Surgical Hypertension

Question 0

Primary hyperaldosteronism – caused by? (How to differentiate between causes?)

Imaging?

Answer 0

Adenoma or hyperplasia (appropriate response to postural changes suggests hyperplasia; inappropriate/no response suggests adenoma)

CT scan

Question 1

Causes of hypertension that require surgical solution?

Answer 1

#Primary hyperaldosteronism
#Pheochromocytoma
#Coarctation of the aorta
#Renovascular hypertension

Question 2

Key metabolic findings in primary hyperaldosteronism?

Answer 2

#Hypertensive
#Hypokalemia and Hypernatremia
#Metabolic alkalosis

Question 3

Symptoms of pheochromocytoma? Work up?

Answer 3

Attacks headache, perspiration, palpitations, power, hypertension

1. 24 hour urine vanillylmandelic acid, Metanephrines, catecholamines
2. CT scan or radionucleotide studies

Question 4

Important point of care during surgery for pheochromocytoma?

Answer 4

Give alpha-blockers to prevent surge when touching tumor

Question 5

Coarctation the aorta – PE finding? Suggested finding on imaging? Diagnosed with?

Answer 5

Hypertension in the arms with normal/low blood pressure in extremities

CXR – scalloping of the ribs

CT Angeo

Question 6

Renovascular hypertension – demographics? Physical exam finding? Imaging used in work up? Therapy?

Answer 6

Young women with fibromuscular dysplasia or old men with arteriosclerotic occlusive disease

Bruit over flank

Duplex scanning and CT Angio

Dilation and stenting in young females; controversial and older males