Postural hypotension, dyslipidaemia and valvular heart disease Flashcards
Define Postural hypotension
A fall in systolic BP of >20mmHg and/or a fall in diastolic BP of >10mmHg within 3 minutes of standing
In HTN patients the fall in systolic BP must be >30mmHg
what is aetiology of OH?
older age Alpha blockers Diuretics TCA's and anti-hypertensives volume depletion
Peripheral neuropathy
Pakinsons
Lewy body dementia
Pure autonomic failure
What are the S&S of OH?
postural lightheadedness
Syncope
cerebral hypoperfusion signs like visual changes, weakness
What are the investigations for OH?
Serial BPs from sitting to standing for 3 mins
Tilt table testing
Plasma noradrenaline - decreased compared to normal on standing
Deep breathing - diminished beat to beat variation on ECG during inspirationa and expiration
Nerve conduction studies
What are the treatment options for OH?
Stop causative Meds
Education
- lie down when diizzy
- valsalva like manoeuvres should be avoided
- frequent small meals to reduce post prandial hypotension
- avoid hot environments
- raise head of bed
mineralocorticoid therapy e.g fludrocortisone
what is dyslipidaemia?
it is defined as serum total cholesterol (TC), LDL-C, triglycerides, apolipoprotein B, or lipoprotein (a) concentrations above the 90th percentile or HDL-C or apolipoprotein A-1 concentrations below the 10th percentile for the general population
what is the aetiology of dyslipidaemia?
primary = familial hypercholesterolaemia
secondary = high fat diet, sendentary lifestyle, chronic renal insufficiency, obesity, DM, hypothyroidism
what drugs can cause dyslipidaemia?
thiazides, oral oestrogens, glucocorticoids, anabolic steroids.
whats are the S&S of dyslipidaemia?
presence of RF's and family hx high fat diet obesity xanthelomas tedninous xanthomas corneal arcus <45
What investigations highlight dyslipidaemia?
lipid profile
- TC >5.18mmol/l
- LDL-C >2.58mmol/l
- HDL-C <1.04mmol/l
- Triglycerides >1.7mmol/l
Serum TSH
- in hypothyroidism there is increases in TC, LDL and apolipoprotein B, so this must be ruled out
Lipoprotein (a)
- >50mg/dl
what are the treatement options for dyslipidaemia?
Lifestyle change
Statins
Ezetimibe - inhibits intestinal absorption of cholesterol
PCSK9 inhibitor such as alirocumab
outline the pathology of mitral stenosis
reduction in size of the mitral orifice. This leads to impeded flow between LA and LV, meaning the pressure in the LA remains higher than LV.
The increased LA pressure is referred to the lungs leading to congestion and the LV filling is reduced, leading to reduced CO
The effects of mitral stenosis produces a syndrome mimicking left HF
what are the S&S of mitral stenosis?
Dyspnoea and orthopnoea
Diastolic murmur with loud S1 (opening snap)
Neck vein distension
Malar flush on cheeks
Haemoptysis (bronchial vein anastomoses rupture due to PH)
peripheral oedema
How is mitral stenosis diagnosed and treated?
Diagnosed via echo and treated with diuretics, balloon valvulplasty and B-blocker + anticoagulant if arrhythmia risk
What are the signs and symptoms of mitral regurg?
exertional dyspnoea peripheral oedema pansystolic murmur at apex radiating to axilla Diminished S1 and presence of S3 palpitations
how is mitral regurg diagnosed and treated?
diagnosed via echo and treated with annuloplasty, mechanical valve insertion and diuretics, B-blockers, ACEi
whats is the aetiology of aortic stenosis?
Calcification (80%)
Bicuspid valve
Coarctation of the aorta
Rheumatic heart disease
what are the S&S of aortic stenosis?
dyspnoea
chest pain (exertional)
Syncope (postural hypotension)
Ejection systolic murmur with crescendo-decresendo pattern that peaks in mid systole and radiates to carotid
Narrow pulse pressure
Paradoxically split S2. In severe disease the aortic valve closure becomes so delayed it comes after the pulmonary valve closure
How is AS diagnosed and treated?
diagnosed via echo. ECG may show LVH, absent Q waves, LBBB or AV block
Treated with balloon valvuloplasty or replacement. Transcatheter aortic valve replacement (TAVR) used.
What is the aetiology of acute and chronic aortic regurg?
acute = IE, ascending aortic root dissection, chest trauma
chronic = rheumatic heart disease, biscuspid valve, aortic root dilation, CT disordered (SLE, RA, Marfans)
What are the S&S of AR?
high pitched early diastolic murmur
dynspnoea fatigue pulmonary oedema JVP distension Collapsing pulse + weak pulse pressure
How is AR diagnosed and treated?
Echo
ECG may show LVH, LAD and ST-T wave changes
Acute AR = inotropes, vasodilators and urgent repair
Chronic = mild to moderate needs no treatment. Severe needs valve repair or replacement with vasodilator and ACEi therapy
