Cardiovascular - Hypotension

Cardiovascular - Varicose Veins

References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Attaran RR, Edwards ML, Arena FJ, et al. 2025 SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease: This statement was endorsed by the Society for Vascular Medicine (SVM). J Soc Cardiovasc Angiogr Interv. 2025;4(8):103729. Published 2025 Jun 30. doi:10.1016/j.jscai.2025.103729 3. O'Malley PG, Fukaya E, Kolluri R. Nonsurgical Management of Chronic Venous Insufficiency. N Engl J Med. 2024;390:727-735. DOI: 10.1056/NEJMcP2310224 4. The 2020 update of the CEAP classification system and reporting standards. Lurie, Fedor et al. Journal of Vascular Surgery: Venous and Lymphatic Disorders, Volume 8, Issue 3, 342 - 352

Cardiovascular - Hypotension

*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id= "request-69209691-f368-832a-9fca-8c5d6a87f659-9" data-turn-id-container= "request-69209691-f368-832a-9fca-8c5d6a87f659-9" data-testid= "conversation-turn-242" data-scroll-anchor="false" data-turn= "assistant"> In this episode, we review hypotension, a clinical state of abnormally low blood pressure that can lead to inadequate tissue perfusion and organ dysfunction. We discuss the major underlying mechanisms, including hypovolemia, distributive shock, cardiogenic causes, and obstructive physiology, along with common risk factors such as dehydration, hemorrhage, sepsis, medications, endocrine disorders, and cardiac disease. The episode highlights classic signs and symptoms including dizziness, syncope, weakness, altered mental status, tachycardia, and signs of shock, emphasizing the importance of identifying the underlying cause rather than treating the blood pressure value alone. We also review key components of the diagnostic evaluation, including orthostatic vitals, laboratory studies, EKG, and bedside assessment of perfusion, as well as initial management with fluid resuscitation, vasopressors when indicated, and rapid treatment of the underlying etiology. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Wieling W, Kaufmann H, Claydon V et al. Diagnosis and treatment of orthostatic hypotension. The Lancet Neurology, 21, 735-746 3. Goldberger, Z, Petek, B, Brignole, M. et al. ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison. JACC. 2019 Nov, 74 (19) 2410–2423. https://doi.org/10.1016/j.jacc.2019.09.012 [https://doi.org/10.1016/j.jacc.2019.09.012] 4. VanWijnen VK, Finucane C, Harms MPM, Nolan H, Freeman RL, Westerhof BE, Kenny RA, terMaaten JC, Wieling W (University Medical Center Groningen, University of Groningen, The Netherlands; St James's Hospital; Lincoln Gate, Trinity College, Dublin, Ireland; Harvard Medical School, Boston, MA, USA; VU University Medical Center; Academic Medical Center, Amsterdam, The Netherlands). Noninvasive beat-to-beat finger arterial pressure monitoring during orthostasis: a comprehensive review of normal and abnormal responses at different ages (Review). J Intern Med2017; 282: 468–483 5. Kim, M. J., & Farrell, J. (2022). Orthostatic Hypotension: A Practical Approach. American family physician, 105(1), 39–49.

Cardiovascular - Hypertension Emergency

In this episode, we review hypertensive emergency, a life-threatening condition defined by severely elevated blood pressure accompanied by acute end-organ damage. We discuss the underlying pathophysiology of vascular endothelial injury and impaired autoregulation, along with common risk factors such as chronic uncontrolled hypertension, medication nonadherence, kidney disease, stimulant use, and endocrine disorders. The episode highlights classic clinical presentations including neurologic deficits, chest pain, pulmonary edema, acute kidney injury, and retinal changes, emphasizing the importance of identifying organ dysfunction rather than focusing on the blood pressure number alone. We also cover diagnostic evaluation, including laboratory testing, EKG, imaging, and fundoscopy, as well as evidence-based treatment with carefully titrated IV antihypertensive therapy to avoid overly rapid blood pressure reduction. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Peixoto AJ. Acute severe hypertension. N Engl J Med. 2019;381(19):1843-1852. doi:10.1056/NEJMcp1901117 3. Bress AP, Anderson TS, Flack JM, et al. The management of elevated blood pressure in the acute care setting: a scientific statement from the American Heart Association. Hypertension. 2024;81(8):e94-e106. doi:10.1161/HYP.0000000000000238 4. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007

Cardiovascular - Giant Cell Arteritis

In this episode, we review giant cell arteritis (GCA), an autoimmune large-vessel vasculitis that most commonly affects the temporal arteries and can lead to devastating ischemic complications if not recognized early. We discuss the underlying inflammatory pathophysiology, major risk factors including advanced age and polymyalgia rheumatica, and the hallmark presentation of temporal headache, jaw claudication, scalp tenderness, and transient vision loss. The episode also covers key diagnostic findings such as elevated ESR and CRP, the classic "halo sign" on Doppler ultrasound, and why temporal artery biopsy remains the gold standard for diagnosis. Treatment focuses on the urgent initiation of high-dose glucocorticoids to prevent permanent vision loss and other vascular complications. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Weyand, C. M., & Goronzy, J. J. (2023). Immunology of Giant Cell Arteritis. Circulation research, 132(2), 238–250. https://doi.org/10.1161/CIRCRESAHA.122.322128 [https://doi.org/10.1161/CIRCRESAHA.122.322128] 3. Samson, M., Corbera-Bellalta, M., Audia, S., Planas-Rigol, E., Martin, L., Cid, M. C., & Bonnotte, B. (2017). Recent advances in our understanding of giant cell arteritis pathogenesis. Autoimmunity reviews, 16(8), 833–844. https://doi.org/10.1016/j.autrev.2017.05.014 [https://doi.org/10.1016/j.autrev.2017.05.014] 4. Cacoub, P., Vieira, M., Langford, C. A., Tazi Mezalek, Z., & Saadoun, D. (2025). Large-vessel vasculitis. Lancet (London, England), 406(10514), 2017–2032. https://doi.org/10.1016/S0140-6736(25)01436-9

Cardiovascular - Atrial Flutter

In this episode, we review atrial flutter, a supraventricular tachyarrhythmia caused by a reentrant electrical circuit within the atria that produces the classic "sawtooth" flutter waves on EKG. We discuss the underlying pathophysiology, major risk factors including heart failure, COPD, coronary artery disease, hypertension, hyperthyroidism, and obstructive sleep apnea, and the typical presentation of palpitations, dyspnea, fatigue, and chest pain. Diagnostic evaluation focuses on recognizing the characteristic 2:1 AV conduction pattern with atrial rates near 300 bpm and ventricular rates around 150 bpm. We also cover acute management with rate control, rhythm control, and cardioversion, as well as long-term treatment strategies including catheter ablation and anticoagulation guided by the CHA₂DS₂-VASc score. References 1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 2. Writing Committee Members, Joglar JA, Chung MK, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109-279. doi:10.1016/j.jacc.2023.08.017 3. Wolfes, J, Ellermann, C, Frommeyer, G. et al. Comparison of the Latest ESC, ACC/AHA/ACCP/HRS, and CCS Guidelines on the Management of Atrial Fibrillation. J Am Coll Cardiol EP. 2025 Apr, 11 (4) 836–849. 4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267. doi:10.1161/CIR.0000000000000041