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 Hypertension

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dr saad
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عدد المساهمات : 176
تاريخ التسجيل : 12/12/2010
العمر : 35
الموقع : http://medsurgery.ba7r.org

مُساهمةموضوع: Hypertension    الجمعة 01 أبريل 2011, 20:58

1424 H
95%  essential HTN
5% 
R: Renal:
- Polycystic Kidney Disease
- CRF
- GlumeruloNephritis
- Renal Artery Stenosis
- Renal Cell Carcinoma
E: Endocrine:
- Cushing's
- Pheochromocytoma
- Acromegaly
- Thyrotoxicosis
- Conn's
- Carcinoid tumor
- Hyperparathyroidism
- Primary hypothyroidism
- Congenital adrenal hyperplasia
C:
- Corticosteroids
- Contraceptive pills
- Clonidine withdrawal
- Coarctation of aorta
A:
- Arteritis (eg. Takaiaso)
- Alcohol
P:
- Pregnancy
- Polycythemia rubra vera (PRV)
D: Drugs:
- NSAIDs
- Sympathomimitics
* Refractory "Resistant" HTN: 
3 anti-HTN medications with maximum dose. One of them is Diuretic for 3
months
Examination:
• Inspection:
- Acromegaly
- Cushing
- Thyroid
• Palpations:
- Renal "for polycystic"
- Radio femoral artery "Coarctation"
مھم
• auscultation:
Renal bruit for tumor, renal aneurysm
• Then look for an end organ damage
• Heart "apex beat"
• Eye for papilloedema
Investigations: in all patients with HTN
(1) U & E:
 К+
- Conn's
- Pheochromocytoma
- Cushing
 К+  CRF
(2) Blood glucose  hyperglycemia  DM
(3) Urinalysis (Active sediments):
- RBC cast
- Haematuria
- Proteinuria
(4) Lipid profile  atherosclerosis
(5) CXR
- Cardiomegaly
- Coarctation of aorta
(6) ECG  Left ventricular hypertrophy
(7) Echo  Left ventricular hypertrophy
------------------
Serum urea & Creatinine: RF
Serum uric acid before ttt with diuretics:
If the patient has hyperuricemia  diuretic therapy is contraindicated
Cushing:
Overnight suppression test
Or
24 hrs urine cortisone
If you're suspecting it's secondary to a Connective Tissue disease 
screening must be made.
Main diagnosis for renal artery stenosis:
(The most common cause of HTN in young patient)
1- Doppler US
2- INP = delayed uptake
3- Captopril renogram
4- Angiogram
Pheochromocytoma:  Investigation:
 Chatecholamines either in urine or blood
CT for the abdomen  localize the tumor
If not localized, do adrenal venous sampling to localize
GENE
RAL
Vasodilators
Β-blocker
diuretic
Treatment: step one management
- IHD: ACE inhibitor &/or B-Blocker
- DM: Diltiazam – verapamil
Never use Dihydro__?_____ in HTN & DM patient, because they worsen
proteinuria:
- Amlodipin
- Nifidipin
HTN Emergency:
HTN + Brain Hemorrhage  don't lower the Blood Pressure rapidly
HTN + HF  lower the Blood Pressure
 ناقص
 α-methyl dopa  poor or pregnant
ACE inhibitors
Β-blockers
Hydralazine
 Thiazide
الرجوع الى أعلى الصفحة اذهب الى الأسفل
http://medsurgery.ba7r.org
 
Hypertension
استعرض الموضوع السابق استعرض الموضوع التالي الرجوع الى أعلى الصفحة 
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