51 - low blood pressure, 55 Hypertension Flashcards
define shock
Inability of the circulatory system to maintain end-organ perfusion
which system monitors signs of shock?
SHEWS
few general signs of shock
Hypotension with responsive tachycardia (masked by beta blockers), anuria, disturbed consciousness, thirst, signs of dehydrations, cold skin.
4 types of shock
Cardiogenic
Distributional (incl. septic)
Hypovolemic (blood loss)
Obstructive (tamponade, tension pneumothorax)
What is addisons?
Primary adrenal insufficiency; adrenal glands do not produce sufficient hormones.
Often autoimmune
Sx of addisons?
Abdominal pain, weakness, increased skin pigmentation and weight loss.
Dx addisons
ACTH stimulation test
Secondary cause of addisons
lack of ACTH
Mx addisons
Replace hormones with fludrocortisone and hydrocortisone (with sick day rules)
What happens in addisonian crisis? triggers?
Addisonian crises may occur: hypotension, vomiting, lower back pain and LoC.
Triggered by infection, injury, surgery or stress.
Mx addisonian crisis?
Give hydrocortisone IM or IV with saline.
Fludrocortisone not needed.
Define orthostatic hypotension
Fall systolic 20mmHg and 10 for diastolic
Lifestyle factors affecting HTN
Obesity High salt intake Smoking Alcohol Stress Birth control
Secondary causes of HTN …Name 4
Diabetes, PKD, RAS, renal failure, phaeo, Conn’s syndrome, hyperparathyroidism, hyperthyroidism, Cushing’s, CAH, OSA, scleroderma, neurofibromatosis, cancer, drugs, pregnancy
2 things that maintain blood pressure
cardiac output
systemic vascular resistance
HTN mx
A: 55+ or Black Carribbean: Amlopidine
A2: ACE inhibitor or ARB if under 55.
B: Combine the two
C: Add thiazide diuretic.
D: Specialist care.
How do CCBs work
block entry of calcium into arterial muscle walls, reducing contraction and systemic vascular resistance.
Whats seen on CXR / Echo of pulm HTN
CXR shows effusions and oedema.
Echo shows RIGHT heart failure
phaeochromocytoma
Sx? Dx? Mx?
Flank pain, tachycardia, hypertension with orthostatic hypotension, anxiety, palpitations, headaches, weight loss, sweating
Diagnose by 24 catecholamine and metanephrine in urine collection. Scan to localise tumour.
Treat with surgical resection
What happens in renal artery stenosis ?
Narrowing of renal arteries. Often atherosclerotic. Impedes blood flow to kidney which produces systemic hypertension.
How does renal artery stenoiss increase blood pressure further
Reduced blood supply and renal hypoxia promotes renin release which further raises blood pressure.
Mx renal artery stenosis
Treat with antihypertensives and diuretics.
Surgery is a last resort.
