THE CONTEXT
The interpretable material explains drug classes and additional treatment options for resistant hypertension, followed by causes of acute valve failure and broader causes of valve disease.
Antihypertensive drug classes
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A denotes an angiotensin-converting enzyme (ACE) inhibitor, with an angiotensin II receptor blocker (ARB) as an alternative; the source advises choosing a low-cost ARB.
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C denotes a calcium channel blocker (CCB). A CCB is preferred, but a thiazide-like diuretic may be considered if it is not tolerated or if the patient has oedema, evidence of heart failure or a high risk of heart failure.
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D denotes a thiazide-type diuretic.
Further treatment for resistant hypertension
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Additional diuretic options include a low dose of spironolactone or higher doses of a thiazide-like diuretic.
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An α- or β-blocker may be considered if further diuretic therapy is not tolerated, is contraindicated or is ineffective.
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The resistant-hypertension treatment diagram advises considering expert advice.
Causes of acute native valve failure
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Acute aortic regurgitation may result from aortic dissection or infective endocarditis.
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Acute mitral regurgitation may result from papillary muscle rupture due to acute myocardial infarction, infective endocarditis or rupture of chordae due to myxomatous degeneration.
Prosthetic valve failure
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Mechanical prosthetic valves may fail through fracture, jamming, thrombosis or dehiscence.
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Biological prosthetic valves may fail through degeneration with a cusp tear.
Principal causes of valve disease
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Causes of valve regurgitation include congenital disease, acute or chronic rheumatic carditis, infective endocarditis and cardiac failure.
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Other listed causes of regurgitation are syphilitic aortitis or aortic root dilatation, traumatic valve rupture, senile degeneration, and damage to chordae and papillary muscles.
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Cardiac failure causes dilatation of the mitral and tricuspid valve rings.
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The listed causes of valve stenosis are congenital disease, rheumatic carditis and senile degeneration.