Tiêu đề ACS | ARRYHTMIAS | CARDIOMYOPATHY | CHRONIC ✅

CHRONIC MEDICAL DISORDER 1. YOUNG HYPERTENSION Ref : CPG Management of Hypertension 5th edition Page: 35-36 History taking • duration and level of elevated BP if known • symptoms of secondary causes of hypertension • symptoms of target organ complications (i.e. renal impairment and heart failure) • symptoms of cardiovascular disease (e.g. CHD and cerebrovascular disease) •symptoms of concomitant disease that will affect prognosis or treatment (e.g diabetes mellitus, heart failure, renal disease and gout) • family history of hypertension, CHD, stroke, diabetes, renal disease or dyslipidemia • dietary history including salt, caffeine, liquorice and alcohol intake • drug history of either prescribed or over-the-counter medication (NSAIDs, nasal decongestants, OCP/HRT) • exposure to traditional or complementary medicine • lifestyle and environmental factors including air pollution that will affect treatment and outcome (e.g. smoking, physical inactivity, substance abuse; recreational & doping, psychosocial stressors and excessive weight gain) • presence of snoring and/or day time somnolence which may indicate sleep apnoea Physical Examination • General examination including height, weight and waist circumference • Measure BP appropriately. • Fundus examination • Examination for carotid bruit, abdominal bruit, presence of peripheral pulses and radio-femoral delay • Cardiac examination for cardiomegaly, signs of heart failure and aortic regurgitation • Abdominal examination for renal masses/bruit and aortic aneurysm • Neurological examination to look for evidence of stroke • Signs of endocrine disorders (e.g. Cushing syndrome, acromegaly and thyroid disease) • Ankle brachial index (if available)
Investigation The minimum initial investigations aim to screen for presence of secondary causes of hypertension, determine the presence of CV risk factors, target organ damage (TOD) and target organ complication (TOC). They should include the following: • Full blood count • Blood glucose • Renal function tests (creatinine, eGFR, serum electrolytes) • Lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) • Uric acid • Urinalysis (dipstick: albuminuria/microalbuminuria & microscopic haematuria) • Electrocardiogram (ECG) If the examination or investigations suggest the presence of a secondary causes, the patient should be referred for specialist evaluation. If there is evidence of TOD or TOC, further tests should be considered. Management Problem list in this patient 1. Uncontrolled hypertension despite 2 anti hypertensive 2. Blood pressure 140/80 3. Obesity Lifestyle and non pharmacological management (CPG Management of Hypertension 5th edition Page 39-41) ● Weight reduction ● Dietary sodium restriction: <2g/day ● Increase dietary fruits, vegetables, low fat dairy products intake while minimizing saturated and total fat intake ● Carries out regular activity ● Limits alcohol intake & stop smoking (Adult)
Pharmacological management (CPG Management of Hypertension 5th edition Page 97- 98 Target blood pressure: Once pharmacologic therapy is initiated, BP must be reduced to <90th percentile (Systolic and Diastolic) and <130/80 mmHg in adolescents ≥13 years old. Based on this flow chart, must add another class of anti Hypertensive.
Case 1 EXAMINER NO GILIRAN PELAJAR BATCH FINAL DIAGNOSIS PROBLEM LIST - - 5 Young hypertension (secondary to renal problem) 1. Hypertensi on 2. Renal problem 3. Treatment resistance hypertensi on 4. Obese CASE Patient came with complain of palpitations since 2 years ago and currently free of active complaints Has underlying hypertension and renal problem since 3 years ago. Had proteinuria 2+ for 3 consecutive weeks and occasional headache Was on ACEI>diltiazem>ACEI>ARB>telmisartan now Claimed that medications are either still not effective and had side effects: palpitations Also had history of white coat hypertension Strong family history of hypertension, DM O/e: obese, tachycardic & bilateral pitting edema NO SPECIFIC QUESTION FOR THE CASE / OTHER PROBLEM LIST SOURCE 1. Provisional diagnosis young hypertension 2. Differential diagnosis Rule out all secondary causes of hypertension CPG Management of hypertension 5th edition Pg 34