Renal vascular disease, Valvular heart disease, Varicose veins Flashcards
what isthe MC patient demographic for renal artery stenosis
> 45 years old with atherosclerotic disease
CKD, CM, tobacco, and HTN are also risks
what are the signs/symptoms of renal artery stenosis
- hypertension (refractory or new onset)
- abdominal bruit in upper quadrants
what is the diagnostic modalities used for renal artery stenosis
what will they show
- Doppler US - asymmetric kidneys (if unilateral) or * small hyperechoic kidneys (if bilateral)
- renal angiography is GOLD standard!
what is the treatment for renal artery stenosis
- angioplasty or surgical bypass
- medical managament of HTN
what is nephrosclerosis and what causes it
sclerosis of arteries and arterioles caused by hypertension
what is the treatment of nephrosclerosis
multiple antihypertensives:
thiazides + ACE/ARB common
what is cholesterol atheroembolic disease
emboli to the kidneys
what are the s/s of cholesterol atheroembolic disease
- worsening HTN and renal function
- fever, abdominal pain, weight loss
- levido reticularis and localized gangrene
How do you definitively diagnose cholesterol atheroembolic disease
kidney biopsy
what is the treatment for cholesterol atheroembolic disease
no specific effective therapy
but says to start statin and give supportive tx.
Presentation of aortic stenosis
- angina, syncope, CHF
- mid systolic, right 2nd intercostal, rad to carotids
what is the diagnostic of choice for ALL valvular heart diseases
echo
what is the treatment for patients with aortic stenosis
- TAVR
- warfarin +/- ASA if mechanical valve
- plavix+ASA if not mechanical
what is the presentation of aortic regurgitation
- exertional dyspnea, fatigue, angina
- diastolic at 2nd-4th left intercostals radiating to apex
what is the treatment for aortic regurgitation
- surgery for symptomatic and severe or with LV changes
- ACE/ARB
what is the presentation of mitral stenosis
- fatigue, extertional dyspnea, peripheral edema
- diastolic murmur heard at apex with opening snap following S2
what will echo show in mitral stenosis
hockey stick sign
what is the treatment for mitral stenosis
- BB
- diuretics
- refer for surgery if severe presentation
what is the presentation of mitral regurgitation
- fatigue, dyspnea on exertion, and peripheral edema
- holosystolic murmur at apex, radiates to axilla and back
what is the treatment for mitral regurgitation
- ACE/ARB or hydralazine for afterload reduction
- surgical is definitive
what is the presentation of mitral valve prolapse
- nonspecific chest pain
- mid systolic click followed by late systolic murmur
what is the treatment for mitral valve prolapse
no intervention required unless symptoms are severe or they develope severe mitral regurgitation
what is the presentation of tricuspid stenosis
- hepatomegaly, ascites, peripheral edema, fatigue, elevated JVP
- diastolic murmur along LLSB
what is the treatment for tricuspid stenosis
- treat heart failure symptoms with loop diuretics or aldosterone antagonists
- valve replacement indicated if patient is symptomatic
