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Common Congenital Heart Lesions - page 53 / 126

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        TREATMENT:

        • Pharm = alpha receptor blocker [phenyoxybenzamine] plus a beta blocker

        • Surgery = resection

        • Prevention of catecholamine synthesis [methyltyrosine]

  • Adrenocortical Hormone Excess

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      Mineralocorticoids (aldosterone) increase blood volume by stim Na reabsorption, in exchange for K.

      • Can be primary aldosteronismÆadrenal adenoma or bilateral hyperplasia of adrenal gland

      • Asymptomatic

      • Can be secondary aldosteronismÆrenin-secreting tumor (increased ang II)

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        DIAGNOSIS:

        • Hypokalemia

        • Excess aldosterone secretion

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        THERAPY:

        • Surgical removal

        • Aldosterone receptor antagonist (spironolactone)

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        Glucocorticoids (cortisol)

        • Increased renin synthesis and increased blood volume

        • CUSHINGS SYNDROME

        • Round face, central obesity, muscle weakness, hirsutism

        • ACTH secreting tumor in the pituitary

        • Or ACTH secreting tumor in periphery

        • DIAGNOSIS= 24 urine collectionÆmeasure cortisol

        • Or dexamethasone test to see if cortisol secretion is stopped.

  • Thyroid HormoneAbnormalitiesÆeither hyper or hypothyroidism

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      TH : Induce Na/K ATPase in the heart

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        TH : Increase blood volume

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        TH : Stim metabolism and O2 demand Æcardiac hyperactivity and vol.

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        Too little TH: metabolic rate falls, and the vasodilator metabolites decrease, which causes vasoconstriction.

Essential Hypertension:

  • Elevated BP with no definable reason.

  • Diagnosis of exclusionÆfirst rule out all the causes of 2ndary hypertension

  • Most people have mild form (stage 1)

  • Usual age of onset = 20-50

  • Usually a combination of defects, both genetic and acquired.

  • Although no genetic markers have been found, ET runs in families

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