pathology

Aortic regurgitation Murmur -- early diastolic murmur Exam findings -- hyperdynamic pulse, bounding or "water-hammer" peripheral pulses Detailed explanations blood regurgitates into the LV from the aorta --> even less blood in the aorta --> decreased DBP --> peripheral arteries "collapse". When the LV contracts the next time it has more blood to pump out -> increased stroke volume -> increased SBP -> peripheral arteries must accomodate this increased flow and pressure and they "expand". Net result "bounding" pulse Aortic stenosis Murmur --  Exam findings -- pulsus parvus et tardus (low amplitude and delayed upstroke) Mitral regurgitation Mitral stenosis Apical diastolic rumble Atrial septal defect Murmur -- widening and fixed splitting of S2, may have midsystolic pulmonary flow murmur Exam findings -- if large, tachypnea. Details ASD -> L to R shunting -> more blood in RA then RV ...

Terminology Severe hypertension = blood pressure >/= 180/120 mmHg Hypertensive urgency = severe hypertension without symptoms or acute end-organ damage Hypertensive emergency = severe hypertension with acute, life-threatening, end-organ complications. Malignant hypertension = hypertensive emergency where the end-organ damage presents as retinal hemorrhages, exudates or papilledema Hypertensive encephalopathy = hypertensive emergency where the end-organ damage presents as cerebral edema and non-localizing neurologic symptoms and signs. For example, headaches, nausea, vomiting, restlessness, confusion, agitation, seizures, and even coma. Management Blood pressure should be lowered slowly, 10-20% in the first hour then 5-15% over the next 23 hours. Cerebral ischemia can occur if blood pressure is lowered to fast, resulting in altered mental status and/or generalized seizures.