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Questions and Answers
Hypertension is diagnosed when blood pressure is consistently above 140/90 mmHg.
Hypertension is diagnosed when blood pressure is consistently above 140/90 mmHg.
True
Secondary hypertension occurs in 90% of hypertension cases due to an identifiable cause.
Secondary hypertension occurs in 90% of hypertension cases due to an identifiable cause.
False
Patients with uncomplicated primary hypertension often show noticeable symptoms.
Patients with uncomplicated primary hypertension often show noticeable symptoms.
False
The goal blood pressure for patients with chronic kidney disease is less than 130/80 mmHg.
The goal blood pressure for patients with chronic kidney disease is less than 130/80 mmHg.
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Those with diabetes and hypertension should aim for a systolic blood pressure below 160 mmHg.
Those with diabetes and hypertension should aim for a systolic blood pressure below 160 mmHg.
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Calcium channel blockers are recommended as a first-line treatment option for individuals over 55 years of age or black individuals.
Calcium channel blockers are recommended as a first-line treatment option for individuals over 55 years of age or black individuals.
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β-blockers are currently considered the first-line treatment for hypertension across all patient groups.
β-blockers are currently considered the first-line treatment for hypertension across all patient groups.
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Methyldopa is the preferred medication for treating hypertension in pregnant patients due to its safe profile.
Methyldopa is the preferred medication for treating hypertension in pregnant patients due to its safe profile.
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Heart failure with diastolic failure is characterized by the inability of the heart to pump blood effectively during systole.
Heart failure with diastolic failure is characterized by the inability of the heart to pump blood effectively during systole.
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Thiazide-type diuretics are the preferred type of diuretic for treating hypertension.
Thiazide-type diuretics are the preferred type of diuretic for treating hypertension.
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Exertional dyspnea is a condition where breathlessness is caused by mental stress.
Exertional dyspnea is a condition where breathlessness is caused by mental stress.
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Orthopnea is characterized by difficulty breathing while standing.
Orthopnea is characterized by difficulty breathing while standing.
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Paroxysmal nocturnal dyspnea (PND) causes patients to suddenly awaken feeling breathless.
Paroxysmal nocturnal dyspnea (PND) causes patients to suddenly awaken feeling breathless.
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The most common symptom in Class III heart failure is the absence of symptoms during rest.
The most common symptom in Class III heart failure is the absence of symptoms during rest.
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An echocardiogram can assess the left ventricle's size and function.
An echocardiogram can assess the left ventricle's size and function.
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A sodium intake of more than 5-6 g salt per day is recommended for heart failure patients.
A sodium intake of more than 5-6 g salt per day is recommended for heart failure patients.
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Fluid restriction is always required for all patients with heart failure.
Fluid restriction is always required for all patients with heart failure.
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Regular low-intensity aerobic exercise is encouraged for stable heart failure patients.
Regular low-intensity aerobic exercise is encouraged for stable heart failure patients.
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Neprilysin inhibitors are effective because they increase the availability of bradykinin and adrenomedullin.
Neprilysin inhibitors are effective because they increase the availability of bradykinin and adrenomedullin.
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ACE inhibitors, ARBs, and β-adrenergic blockers are recommended to be used without any background therapy in heart failure.
ACE inhibitors, ARBs, and β-adrenergic blockers are recommended to be used without any background therapy in heart failure.
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The combination of neprilysin inhibitors and ACE inhibitors should be avoided due to the increased risk of angioedema.
The combination of neprilysin inhibitors and ACE inhibitors should be avoided due to the increased risk of angioedema.
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Sacubitril/valsartan is an example of a neprilysin inhibitor alone that does not require combination therapy.
Sacubitril/valsartan is an example of a neprilysin inhibitor alone that does not require combination therapy.
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The updated ACC/AHA guidelines recommend replacing existing ACE inhibitors or ARBs with an ARNI if tolerated.
The updated ACC/AHA guidelines recommend replacing existing ACE inhibitors or ARBs with an ARNI if tolerated.
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All patients with stable systolic heart failure should not be prescribed β-blockers if they have a contraindication.
All patients with stable systolic heart failure should not be prescribed β-blockers if they have a contraindication.
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A decrease in morbidity and mortality in heart failure can be achieved only with the use of diuretics.
A decrease in morbidity and mortality in heart failure can be achieved only with the use of diuretics.
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Study Notes
Cardiovascular Disease: Hypertension and Heart Failure
- Hypertension (HTN): A condition where blood pressure (BP) is consistently above 140/90 mmHg.
- Essential Hypertension: 90-95% of hypertension cases; no identifiable cause for elevated BP.
- Secondary Hypertension: Elevated BP with a specific identified cause.
- Hypertensive Crises: Situations with markedly elevated BP (>180/120 mmHg).
- Uncomplicated Primary Hypertension: Usually asymptomatic. Most common complications are stroke and myocardial infarction.
- Diagnosis: Diagnosis is made after averaging two or more BP measurements taken on separate occasions (repeated in weeks).
Heart Failure (HF)
- Definition: A condition where the heart struggles to pump sufficient blood to meet the body's metabolic needs.
- Systolic Failure: Inability to pump blood effectively during contraction.
- Diastolic Failure: Difficulty filling the heart with blood during relaxation; often from reduced ventricular relaxation.
- Common Underlying Etiologies: Coronary artery disease and hypertension.
- Clinical Manifestations (Left-sided): Pulmonary congestion (e.g., shortness of breath, orthopnea, paroxysmal nocturnal dyspnea); edema.
- Clinical Manifestations (Right-sided): Systemic congestion (especially edema in legs/ankles).
Diagnosis and Investigations
- Echocardiogram: Used to assess left ventricle (LV) size and ejection fraction (EF). Normal EF is usually above 50%.
- Chest X-Ray: Used for detecting cardiac enlargement and pulmonary edema.
- ECG: Used for evaluating other cardiac problems like arrhythmias.
Treatment
- Desired Outcome: Goal blood pressure values are <140/90 mmHg for uncomplicated hypertension and <130/80 mmHg for those with related conditions.
- Nonpharmacological Therapy:
- Weight Reduction (BMI <25 kg/m²)
- Low-fat/Low-sodium diet
- Exercise (at least 30 minutes daily)
- Smoking cessation
- Pharmacological Therapy (Initial): Drug selection depends on BP elevation and comorbid conditions.
- Thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers are often used as first-line options.
- Special Considerations:
- Diabetes and Hypertension: ACE inhibitors or ARBs may be preferred.
- Pregnancy: Methyldopa is a suitable choice for most pregnancies.
- HF: Diuretics, nitrates, and hydralazine (often combined) are common treatments.
- β-Blockers: Should generally be used cautiously for initial treatment and gradually increased; beta-blockers need careful monitoring (start low and gradually increase dose).
- ARB (Angiotensin receptor blocker): Can be an alternative to ACE inhibitor in patients with intolerance.
- Aldosterone antagonists: May be beneficial in patients with severe HF.
Specific Medications
- Digoxin: Improves symptoms only, not long-term survival in HF.
- Neprilysin Inhibitors: Are combined with other agents to improve symptoms.
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Description
This quiz explores key concepts related to hypertension and heart failure. It includes definitions, types of hypertension, diagnosable criteria, and the implications of heart failure. Test your knowledge on cardiovascular diseases and their impact on health.
