hanialkhadher
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75 y old male reports chest pain on climbing stairs, On physical exam found to have 2/6 systolic murmur and delayed upstroke of carotids & diminished volume.
Recommended therapy is:
A) Nitrates.
B) Beta blockers.
C)ACE-I.
D)Calcium channel blocker.
E)Immediate Aortic valve replacement.
Edited by hanialkhadher on 06/07/07 - 06:27 PM
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| cirus
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I'm between C & E but since he has pain which I interpretted as ischemia, & delayed upstroke meaning that has a high risk for Cardiac ischemia (Most common presnet of AS) ill go for E
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| virgola82
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It looks like aortic stenosis that should associate with ventricular hypertrophy. Shouldn't a beta blocker be advisable to reduce risk of arrythmia?
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| prathapdoctor
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best therapy would be aortic valve replacement.
initially, therapy can be started with Beta blockers.
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| cirus
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TTT of valvular disease:
MS,AS,MR,AR----->Diuretics,ACE inhibitors & Digitalis(i.e. TTT of Heart failure)
BBs are contraindicated here,
While on the other hand the TTT of MVP & HOCM---BBs is the main stay of therapy to decrease Heart rate.
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| cirus
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& another thing that made me exclude C as an answer, is the old age of the pt wich my cause intolerance to ACE inh but as it isn't an absoulute contraindication i was still hesitent,diminished volume also helped, but if the pt was in better condition I would have definetly answered C
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| Adam
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i guess medical therapy wouldn't be sufficient, >> Valve replacement E
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| arlete
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We never give digital for aortic stenosis (increases the gradient), unless there is regurgitation associated.
I would do a catheterization (study the coronaries too), and valvar replacement, so: E.
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| Justice
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C)ACE-I.
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| hanialkhadher
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In Aortic stenosis producing angina ttt is Replacement.
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