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LMCC objectives: Hypertension
Diagnose and determine severity
Investigate target organ damage and 2nd causes
List medical management (po and iv)
2nd Causes: Cardiac output (pump demand)
Renal failure + fluid overload++ aldosteroneAortic coarctation
2nd Causes: Vascular resistance (stiff pipes)
Renal artery stenosisPheochromocytomaDrugs Brain (CVA, ICH, SAH)
MCQ 8: What is the most common treatable 2nd cause for HTN?A. HyperaldosteronismB. Renal artery stenosisC. PheochromocytomaD. Aortic coarctationE. Sympathomimetic use
Investigations
Aortic coarctation
HTN in Upper extremitySystolic murmur over backDelayed Femoral Pulse
Echo, Angio
Vascular resistance (stiff pipes)Renal artery stenosis
Young female + fibromuscular dysplasiaResistant to HTN medsMost common treatable cause
Abdo bruits, low K, Abdo US
Vascular resistance (stiff pipes)Pheochro-mocytoma
Episodes of HTN + HA + palp +diaphoresis
Urine catecholamines, metanephrines
Vascular resistance (stiff pipes)Drugs
Amphetamines, sympathomimeticsMAOI
Clinical exam: toxidromeUrine toxECG
MCQ 9: Which is not an HTN emergency?
A. 35 M 220/140, dizzy, normal neuro exam
B. 50 M 200/120, chest pain, CXR wide mediastinum
C. 25 F 28 wks pregnant, 150/80, seizure
D. 80 F 220/120, left arm weaknessE. 45 F 200/120, crackles to apex,
JVP 6cm
Investigations for HTN emergency
ACS
Pulmonary edema
Aortic Dissection
Bleeds, seizure,
encephalopathy
ARF
Specific Treatment: DissectionIv Nitroprusside + beta-blocker
Iv labetolol
Surgery if ascending aorta
MCQ 10: What test is not needed in ambulatory testing for HTN?
A. Urine, urine albumin (DM)B. Lytes + creatinineC. Fasting glucose +
cholesterolD. CBC + diff E. ECG
No co-morbid – 1st line
Thiazide (HCTZ 251)Beta-blocker (Metoprolol 252)CCB (Amlodipine 51)ARB (Losartan 25mg )