CSW2 severe hypertension (karim meeran) Flashcards
What are signs of chronic hypertension on examination?
Papilloedema
Raised JVP
What will happen to the heart in chronic hypertension?
It will shrink
What are the 4 grades of retinopathy?
1= silver wiring
2= ateriovenous nipping
3= flame haemorrhage
4=papilloedema
What is stage 1 retinopathy in chronic hypertension? What will you see
Silver wiring
Arteries are white and veins are dark (oxygenated vs deoxygenated blood)
What is stage 2 retinopathy in chronic hypertension? What will you see
AV nipping
As an artery passes a vein it nips it
What is stage 3 retinopathy in chronic hypertension? What will you see
Flame haemorrhage
What is stage 4 retinopathy in chronic hypertension? What will you see
Papilloedema
What do cotton wool spots on a retina suggest is happening?
Ischaemia
In chronic hypertension what happens to the heart?
Left ventricular hypertrophy
How is LVH detected on examination?
You cannot detect it on exam
You might feel a heave
You might hear a fourth heart sound (gallop rhythm)
What is seen on ECG if theres LVH?
Tall r waves
Deep s waves
What are causes of hypertension?
Conn's Acromegaly Cushing's Renal artery stenosis Fluid overload in renal failure Phaeochromocytoma
What base ix should be done for someone with hypertension and why?
FBC- check for polycythaemia
UE- potassium may be low (conns, cushings, phaeo all cause low K+) and you need to check renal function
ECG- check for LVH
Urinalysis- check for nephritis and renal disease
Fasting glucose- they are at risk of diabetes
Lipids
What arteriole does angiotensin II constrict in the kidney?
Efferent
What does angiotensin II stimulate adrenal glands to make?
Aldosterone
What hormone do the adrenals produce to increase BP?
Aldosterone
What tests are done for cushings?
low dose dexamethasone
urine free cortisol
How will phaeo’s present?
Nervousness Excess sweat Racing heartbeat Episodic severe hypertension May have necrotic bowel due to severe vasconstriction
How is hypertension characterised in phaeo?
severe and episodic
Why is hypertension episodic in phaeo?
Because adrenaline is stored and then released all in one go
How is phaeo treated?
Rehydrate is dehydrated Alpha blockade first Beta blockade Localise the lesion Surgery to remove it
What is the first step in medical management of a phaeo?
Alpha blockade
In essential hypertension what is the next step in management when htn isnt controlled with acei/arb + CCB + thiazide like diuretic
Consider further diuretic or alpha or beta blocker and consider seeking expert advice