CCC - Hypertension Flashcards
What is seen in stage 1 hypertension, retinopathy?
Silver wiring
What is seen in stage 2 hypertension, retinopathy?
AV nipping
What is seen in stage 3 hypertension, retinopathy?
Flame haemorrhage
What is seen in stage 4 hypertension, retinopathy?
Optic disc is flatten in papilloedema
Signs of hypertension other than retinopathy?
Left ventricular hypertrophy - may feel a heave or hear S4
Causes of hypertension?
Secondary - Phaeochromocytoma Cushing's Conn's Acromegaly Renal artery stenosis Co-arctation of the aorta
Primary - essential HTN
Investigations for hypertension?
FBC - polycythaemia U&Es - pot might be low in secondary causes e.g. phaeos ECG - hypertrophy Urinalysis - nephritis or renal disease Fasting glucose - diabetes Lipids
Special tests for secondary causes of HTN?
Renin Aldosterone 24hr urine for catecholamines 24hr urine for cortisol and LDDST if cushingoid Glucose test is acromegalic
How does conn’s cause HTN?
Adrenal tumour causes raised aldosterone
Raised BP
This high aldosterone suppresses renin so renin levels will be low on testing.
How does renal stenosis cause HTN?
Increases renal HTN
Renin high
Angiotensin high
Stimulates adrenal gland a lot which raises aldosterone again
(co-arctation of the aorta does the same thing)
How does a phaeochromocytoma cause HTN?
Adrenal medulla tumour
Increase catecholamines that increase stress
Adrenaline is suddenly pushed out all at once and binds to beta 1 receptors causing episodes of HTN
Renin, aldo, angio will all be normal though
How do phaeochromocytomas present?
Periods of Nervousness Sweat over face Palpitations Episodic, severe HTN Can even cause ischaemic bowel episodes.
Episodes can last a year or so as the tumour grows
Therapeutic steps in phaeo’s
- Alpha blockade (stay on this for future steps)
- Beta blockade
- Localise lesion
- Surgery
What are the grade of hypertension?
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IMAGE
What is the pathway to treating hypertension?
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