doyoudig
Forum Guru
Topics: 144
Posts: 613
|
An 18-year-old man comes to the physician 1 week after he had a blood pressure of 140/110 mm Hg during a routine precollege examination. His temperature is 37.1 C (98.7 F), blood pressure is 140/100 mm Hg, pulse is 92/min, and respirations are 12/min. The upper extremities appear to be more muscular than the lower extremities. Radial pulses are normal; femoral, posterior tibial, and dorsalis pedis pulses are decreased. A grade 2/6 systolic murmur is heard over the precordium, anterior chest, and back. An ECG shows left ventricular hypertrophy. Which of the following is the most appropriate next step in management?
A ) Limiting physical activity
B ) Repeat blood pressure measurement in 1 month
C ) Initiate a low-sodium diet and exercise program
D ) Pharmacologic management
E ) Operative treatment
|
| Justice
Just signed contract
Topics: 118
Posts: 2,369
|
E ) Operative treatment
___________________
The winner takes it all...
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
justive why do you take this pt to surgery 1st before controlling his BP??
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
He is stable, he can go directly to surgery. If he'd presented with hart failure or accelerated hypertension, than you'd do drugs to stabilize prior proceeding to surgery.
Am I correct?
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
what i am asking here is if this BP is acceptable or not for surgery??
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
I think it is OK. At least his clinical picture looks OK. To be straight, I don't know whether he is the best candidate for surgery, bud I'd send him to OR. At least on the test. 
|
| new_n_lost
Forum Hero
Topics: 724
Posts: 6,388
|
I think wht Doyoudig is trying to say that a diasystolic BP of 110 is fit for surgery or not
___________________
"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| vradojc1
Forum Elite
Topics: 21
Posts: 309
|
I got that but I don't know. To me he seems OK. Although anyone with diastolic pressure >100 should be treated (with 2 drugs), I'm not sure whether it is the case in coarctation. And whether his BP presents any significant risk to surgery.
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
thx guys clear now
|
| Justice
Just signed contract
Topics: 118
Posts: 2,369
|
I think that high PB is this Pt with coarctation would be barely retractable with drugs, but if it would, very low PB in the bottom half of the Pt ( ) will not be enjoyable by him... He is an ideal candidate for surgery at this moment...
___________________
The winner takes it all...
|
| nany
Forum Guru
Topics: 14
Posts: 1,060
|
I think that Aortic diseases can't wait long for surgery and his BP is good and not that high.
so I'll choose :
E) OPERATIVE TREATMENT
___________________
" You Are Limited Only By What You Think "
|
| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,301
|
- Indication for intervention: At present, 3 specific indications exist for intervention in patients with coarctation of the aorta.
- Significant coarctation or recoarctation of the aorta with long-standing hypertension with or without symptoms ( this px has LVH on EKG )
- Hemodynamically significant aortic stenosis
- Female patient contemplating pregnancy
Big Time Agree with Justice 
___________________
The elevator to succes is broke ,you must take the stairs
|
| usmile2
Forum Senior
Topics: 1
Posts: 25
|
Initiate repair as early as possible given the risks of heart failure, premature
CAD, and intracerebral hemorrhage.
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Thank You All for Ur responses, I don't have an answer for this questions but agree with doccalaire & justice explanations. thx again
|
|
| |
| | | | | | | | | | | | | | |
Similar forum topics