6: Murmur, HTN (Quiz W7)

Question 1

Mitral Regurg RFs

Answer 1

MVP, RF, Male, infxs endo, LV dilation, structural damage

Question 2

Mitral Regurg sxs

Answer 2

early: asx (until LV loss of fxn)
insidious onset DOE, weakness
late: cough, orthopnea, PND, peripheral edema

Question 3

Mitral Regurg PE

Answer 3

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

Question 4

Mitral Regurg Imaging

Answer 4

EKG: large L atrium, L ventricle/R ventricle
CXR: large LA or LV
TTE: to confirm dx
CA: to confirm dx

Question 5

Mitral Regurg Prognosis

Answer 5

surgery when LV ESD >4.5cm or EF<55%

seq: CHF, MI (if CAD)

Question 6

Acute Mitral Regurg

Answer 6

due to papillary muscle rupture post MI or post ifxs endo

sxs: pulmonary edema, tachypnea, dyspnea, S4

Question 7

Mitral Valve Prolapse

Answer 7

#1 most common human heart valve anomaly
RF: idiopathic myoxatous degen, RF, transient in pregnancy, dehydration, Marfans

Question 8

MVP Syndrome 1

Answer 8

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

Question 9

MVP syndrome 2

Answer 9

men 20-40 yrs
MVP with valve leaflet thickening, more likely to get MR
prognosis: may get hemodynamically sig MR

Question 10

MVP Murmur

Answer 10

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

Question 11

MVP murmur augmentation

Answer 11

valsalva, isometric handgrip, standing from squat

Question 12

MVP Dx

Answer 12

Echo

Question 13

MVP Tx

Answer 13

BB (for palpitations, chest pain, anxiety)
CoQ10
check E/P balance

Question 14

Essential HTN

Answer 14

mutifactorial pathophys: increased Na+, increased sensitivity to sympathetic stim

Question 15

RFs for essential/primary HTN

Answer 15

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

Question 16

secondary HTN

Answer 16

1=renal a stenosis (dx with angiography)

meds (NSAIDs, thyroxine, SNRI, amphetamines, HRT, steroids)
sleep apnea
aortic coarctation
endocrine HTN

Question 17

HTN sxs

Answer 17

asx, dizziness, occipital HA, fatigue, epistxis, nervousness

Question 18

preHTN

Answer 18

120-139/80-89

dont need drugs (unless CAD, HF, MI)

Question 19

stage 1 HTN

Answer 19

140-159/90-99

1 drug

Question 20

Stage 2 HTN

Answer 20

> 160/>100

2 drugs

Question 21

Home readings

Answer 21

don’t count. If they are stressy enough to get white coat HTN, they are likely stressy enough to get HTN with everyday stressors

Question 22

Malignant HTN

Answer 22

organ damage- retinal hemorrhages, exudates, papilledema, HTN, encephalopathy

usu diastolic >120

Question 23

HTN Urgency

Answer 23

diastolic >120 in asx pts

Question 24

PEs to assess for end organ damage

Answer 24

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

Question 25

Work Up for new dx HTN

Answer 25

CMP, CBC, TSH, UA, 25-OH D, ECG

optional: CXR, HbA1c, lipids

Question 26

HTN Dx

Answer 26

2 BP readings (supine, standing) on 3 separate days at least 24 hours apart

Question 27

BP Goals

Answer 27

<140/90 for pts <65 yrs

<150/90 for pt >65 yrs

Question 28

ER Rx for HTN

Answer 28

propanolol 40mg BID

Question 29

ND Tx for HTN

Answer 29

DASH-s diet, low alcohol/caffeine, smoking
stress restructuring
diet: garlic, capsicum, celery
Mg, K+
EFAs
B complex
Bonita fish peptides (mild ACE-i)

Question 30

HTN First Line Drugs

Answer 30

Thiazide diuretics=HCTZ
ACE-i= Lisinopril
CCBs (DHP) Amlodipine
ARBs = Losartan

Question 31

HTN Drug Rules

Answer 31

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

Question 32

ND Herbs HTN

Answer 32

Cratageus
Rauwolfia
Linden
hellbrun
Coleus