Week 6 Flashcards
What maneuvers increase the sounds of aortic stenosis
Squatting, leaning forward and valsalva release
What does aortic stenosis sound like and what confirms diagnosis
Systolic high pitched cresendo decresendo
Transthroacic doppler echo
What point should valve replacement be considered in aortic stensosi
Valve area <0.7cm
Valve gradient >50mmHg
Sx present
S4 sound heard
What is the only drug approved by the FDA for anticoagulation in valve replacement
Warfarin
What is the most common congenital heart anomaly in the US.
What is happenin?
Biscupid aortic valve
-aneurysm at the root of the valve
Most common cause of aortic stenosis
aortic sclerosis
What does mitral regurg sound like
high pitched, blowing, holosystolic
When is MR hemodynamically significant
S3 gallop present, rumble at apex
When to consider surgical repair for MR
when LV ESD >4.5 on echor EF <55%
Acute MR sx
NO LONGER HOLOSYSTOLIC! No is systolic decresencdo
abrupt pulmonary edema, severe hemodynamic compromise (tachypnea, dyspnea s4 gallop)
What is the most comon heart valve abnormality What does it sound like
MVP
Mid sysolic click, high pitched, blowing, cresendo decresendo
What are the 2 syndromes of MVP
Women 20-50 thin, atypical chest pain with palpitations and anxiety, no MR on echo
-Men 20-40 with valve leaftlet thickening and more likely to develop hemodynamically significant MR
What maneuvers allow you to hear MVP better
Valsalva, isometric handgrip, standing from squatting
What maneuver causes a derease in MVP sounds
squatting from standing and passive leg raise
What is the main treatment for MVP
Beta blockers, magnesium with tauren, CoQ10 with carnitine
What are the high risk patients for primary htn
HTN +DM+ Chronic kidney disease
What is the #1 cause of secondary hypertension
what are some other causes
1: Renal artery Stenosis
- meds(nsaids,thyroxine,snri,ndsri, amphetanmine,hrt,steroird,ginseng,licorice)
- obstructive sleep apnea
- endocrine disorders
When to evaluate for secondary hypertension
- onset prior to puberty
- acute rise in well controlled patient
- -svere and nonresponsive to therapy
- age<30, not obsese,noFhx, non AA
- malignant htn
According to the JNC8 what are blood pressure goals
<140/90 for pts <60yo
<150/80 for pts >60yo
<130/80 for pts with DM and Kidney disease
What is the formula to lower blood pressure safely
2/3 diastolic + 1/3 systolic, reduce MAP by 20-25% in 24 hours to avoid hemodynamic compramise
What is the ER diagnosis to lower bp
30mg propanolol BID
What medication decreases preload and afterload on the ventricles
Ace Inhibitors
List the follow blood pressures Optimal Pre htn Stage 1 Stage 2
Optimal: 120/80
Prehtn: 120-139/80-89
Stage 1: 140-159/90-99
Stage 2: >160/>100
What is malignant HTN
Hypertensive retinopathy
Usually at diastolic >120
