6: Murmur, HTN (Quiz W7) Flashcards
Mitral Regurg RFs
MVP, RF, Male, infxs endo, LV dilation, structural damage
Mitral Regurg sxs
early: asx (until LV loss of fxn)
insidious onset DOE, weakness
late: cough, orthopnea, PND, peripheral edema
Mitral Regurg PE
high pitched, blowing, holosystolic
best heard at apex, radiates to axilla
severity–not about murmur intensity! assoc with diastolic events
hemodynamically sig MR: S3 gallop, short diastolic flow rumble at apex
Mitral Regurg Imaging
EKG: large L atrium, L ventricle/R ventricle
CXR: large LA or LV
TTE: to confirm dx
CA: to confirm dx
Mitral Regurg Prognosis
surgery when LV ESD >4.5cm or EF<55%
seq: CHF, MI (if CAD)
Acute Mitral Regurg
due to papillary muscle rupture post MI or post ifxs endo
sxs: pulmonary edema, tachypnea, dyspnea, S4
Mitral Valve Prolapse
#1 most common human heart valve anomaly RF: idiopathic myoxatous degen, RF, transient in pregnancy, dehydration, Marfans
MVP Syndrome 1
women 20-50yrs
thin, lean, leaflet abnormalities, no MR on echo, asx
MVP Syndrome Triad: atypical chest pain, palpitations, anxiety
Prognosis: good, higher risk death ventricular arrhythmias, risk of sudden MR
MVP syndrome 2
men 20-40 yrs
MVP with valve leaflet thickening, more likely to get MR
prognosis: may get hemodynamically sig MR
MVP Murmur
click: short, midsystolic, high pitched low intesnity sound; best heard at sternal border and cardiac apex
murmur; mid to late systolic, low to mod intensity, musical-blowing, cres-descres pattern
MVP murmur augmentation
valsalva, isometric handgrip, standing from squat
MVP Dx
Echo
MVP Tx
BB (for palpitations, chest pain, anxiety)
CoQ10
check E/P balance
Essential HTN
mutifactorial pathophys: increased Na+, increased sensitivity to sympathetic stim
RFs for essential/primary HTN
FHx HTN, FHX premature CVD tobacco, obesity sedentary, dyslipidemia DM renal dz age >55y M, >65 y F
*high risk pt= HTN +DM or chronic kidney dz
secondary HTN
1=renal a stenosis (dx with angiography)
meds (NSAIDs, thyroxine, SNRI, amphetamines, HRT, steroids)
sleep apnea
aortic coarctation
endocrine HTN
HTN sxs
asx, dizziness, occipital HA, fatigue, epistxis, nervousness
preHTN
120-139/80-89
dont need drugs (unless CAD, HF, MI)
stage 1 HTN
140-159/90-99
1 drug
Stage 2 HTN
> 160/>100
2 drugs
Home readings
don’t count. If they are stressy enough to get white coat HTN, they are likely stressy enough to get HTN with everyday stressors
Malignant HTN
organ damage- retinal hemorrhages, exudates, papilledema, HTN, encephalopathy
usu diastolic >120
HTN Urgency
diastolic >120 in asx pts
PEs to assess for end organ damage
fundoscope
acute: arteriole narrowing, hemorrhages, exudate, papilledema
chronic: AV nick, copper/silver wiing
neuro past strokes?
thyroid
lungs-assess for CHF
cardiac-bruit, 4th heart sound, displaced PMI, JVD, ascites, edema
abdominal- aortic pulsation
peripheral vasc-pulses, cap refill; compare pulses in femoral and radial arteries
Work Up for new dx HTN
CMP, CBC, TSH, UA, 25-OH D, ECG
optional: CXR, HbA1c, lipids
HTN Dx
2 BP readings (supine, standing) on 3 separate days at least 24 hours apart
BP Goals
<140/90 for pts <65 yrs
<150/90 for pt >65 yrs
ER Rx for HTN
propanolol 40mg BID
ND Tx for HTN
DASH-s diet, low alcohol/caffeine, smoking stress restructuring diet: garlic, capsicum, celery Mg, K+ EFAs B complex Bonita fish peptides (mild ACE-i)
HTN First Line Drugs
Thiazide diuretics=HCTZ
ACE-i= Lisinopril
CCBs (DHP) Amlodipine
ARBs = Losartan
HTN Drug Rules
don’t use ACEs and ARBs tog
don’t use CCBs and BBs tog (bradycardia)
African Am: use thiazide or CCB as first line
DM: ACE-i first line
BB are no longer preferred dt increased risk of stroke; still are first line for stable angina pts
ND Herbs HTN
Cratageus Rauwolfia Linden hellbrun Coleus
