SG3: CVS1

Question 1

Hypertension-associated complications

Answer 1

Atherosclerotic vascular disease

• Coronary artery disease
  
  • Myocardial infarction
  • Acute coronary syndromes
  • Chronic stable angina
• Carotid artery disease
  
  • Ischemic stroke
  • TIA
• Peripheral arterial disease
• Abdominal aortic aneurysm

Other forms of CV disease

• Left ventricular dysfunction (systolic heart failure)
• Chronic kidney disease
• Retinopathy

Question 2

What antihypertensives are recommended in pregnancy?

Answer 2

Methyldopa

• Widely considered the first-line agent for treatment of hypertension during pregnancy.
• Pregnancy B
• Precautions: Adverse effects include somnolence and dry mouth; caution in liver disease; hemolytic anemia and liver disease may occur; reduce dose in renal disease

Question 3

What drugs are recommended to prevent seizures in severe preeclampsia or eclampsia?

Answer 3

Magnesium sulfate

• Pregnancy D
• PRECAUTIONS:
  
  • May cause loss of reflexes, diplopia, flushing, or slurring of speech;
  • higher levels may cause muscular paralysis, ventilatory failure, and circulatory collapse; magnesium may alter cardiac conduction, leading to heart block in digitalized patients; in overdose, calcium gluconate IV can be administered as antidote for clinically significant hypermagnesemia

Question 4

What is an hypertensive crisis?

Answer 4

• severe elevation in blood pressure (BP), generally considered to be a diastolic pressure >120 mmHg.
• divided into 2 general categories: hypertensive emergencies and hypertensive urgencies.
  
  • hypertensive emergency: severe hypertension with signs of damage to target organs
  • hypertensive urgency: Very high blood pressure (eg, diastolic > 120 - 130 mm Hg) without target-organ damage

Question 5

Parenteral Drugs Commonly Used in the Treatment of Hypertensive Emergencies

Answer 5

• Nitroprusside
• Enalaprilat
• Esmolol
• Fenoldopam
• Hydralazine
• Lebetalol
• Nicardipine
• Nitroglycerin
• Phentolamine

Question 6

Management of patients with AF

Answer 6

• involves three objectives: slowing the ventricular rate, prevention of thromboembolism and correction of the rhythm disturbance.
• The first treatment goal is to slow the ventricular response rate, which allows better ventricular filling with blood. Anticoagulation can help achieve the second goal if it is indicated.
• Cardioversion to normal sinus rhythm can be delayed unless the patient is hemodynamically compromised due to the AF.

Question 7

What drugs are recommended to control the ventricular rate?

Answer 7

• First line drugs for rate control are the β-blockers (eg metoprolol, esmolol), verapamil and diltiazem.
• In the acute setting, IV formulations can be used.

Question 8

Which drugs can be used to achieve cardioversion?

Answer 8

• Many class I and III antiarrhythmic agents have been evaluated for efficacy in conversion of AF or atrial flutter to normal sinus rhythm.
• Flecainide, propafenone, dofetilide and amiodarone are widely recommended agents.