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Old 07-22-2012
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Heart Coarctation of Aorta; Pharmacotherapy or Surgery?

If an adult had high blood pressure with a sysolic in the 150-160's....and you discovered that they have coarctation of the aorta...
What would be your first step in intervention? Medical to try to control the BP and bring it down? Or you wouldn't initiate pharmacotherapy and just schedule the pt for surgical correction?
Which would you chose?
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Old 07-22-2012
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next step in management>>>>>> Control BP

Best step in management>>>>>>> Corrective surgery

In real life you would have to control BP in order to schedule surgery.
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Quote:
Originally Posted by Novobiocin View Post
next step in management>>>>>> Control BP

Best step in management>>>>>>> Corrective surgery

In real life you would have to control BP in order to schedule surgery.
one of the nbmes had a similar question... what is the "next best step in management?" (not unstable .. findings seen on regular check up -- the classic UL having higher BP and more developed than LL etc)

and the answer was surgery.

(other options being
1- repeat BP testing, 2- Pharm treatment to lower BP, 3- sodium restriction)



if you look at kaplan/DIT they say
for Coarctation the best/initial Rx is Sx
for DIssection -- the initial Rx is BP control followed by Sx.
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Quote:
Originally Posted by mbbs2010 View Post
one of the nbmes had a similar question... what is the "next best step in management?" (not unstable .. findings seen on regular check up -- the classic UL having higher BP and more developed than LL etc)

and the answer was surgery.

(other options being
1- repeat BP testing, 2- Pharm treatment to lower BP, 3- sodium restriction)



if you look at kaplan/DIT they say
for Coarctation the best/initial Rx is Sx
for DIssection -- the initial Rx is BP control followed by Sx.
When you say the answer is surgery on that q....how do you know for sure?
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Originally Posted by usmledee View Post
When you say the answer is surgery on that q....how do you know for sure?
i think it was on the form i did online with extended feedback.. and it wasnt one of my wrong questions.



also check this out http://emedicine.medscape.com/article/895502-treatment
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Originally Posted by mbbs2010 View Post
i think it was on the form i did online with extended feedback.. and it wasnt one of my wrong questions.



also check this out http://emedicine.medscape.com/article/895502-treatment
"Remember that relieving the aortic obstruction promptly rather that attempting to treat hypertension with antihypertensive medications is better"

According to this ... Surgery is preferred over antihypertensives .

Can you please tell what form NBME had this q. I thought the only expanded feedback was in form 4 and I think this q is in either 1 or 2.
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Old 07-23-2012
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im sorry i donot remember which one had it.
but im sure one of them did... dont hv the forms offline.. so i dont know which one it was.
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