Week 5--lecture slides Flashcards
what is pseudohypertension
seen in older patients
when blood vessel wall becomes more rigid with aging because of hyaline degeneration and endothelial hyperplasia
this increases the impedance to blood flow–> exacerbated by presence of atherosclerosis
result–> BP measures in elderly may be overestimated
what does a positive osler’s sign suggest
pseudoHTN
what is osler’s sign
suggests pseudo HTN
is a palpable brachial artery well when the BP cuff is inflated above sBP with disappearance of korotkoff-I sounds
definition of orthostatic BP
drop of sPB by at least 20 mmHg and/or dBP by at least 10 mmHg when changes from supine to standing
ddx orthostatic BP
meds
autonomic dysfunction
depleted intravascular volume
how do you make the definitive diagnosis of aortic stenosis vs sclerosis
by echo or angio
increased aorto-ventricular pressure gradient
decreased cross-sectional aortic valve area
what are some clinical findings in aortic sclerosis
narrow pulse pressure
pulsus parvus et tardus (uncommon in elderly due to rigid carotid artery wall)
*intensity and pattern of AS murmur NOT helpful
how do you manage patient with new AS murmur but otherwise no sx
watchful waiting
how do cardiac myocytes changes as we age
increased oxidative stress
decreased cell renewal capacity
accumulation of metabolic wastes in myocytes leads to increased risk of apoptosis
even in absence of disease, what % of myocytes in the aging heart are lost to apoptosis
30%
cardiac causes of palpitations
- arrhythmias
- acute CHF
- cardiomyopathy
- valvular disease
- pericarditis
- prosthetic materials
- previous MI
non cardiac causes of arrhythmias
- drugs
- aortic aneurysm
- high cardiac output states (anemia, fever)
- metabolic diseases (thyrotoxicosis, hypoglycemia)
- pheochromocytoma
- psychiatric
- lifestyle (alcohol)
what types of drugs can cause palpitations
anticholinergic drugs
adrenergic drugs
amphetamines
caffeine/theophylline
nicotine
symptoms of apathetic thyrotoxicosis
can present in older people
palpitations tremor diarrhea depression/anxiety delirium falls
*dx of biochemical hyperthyroidism with TSH is important
what impact does spironolactone have in the treatment of CHF
REDUCES MORTALITY