elitoki
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Elderly pt with BP 168/65, how can I differentiate the Dx between isolated systolic hypertension from aortic insufficiency?
Are there any clinical manifestations that I can use as key word?
Or the differences are just by echocardiography?
I'll appreciate your comment.
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| arlete
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Aortic insufficiency: regurgitating diastolic murmur, very intense (bounding) peripheral pulses, pulsus bispheriens (2 systolics peaks), the patient may have already symptoms that suggest CHF (and S3), tachycardia, atrial gallop (S4).
In isolated systolic hypertension, most of the times the patient is asymptomatic.
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| Step2300
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You can use any of the half dozen eponym that they have for AI (Quincke’s sign, Becker’s sign, Duroziez sign, Hill’s sign, Traube’s sign, and de Musset’s sign).
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| epica
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Clinical picture is different, is not it?
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| elitoki
Forum Guru
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Yes. The clinical picture is different.
Here is one Question of UW.
74 yo man asymptomatic has BP 165/75 ,
PE: mild systolic ejection type murmur at base of the heart, to the right.
EKG: LVH and secondary ST segment and T wave changes
Echo: mod LVH without any flow abnl.
EF is 60%
What is the most probable cause of his HTN?
A) Rigidity of the arterial wall
B) increase plama renin
C) A. insufficiency
D) increase Intravascular Vol.
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| elitoki
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And Thanks arlete, I think I got it now~ 
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| Justice
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elitoki wrote:
Yes. The clinical picture is different.
Here is one Question of UW.
74 yo man asymptomatic has BP 165/75 ,
PE: mild systolic ejection type murmur at base of the heart, to the right.
EKG: LVH and secondary ST segment and T wave changes
Echo: mod LVH without any flow abnl.
EF is 60%
What is the most probable cause of his HTN?
A) Rigidity of the arterial wall
B) increase plama renin
C) A. insufficiency
D) increase Intravascular Vol.
C) A. insufficiency
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| elitoki
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Answer is A. I made the same mistake.
This pte is asymptomatic and he has systolic ejection type murmur, Aortic Insufficiency is Diastolic type murmur.
His diagnosis is Isolate Systolic HTN, ISH is common HTN is elderly due to decrease elasticity of the art. wall, which leads to an increased systolic blood pressure without increasing, neither decreasing diastolic pressure
Drug of Choice is HTZ.
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| arlete
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| Justice
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elitoki wrote:Answer is A. I made the same mistake. This pte is asymptomatic and he has systolic ejection type murmur, Aortic Insufficiency is Diastolic type murmur. His diagnosis is Isolate Systolic HTN, ISH is common HTN is elderly due to decrease elasticity of the art. wall, which leads to an increased systolic blood pressure without increasing, neither decreasing diastolic pressure Drug of Choice is HTZ.
How all this explains EF is 60%? Shouldn't it dicrease instead?
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| arlete
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Justice:
I did not understand your reasoning. Ejection fraction measures contractility, which is preserved. The vascular resistance is increased, but the cardiac muscle is able to work normally in isolated systolic HTN.
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