Hypertension Flashcards
Pathogenesis
Narrower lumen due to:
Stress, atherosderosis
Risk factors
Smoking Obesity Diabetes Sedentary lifestyle / lack of physical activity Excessive alcohol consumption High levels of sodium intake Vitamin D deficiency Family history of hypertension Low calcium, potassium and magnesium
Types of hypertension
Primary - no medical cause can explain the patient’s condition
Secondary - result of a specific medical condition
Causes of Secondary Hypertension
Renal causes:
Polycystic kidney Glomerular disease Hydronephrosis Renovascular hypertension Diabetic nephropathy
Causes of Secondary Hypertension
Endocrine causes:
- Suprarenal gland: Hypercorticism (Cushing disease), Hyperaldosteronism (Conn sdr.), Pheochromocytoma
- Thyroid gland: Hypo/Hyperthyroidism
- Parathyroid gland: Hyperparathyroidism
Other causes of Hypertension
Coarctation of the aorta Hipoxia Obesity Diabetes Preeclampsia (after 20 weeks) Medications; painkillers, antidepressants, hormones, herbal supplements, various drugs
Symptoms
– Severe headache – occipital pain – Fatigue or confusion – Dizziness – Nausea – Phospenes – Tinitus – Epistaxis – Blurred vision – Chest pain – Breathing problems – Irregular heartbeat – Blood in the urine
Clinical findings in BP
Cerebral changes – Iritability – Nictemeral rhytm changes (sleeping problems) – Anxiety – Attention defficit Neurological – eadache: occipital pressure in the morning – phosphenes, blurred vision, tinitus, – Dizziness, Amaurosis, aphasia, hemiplegia eart – Palpitations – Precordial pain Respiratory – Dispnea Renal – Nicturia – Poliuria – ematuria Circulatory – Cold extremities – Claudication – Paresthesia – Impotence
Laboratory findings
Hemoglobin, hematocrit Glycemia Cholesterole, Triglycerides Uric acid Creatinine Sodium, Potassium Urine analysis: proteinuria
Paraclinical investigations
X ray: heart size ECG Ecocardiography Ophtalmoscopy Ambulatory recording of BP ( olter) Supra/renal eco CT, MRI
Complications
Due to pump dysfunction: Heart failure Due to arterial wall damage – Coronary heart disease – Aneurysms dissection/rupture – Stroke – Kidney failure – vision loss Memory and thinking problems
Organ damage due to BP
-Headache, convulsion, confusion
-Transient ischemic attacks, stroke,
dementia
-Left ventricular hypertrophy, heart
failure
-Angina, myocardial infarction
-Peripheral vascular disease
-Retinal changes
-Proteinuria, renal failure
Pheocromocytoma
Definition
Suprarenal tumor producing noradrenaline
Pheocromocytoma
Signs and symptoms
– Paroxismal increase of BP – Headache – Sweatings – Palpitations and tacchycardia – Anxiety and nervosity – Nausea and vomiting – Weight loss – Ophalmoscopic changes
Lab findings in pheocromocytoma
-Increased cathecolamines in urine (10-100x)
-Increased metabolites of cathecolamines in urine
(metanephrine, vanil-mandelic acid) (10-100x)
-Increased plasma levels of cathecolamines (adrenaline,
noradrenaline)
-Visible tumor on CT scan – possible located in the
abdomen not above the kidney
