardiomyopathy leading to HFrEF?

Patients receiving cardiotoxic chemotherapy (e.g., anthracyclines) or chronic alcohol abuse.

Which two parameters must be met before stopping bridging anticoagulation to warfarin?

At least 5 days of overlap and two consecutive therapeutic INRs ≥ 24 h apart.

What is the renal adjustment for enoxaparin treatment when CrCl < 30 mL/min?

1 mg/kg SQ once daily (instead of twice daily).

Identify the four forces that constitute ventricular afterload.

Ejection impedance, wall tension, regional wall geometry, systemic vascular resistance.

Which heart failure symptom specifically occurs when bending forward?

Bendopnea.

Name one psychosocial factor that can increase blood pressure.

Chronic stress (including job, financial, or social stressors).

Why are non-DHP CCBs avoided in HFrEF?

They have negative inotropic effects that can worsen systolic dysfunction.

List two algorithms/scores used to stratify PE probability.

Wells Score and Simplified Wells Score (also Geneva not in notes).