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Yr 3 MedEd > Valvular and HTN > Flashcards

Valvular and HTN Flashcards

1
Q

What is clinical definition of hypertension?
What is next investigation to confirm HTN?
What values confirm HTN?

A
  • 140/90 on 3 separate occasions. Lowest of readings 2 or 3 taken as clinical BP.
  • If clinical BP higher than 140/90 offer ambulatory blood pressure monitor (ABPM) or home BP monitor (HBPM) if ABPM not appropriate.
  • Confirmation of diagnosis: Clinal BP >140/90 and ABPM/ HBPM daytime average >135/85.
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2
Q

What are 3 stages of HTN?

What is value of malignant HTN?

A
  1. 140/90-159/99
  2. 160/100-179/119
    3 >180/120
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3
Q

Outline the 4 steps in choosing anti-HTN medication.

A
  1. ACEi/ ARB or CCB
  2. ACEi/ ARB + CCB (or Thiazide diuretic)
  3. ACEi/ ARB + CCB + thiazide-like diuretic.
  4. Confirm resistant hypertension. ?add Spironolactone or Alpha/ Beta blocker.
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4
Q

Give side effects of the following:

  • ACEi (3)
  • CCB (2)
  • BB (1)
  • AB(1)
  • Diuretics (2)
A
  • ACEi: cough, high potassium, raised Cr.
  • CCB: swelling, angioedema
  • BB: dizziness
  • AB: dizziness
  • Diuretics: dry mouth, low potassium levels.
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5
Q

Give 3 categories of patient to measure standing and sitting BP in.
What is upper limit of BP maintenance in >80yr olds.

A
  • T2DM, symptoms of postural hypotension, people aged >80.

- Clinic BP <150/90, ABPM <145/85

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6
Q

What needs to be urgently assessed in stage 3 HTN?

Give 3 reasons to refer to a same-day specialist review.

A
  • Assess target organ damage ASAP.
    Refer to specialist:
  • Retinal haemorrhage/ papilloedema
  • Life threatening Sx; confusion, chest pain, AKI, signs of HF.
  • Suspected phaeochromocytoma- e.g. labile/postural hypotension, headache, palpitations, pallor, abdominal pain, diaphoresis).
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7
Q

How may physiological splitting of S2 occur?
What may cause paradoxical splitting.
What may cause persistent splitting?
What may cause fixed splitting?

A
  • Inspiration, decreased intrathoracic pressure, increased compliance of pulmonary vascular bed, augmented right heart filling. Right ventricle filling increased as result- later valve closure.
  • Paradoxical splitting- results from prolonged LV systole (Prolonged emptying, AS, LBBB).
  • Persistent splitting: prolonged RV systole/ shorter duration of LV systole. PS, RBBB
  • Fixed: Atrial septal defect
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8
Q

What causes the sound of S3.

What patients can it be heard in?

A
  • Produced during passive ventricular flilling, blood strikes compliant LV
  • Healthy young people with well functioning heart.
    Older people with heart failure.
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9
Q

What produces the S4 sound?

Give 3 cardio conditions it can be heard in.

A
  • Forceful atrial contraction ejecting blood into hypertrophied ventricle which cannot expand further. Indicates stiff ventricle, caused by turbulent flow.
  • HTN, aortic stenosis, hypertrophic cardiomyopathy.
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10
Q

Which manoeuvre amplifies mitral stenosis?

Which manoeuvre amplifies aortic regurgitation?

A
  • Lean patient of left hand side

- Lean patient forward.

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11
Q

Describe murmur heard in aortic stenosis.
Give 3 other clinical signs of aortic stenosis
Give 3 non-cardio symptoms.

A
  • Ejection systolic high pitched murmur.
  • Crescendo decrescendo character- flow is fastest mid-systole.
  • Radiates to carotids
  • Slow rising pulse and narrow pulse pressure
  • Patients may complain of exertional syncope.
  • Worsening SOB
  • Leg swelling
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12
Q

Describe mitral regurgitation murmur and radiation.

Give 3 possible causes.

A
  • Pan-systolic high pitched whistling murmur
  • Radiates to left axilla.
  • IHD, Idiopathic with age, connective tissue disorder.
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13
Q

Describe mitral stenosis murmur. How is it accentuated?

Give 2 associated conditions and 1 symptom.

A
  • Mid-diastolic low pitched rumbling with loud S1.
  • Accentuated by lying on LHS
  • Atrial fibrillation, rheumatic fever
  • Malar flush: red cheeks.
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14
Q

Describe aortic regurgitation murmur.
What location and position is it amplified in?

Give 5 clinic signs of aortic regurgitation.

Describe the pulse pressure.

A
  • Early diastolic, soft murmur
  • heard better at Erb’s point: left sternal edge, 3rd intercostal space, holding breath after expiration and sitting forward.
  • Collapsing pulse- Corrigan’s pulse
  • Corrigan’s sign: pulsation of neck.
  • Quincke’s sign: pulsation of nail bed.
  • De Musset’s sign: nodding of head with pulse
  • Becker’s sign: pupil and retinal artery pulsation
  • Muller’s sign: uvula pulsation

Wide pulse pressure

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15
Q

What other type of murmur can be caused by aortic regurgitation?

A
  • Austin flint murmur- aortic incompetence.
    Noise of turbulent blood flow hitting anterior leaflets of mitral valve.
    Causes mid-diastolic murmur: physiological mitral stenosis.
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16
Q

Describe murmur in tricuspid regurgitation, where it is heard best and how it is amplified.

Give two associated conditions.
What clinical sign can be seen.

A
  • Pansystolic murmur- heard better at lower left sternal edge- louder on inspiration- carvallo’s sign.
  • Infective endocarditis, congenital defects.
  • Raised JVP: giant V waves.
17
Q

Define rheumatic fever.
Give 3 general symptoms
Give 3 cardio symptoms.
Give 3 joint symptoms.

A
  • Inflammatory multisystem disorder. Follows Group A Beta-haemolytic Stretococci (GAS) pharyngeal infection.
  • Fever, malaise, anorexia
  • SOB, palpitations, chest pain
  • Swollen, painful, reduced movement.
18
Q

What is the Jones criteria for rheumatic fever?

What other feature is present.

A
  • Joints- polyarthritis
  • Nodules- painless
  • Erythema marginatum
  • Sydenham chorea- involuntary movements with slurred speech
    Also pericarditis/ endocarditis: pericardial effusion, myocardial thickening, valvular dysfunction.
19
Q

What throat culture is taken for rheumatic fever?

What ECG changes are seen?

A
  • Throat culture for growing GAS or anti-Streptolysin O titres.
  • Saddle-shaped ST elevation, PR depression.
20
Q

Give the cause of the following buzzwords:

  • Narrow PP, soft S2, ES murmur radiating to carotids
  • Blowing PS murmur at apex radiating to axilla
  • Wide PP, displaced, EDM at LSE- best heard leaning forward on expiration
  • Tapping apex beat + malar flush. Loud S1, rumbling MDM at apex.
  • PSM LLSE, best heard on inspiration. L parasternal heave, pulsatile liver, raised JVP, IVDU.
A
  • Aortic stenosis
  • Mitral regurgitation
  • Aortic regurgitation
  • Mitral stenosis
  • Tricuspid regurgitation.

Yr 3 MedEd (31 decks)

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