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  #1  
Old 03-07-2012
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Sphygmomanometer Newly diagnosed hypertension in 18-yr-old

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 pre-college 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
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  #2  
Old 03-07-2012
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Diagnosis a COARCTATION of aorta...i think...

so Manage with D as ans

???????
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Old 03-07-2012
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Coarctation of aorta...Surgery is the definite treatment.
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  #4  
Old 03-07-2012
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surgery, bcoz this pt iz asymptomatic so no need of medical thrpy, go for surgery bcoz left vent hypertrophy+decrease pulses+lower muscular mass dec
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Old 03-07-2012
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b?
because repeating atleast 2 weeks distance apart,

yes, appears to be COA. but considering that, ans shud be C because this is what is the initial step in hypertension in general....

i wud have gone with C
whats the ans?
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  #6  
Old 03-07-2012
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ya even i believe next appropriate step wud be manage the HTN 1st ...

and usmlepak- most HTN cases are asympto..so shudnt u manage them?

may be surgery is correct bt ur logic seems a bit twisted??!!??
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Old 03-07-2012
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Correct Answer Pharmacological intervention

Patient already has LVH, but otherwise asymptomatic. This signifies chronic stress on heart (most likely afterload, if it is COA). This should be treated with meds and not diet and salt control. Then Further investigations should be ordered (rember Gr2/6 systolic murmurs can be benign too, though the vignette hints at COA in this).
Indications for surgery in COA are-
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
Hemodynamically significant aortic stenosis
Female patient contemplating pregnancy.
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Old 03-07-2012
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Correct Answer MEDS

Quote:
Originally Posted by Aussie Guy View Post
Patient already has LVH,but otherwise asymptomatic.This signifies chronic stress on heart(most likely afterload,if it is COA).This should be treated with meds and not diet and salt control.Then Further investigations should be ordered(rember Gr2/6 systolic murmurs can be benign too,though the vignette hints at COA in this).
Indications for surgery in COA are-
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
Hemodynamically significant aortic stenosis
Female patient contemplating pregnancy.
In this significant coarct is mentioned, which if would have been in this patient he would have been diagnosed much earlier. He must be treated for HTN and then evaluated further.
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Last edited by Aussie Guy; 03-07-2012 at 11:44 AM.
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  #9  
Old 03-07-2012
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The ans is E. correct with surgery bcos of the left vent hypertrophy. over correction of the blood pressure thru medication can cause poor blood supply to the lower extremties that is already under perfused. the earlier the correction the longer the patient lives.
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  #10  
Old 03-07-2012
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ya that seams a reasonable explanation...

yes medication wil decrease blood supply furthe to LL..

so Sx is the ans

thanks man
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  #11  
Old 03-07-2012
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is lvh in COA indication for sx or we always go for surgery in coa ?
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  #12  
Old 03-08-2012
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surgery is always the definite treatment to prolong their life and to limit LVH and hrt failure early in life.
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