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75 Cards in this Set
- Front
- Back
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Classify a BP of 100/60
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Normotension
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Classify a BP of 170/90
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Stage 2 Hypertension
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Classify a BP of 138/110
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Stage 1 Hypertension
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Classify a BP of 121/85
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Prehypertension
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List the JNC Classification of hypertension
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Normal<120/80
Prehypertension: 120-139/80-89 Stage 1: 140-159/90-99 Stage 2: >160/>100 |
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Write the equation describing BP that can be derived from Poiseuille's law.
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P=QR-->BP=COxSVR (systemic vascular resistance)
BP=SVxHRxSVR CO=SVxHR |
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What are some sources of catecholamines that can affect blood pressure?
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Pheochromocytoma
Decongestants Anorectics Cocaine MAOi's + tyramine |
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List some sources of excess renin.
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Renovascular HTN
Intrinsic renal dz JG cell tumors UTO Renal compression (page kidney) Coarctation of the aorta? |
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Catecholamines, ATII, serotonin, ADH, ouabain. All of these have what effect on vascular tone?
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Vasoconstriction
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ANP, PTH, PGI2, Calmodulin. All of these have what effect on vascular tone?
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Vasodilation
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List the determinants of PVR.
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Vascular tone
Vascular compliance Blood viscosity |
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Define systolic hypertension.
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SBP>140 & DBP<90
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What are the mechanisms of systolic hypertension?
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Increased SV (adrenergic stimulation, white coat HTN, fever, severe anemia, aortic insufficiency, arteriovenous fistula)
Decreased compliance of arterial system |
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What can be caused by arteriovenous fistula?
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Systolic HTN
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What are the mechanisms of diastolic HTN?
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Increased vascular resistance
Rarely, high blood viscostiy |
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What is the epidemiology of essential HTN?
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M>F, more common in African Americans
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How is a diagnosis of essential HTN made?
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Exclusion of secondary HTN
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List the risk factors for essential hypertension.
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Obesity
Salt intake Calcium intake Alcohol intake Low Birth weight Genetic factors & race |
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What is the relation of salt intake and essential HTN?
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Most individuals are not affected by salt intake.
But some are salt-sensitive and so increased salt consumption-->HTN Salt reduces age-related increased in BP |
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What is the relationship of Calcium intake and essential HTN?
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High Ca intake appears to be associated with lower BP
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Why are high-calcium diets not recommended for individuals with essential hypertension?
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Increased calcium intake increases the risk of kidney stones
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Why is low birth weight associated with essential HTN?
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Smaller kidneys-->smaller number of nephrons
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What is the relationship between K intake and essential hypertension?
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Increased K intake-->reduced BP
High K diet not recommended |
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What are the first tests you run in a patient you think has essential hypertension?
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Serum creatinine
Urinalysis Serum K Lipid profile & ECG |
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Define hypertensive emergency.
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SBP>180 and/or DBP>120 AND evidence of acute end-organ damage
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Define hypertensive urgency.
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SBP>180 and/or DBP>120 without evidence of acute end-organ damage
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What is pseudohypertension?
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Condition in which BP measured by pneumatic cuff is falsely high b/c brachial arterial wall is VERY noncompliant-->measure BP with arterial catheter
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When should you suspect pseudohypertension?
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When a patient has severe generalized PVD (usually elderly or long-standing DM)
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Why is it important to ID pseudohypertension?
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Treatment of pseudohypertension as essential HTN-->decreased tissue perfusion & orthostatic hypotension
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Define resistant HTN.
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BP that remains above goal despite confirmed administration of 3 antihypertensive medications including a diuretic.
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Define pheochromocytoma.
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Tumor of neuroectodermal origin which secretes catecholamines.
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What is the cellular origin of pheochromocytoma?
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Neuroectodeerm
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What is the rule of 10%?
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Pertains to pheochromocytoma
10% bilateral 10% malignant 10% outside adrenal |
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What is the classic triad of pheochromocytoma?
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Sweating attacks
Tachycardia (palpitations) Headaches |
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What casts doubt on a diagnosis of pheochromocytoma?
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Flushing
Absence of triad excludes dx |
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How do you screen for pheochromocytoma?
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24hr urine for metanephrine & normetanephrine
Serum metanephrines |
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How do you confirm pheochromocytoma?
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Plasma catecholamines
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When is a clonidine suppression test used?
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When the plasma catecholamine test used to confirm pheochromocytoma is borderline or modest elevation.
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What is a clonidine suppression test?
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Administer clonidine.
In normal patients, total plasma catecholamine concentration decreases by at least 50% In px w/pheochomocytoma, less supression |
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What can interfere with a clonidine suppression test?
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Beta blockers
Tricyclic antidepressants Diuretics |
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What is the gold standard for imaging of pheochromocytoma?
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MRI/CT
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What can be used to diagnose pheochromocytoma if MRI and CT are inconclusive?
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MIBG scintigraphy
MIBG concentrates in pheochromocytoma |
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How is pheochromocytoma treated?
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Alpha blockers BEFORE beta blockers
Volume expansion Nitroprusside for HTN Metyrosine SURGERY |
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What are the causes of hyperaldosteronism?
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30% bilateral adenoma
65% bilateral adrneal hyperplasia 1% adrenocortical carcinoma |
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What is the triad of hyperaldosteronism?
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HTN
Hypokalemia Metabolic alkalosis |
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What is the hallmark of hyperaldosteronism diagnosis?
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Suppressed plasma renin activity & elevated serum or urine aldosterone
Aldosterone:Renin>20 if aldosterone is elevated |
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What are the steps in diagnosis of hyperaldosteronism?
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Aldosterone:renin
Evidence of renal K wasting Show inappropraite aldosterone secretion |
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How do you show inappropriate aldosterone secretion?
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Infuse 2L saline over 4h-->measure plasma aldosterone-->+ if >10ng/dl
High Na diet x3d-->24hr urine-->+ if 24hr Na>20mmol & urine aldosterone>14mcg |
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How can you differentiate adenoma & hyperplasia?
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Hypokalemia<3mEq/L &/or postural drop in plasma aldosterone-->adenoma
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What imaging is done for hyperaldosteronism?
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CT & MRI
Iodinated cholesterol scan after dexamethasone suppression of normal adrenal cortical activity can separate adenomas & hyperplasias |
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How are adenomas causing hyperaldosteronism treated?
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Surgery
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How is adrenal hyperplasia causing hyperaldosteronism treated?
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K-sparing diuretics & Na-channel blockers
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What is the 2nd most common cause of secondary HTN?
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Renovascular disease
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What are the two types of renovascular disease?
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Renal artery stenosis caused by:
Atherosclerotic OR Fibromuscular dysplasia |
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What type of renal artery stenosis would you expect a 65 year old man to have?
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Atherosclerotic
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What type of renal artery stenosis would you expect a 25 year old woman to have?
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Fibromuscular dysplasia
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How does renal artery stenosis caused by atherosclerotic dz appear?
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Narrowed
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How does renal artery stenosis caused by fibromuscular dysplasia appear?
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Beaded
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What cases would cause you to suspect renal artery stenosis as a cause of HTN?
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Onset of moderate-severe HTN in person<30
HTN in absence of family hx of HTN Dev. of acute renal dysfunction after acceptable BP reduction by conventional meds Unprovoked hypokalemia or severe hypokalemia after diuretic therapy Flank or abdominal bruit |
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Flank or abdominal bruit in a px w/HTN causes you to think of what kind of diseae?
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Renal artery stenosis
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If a young woman has HTN and an abdominal bruit, what do you suspect?
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Fibromuscular dysplasia
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How is renovascular disease diagnosed?
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IVP
Radioisotope renogram Peripheral renins Captopril test |
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Describe the functional test for renovascular disease.
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Captopril scintigraphy
Decreased & delayed peak w/slower washout in stenotic kidney |
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What can affect the results of captopril scintigraphy?
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ACEi use can decrease sensitivity
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What is the gold standard for imaging of renovascular disease?
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renal arteriogram
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What is the goal of treatment of renovascular disease?
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Control BP
Preserve renal mass |
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When is surgery recommended for renovascular disease?
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always for fibromuscular dysplasia
for atherosclerotic lesions that are hemodynamically significant |
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List the indications for diagnostic arteriography for renovascualr dz.
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Onset of HTN<30 or >55
Systolic-diastolic abdominal bruit Accelerated or resistant HTN Recurrent CHF/pulmonary edema Renal failure of uncertain etiology Coexisting diffuse PVD, esp, in smokers Rapid decrease in renal fxn w/ACEis or ARBs Asymmetric kidney in px w/HTN |
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What can cause Cushings?
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Pituitary microadenoma
Adrenal adenoma Iatrogenic Ectopic ACTH |
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What are symptoms of Cushings?
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Sudden weight gain, truncal obesity, abdominal striae, glucose intolerance, HTN, moon facies, muscle weakness, hirsutism
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How is Cushings diagnosed?
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CT/MRI of head and chest
24hr urine cortisol excretion>3x normal upper limit Low dose dexamethasone suppression test: positive>50 Late night salivary cortisol |
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What is the treatment for Cushings?
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Surgical resection
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What is associated with coarctation of the aorta?
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Secondary HTN
Turner syndrome Bicuspid AV valve |
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What are some symptoms of coarctation of the aorta?
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Higher BP in arms than in legs
Physical exam Rib notching on xray Angiography for diagnosis |
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What is the treatment for coarctation of the aorta?
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Surgical correction if done early
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