Hipertensiunea arteriala secundara

Question 1

Clasificarea generala a cauzelor de HTA secundara:

Answer 1

1. neuro-vegetative. = NERV
2. vascular
3. endocrin
4. renal

Question 2

Cele mai frecvente cauze de HTA secundara sunt:

Answer 2

1. hiperaldosteronism primar
2. apnee obstructiva de somn
3. obezitate

Question 3

Cauze secundare de HTA secundara prin ACTIVARE SN SIMPATIC sunt:

Answer 3

1. apneea de somn
2. obezitatea

Question 4

Sarcina si TA:

Answer 4

• datorita sarcinii, creste VC
• VC crescut este compensat de VD=> scade TA
• defectele de formare (1) SAU vascularizare (2) sunt asociate hipertensiunii/ pre-eclampsiei.

Question 5

Medicamente indicate in sarcina sunt:

Answer 5

1.METILDOPA - central simpaticoliza
2. NIFEDIPINA - bcc dhp
3. LABETALOL - bb

Question 6

Cauze vasculare de HTA II ra:

Answer 6

• coarctatia de aorta
• dg: suflu cardiac/ abdo + diferenta TA intre membre sup/ m. sup si m.inf.
• tx: chirurgical

Question 7

Cauze renale de HTA II ra:

Answer 7

1. Stenoza de aa renala
   dg: deteriorare dupa IECA/ARA, EPA cu functie cardiaca normala
   tx: angioplastie/ stent
2. Boala cronica renala
   dg: ITU, GN, rash, mase renale
   lab: bandeleta, RAC, GN: imuno+biopsie
   tx: bolii de baza

Question 8

Cauze endocrine de HTA II ra:

Answer 8

1. Hipo/hiper-tiroidism
2. Hiperaldosteronism
3. Hipercortizolism
4. Feocromocitom
5. Acromegalie

Question 9

Hiperaldosteronismul primar ca si cauza endocrina de HTA II ra:

Answer 9

Question 10

Hipercortizolism ca si cauza endocrina de HTA II ra:

Answer 10

Question 11

Feocromocitomul ca si cauza endocrina de HTA IIra:

Answer 11

Question 12

Acromegalia ca si cauza endocrina de HTA IIra:

Answer 12

Question 13

Cauze respiratorii de HTA II ra:

Answer 13

Apnee obstructiva de somn
Scor Epworth de somnolenta diurna
Scor Mallapati de 3/4 = marirea cefei
Puls-oximetrie +polisomnografie
Tx: scade greutate, avansare mandibulara, CPAP

Question 14

Cauze neurologice de HTA IIra:

Answer 14

Disfunctie autonoma cu:
1. intoleranta posturala
parkinsonisme, tulburari de termoreglare
2. HTA in clinostatism
3. hipoTA/ TA = N in ortostatism