高血压英文ppt精品课件welcome to cardiology boot

Welcome to Cardiology Boot Camp! Board Review Session #1 Steve Madhavan, MD Brenda Fortunate, DO Hypertension Pearls Start with diuretic or beta blocker If no response, try drug from different class or a second agent from a different class (add diuretic if not already used) Diuretics reduce mortality a small cuff may overestimate pressure by 4 - 9.5 mm Hg.) Allow at least 30 seconds (not 5 minutes) between measurements. Measure pressure in both arms; repeat in arm with higher pressure. Do not average. Measure blood pressure in seated position with patients back supported. When in doubt about cuff size, it is better to use a large cuff. (A large cuff causes negligible difference; a small cuff may overestimate pressure by 4 - 9.5 mm Hg.) Allow at least 30 seconds (not 5 minutes) between measurements. Measure pressure in both arms; repeat in arm with higher pressure. Do not average. Which is associated with high serum cholesterol? Diabetes insipidus (correct=diabetes mellitus) Amyloidosis Multiple Sclerosis Nephrotic syndrome (along with hypertension, proteinuria 53(4): 1245-53 During a health maintenance exam, a 54 year old smoker states he is taking beta carotene because it was recommended by a local health food store specializing in natural supplements. He asks what you recommend with regard to this supplement. He should not take the beta carotene. Although beta carotene has not been proven beneficial, there is no harm in taking it. Beta carotene supplementation has been shown to prevent lung cancer. Beta carotene supplementation has been shown to decrease coronary artery disease. He should not take the beta carotene. Although beta carotene has not been proven beneficial, there is no harm in taking it. Beta carotene supplementation has been shown to prevent lung cancer. Beta carotene supplementation has been shown to decrease coronary artery disease. The Beta-Carotene 60(3):895-904 You are chief of staff of a small community hospital. The head of your ED wants to develop a protocol for use of tissue plasminogen activator (tPA) for stroke victims. Which is the #1 reason a specific stroke team program would have little impact on community health? The use of tPA increases short-term mortality. The use so tPA does not reduce long-term disability. MRI scanning would not be available within 3 hours. Very few patients would be eligible for tPA even if a stroke team and protocol were in place. It is often difficult to obtain tPA within 3 hours. The use of tPA increases short-term mortality. The use so tPA does not reduce long-term disability. MRI scanning would not be available within 3 hours. Very few patients would be eligible for tPA even if a stroke team and protocol were in place. It is often difficult to obtain tPA within 3 hours. Ref:Luisi 11(2): 145-51 Discussion Few patients eligible either because they present more than 3 hours after symptom onset or have contras to tPA MRI scan not needed. (24 hour CT scan with expert interpretation needed.) rt-PA may increase early morbidity 34(874):30 Which is not considered a risk factor for myocardial infarction? alcoholism homocystinemia type A personality male sex obesity hypertension hyperlipidemia (esp. high total & LDL, low HDL cholesterol) tobacco use diabetes family history of coronary artery disease increased age sedentary life style type A personality Which is not considered a risk factor for myocardial infarction? alcoholism homocystinemia type A personality male sex obesity hypertension hyperlipidemia (esp. high total & LDL, low HDL cholesterol) tobacco use diabetes family history of coronary artery disease increased age sedentary life style type A personality Ref: Washington manual,29th ed., p81 Smokers paradox: persons who currently smoke are less likely to die from AMI than persons who are former smokers. An 80 year old woman c/o palpitations & mild lightheadedness. PE: unremarkable. EKG: regular narrow complex tachycardia 150 bpm Valsalva slowed rate to reveal classic atrial flutter but did not convert to sinus. What should you try next? Intravenous adenosine to slow ventricular rate Intravenous diltiazem to slow ventricular rate urgent DC cardioversion intravenous dopamine to strengthen cardiac contr