Hemicrania epileptica: A case study, by RxVichuZ! RxVichuZ
This is my 56th powerpoint..it deals with HEMICRANIA EPILEPTICA, one of the rarest clinical conditions. A condition, that results in ipisilateral headache/migraine, owing to seizure discharge. Relevant details have been provided. Do go through this.
GEMC: Case Presentation- Pericarditis: Resident TrainingOpen.Michigan
This is a lecture by Kwaku Nyame from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Hemicrania epileptica: A case study, by RxVichuZ! RxVichuZ
This is my 56th powerpoint..it deals with HEMICRANIA EPILEPTICA, one of the rarest clinical conditions. A condition, that results in ipisilateral headache/migraine, owing to seizure discharge. Relevant details have been provided. Do go through this.
GEMC: Case Presentation- Pericarditis: Resident TrainingOpen.Michigan
This is a lecture by Kwaku Nyame from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin.
Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly.
Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.
An interesting case of recurrent VT/Tdp following chloroquine drug overdose Apollo Hospitals
Chloroquine is a widely available drug, used for the treatment of malaria and as prophylaxis for travelers to endemic countries, rheumatoid disease and systemic lupus erythematosus. Chloroquine has a narrow therapeutic index. Large overdoses are highly fatal and there are no known antidotes. We report, herein, a case of chloroquine poisoning in a 29-year-old lady and recurrent VT/Tdp secondary to it.
Understanding Hypertension - Info from Timberland Medical Centre, KuchingTimberlandMedicalCentre
For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin.
Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly.
Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.
An interesting case of recurrent VT/Tdp following chloroquine drug overdose Apollo Hospitals
Chloroquine is a widely available drug, used for the treatment of malaria and as prophylaxis for travelers to endemic countries, rheumatoid disease and systemic lupus erythematosus. Chloroquine has a narrow therapeutic index. Large overdoses are highly fatal and there are no known antidotes. We report, herein, a case of chloroquine poisoning in a 29-year-old lady and recurrent VT/Tdp secondary to it.
Understanding Hypertension - Info from Timberland Medical Centre, KuchingTimberlandMedicalCentre
For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
The heart is the vital organ in the body, which pumps the blood and the blood flows in the whole body through the vessels called the cardiovascular system (CVS).
Hypertension i.e., high blood pressure, is a very common disorder, coccus due to excessive pressure, exerted against the wall of the arteries as it flows through them. It is also known as the “silent killer” because it usually occurs without any symptoms.
Hypertension Emergencies and their managementpptxUzomaBende
This Presentation talks about Hyprtension, the mode of presentation of hypertensive crisis and the effective management of hypertensive crisis to prevent case fatalities.
Learning Objectives1. Describe why hypertension and diabet.docxSHIVA101531
Learning Objectives
1. Describe why hypertension and diabetes are called silent diseases
2. Describe how hypertension and diabetes affect different individual, familial, and social domains
3. Explain how self-management and medication can be used to treat hypertension
4. Identify disparities in hypertension awareness, treatment, and control
5. Explain how both lifestyle changes and medication can be used to treat diabetes
6. Identify relationships between diabetes prevalence and larger social issues
Silent Disorders:
Hypertension and Diabetes 5
Huntstock/Thinkstock
CN
CT
CO_H
CO_NL
CO_CRD
atL80953_05_c05.indd 133 12/5/13 3:32 PM
CHAPTER 5Section 5.2 Definition and Brief History of Hypertension and Diabetes
5.1 Introduction to Hypertension and Diabetes
“Has Barbara been eating a lot of sweets lately?” the pediatrician asked Barbara’s mother, Margaret, on the phone. “No, she doesn’t have a sweet tooth and we don’t keep a lot of sweets in the house,” Margaret replied. Barbara was 11 and had come
down with a particularly nasty stomach ailment. “Why do you ask?” “Well, most of the tests we
did suggest that Barbara has a viral infection, but Barbara’s urine had a very high concentration of
glucose. Let’s just monitor it for a while and see what happens.”
Barbara used urine glucose test strips for several months. At first, her urine glucose went back to
normal, but a few months later it climbed back up and stayed there. She was diagnosed with type
1 diabetes, also known as diabetes mellitus. At the time Barbara was diagnosed, the family was
undergoing quite a bit of stress, because Barbara’s teenaged step-siblings were moving into the
family home.
5.2 Definition and Brief History of Hypertension
and Diabetes
D iabetes and hypertension have been called “evil twins” and “bad companions,” because they are so often found together in the same person. Both are also “silent” disorders, in that they may cause no early symptoms but create extra work for the heart and blood
vessels. Having hypertension makes it more likely that someone will develop diabetes, and hav-
ing diabetes makes it more likely that the person will develop hypertension. Both hypertension
and diabetes increase the risk for problems in the small blood vessels, known as microvascular
disease, of the eyes, kidneys, and peripheral nerves, as well as problems in the large blood vessels,
or macrovascular disease, of the heart, peripheral vascular system, and brain. The risk for both
microvascular and macrovascular disease is even higher when a person has both hypertension
and diabetes (see Table 5.1).
Table 5.1: Macrovascular and microvascular complications of hypertension
and diabetes
Macrovascular complications
Atherosclerosis Disease of the arteries that can result in heart attack
and stroke
Peripheral vascular disease Narrowing of arteries that can result in ischemia, or
restricted blood supply to tissues, and ulcers
Microvascular ...
SYSTEMIC HYPERTENSION AND SCOPE OF HOMOEOPATHY
Dr. Smita Brahmachari
Abstract:
Hypertension (HTN) is an enormous health problem and is one of the biggest health challenges in the 21st century. Although the condition is common, readily detectable, and easily treatable, it is usually asymptomatic and often leads to lethal complications if left untreated. The prevalence of HTN is increasing rapidly in India driven by diverse health transitions. Apart from health implications it has huge societal, developmental and economic costs to resource constrained health systems, particularly developing nations like India. Further, hypertension is also a leading cause for hospitalizations and outpatient visits.
Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means (medicines). Homoeopathic system of medicine particularly individualized constitutional approach has significant beneficial effects on patients suffering from HTN and thus widely used in length and breadth of our nation as an alternative public health approach in curbing the increasing prevalence of HTN because of its cost effectiveness and minimal side effects.
In current scenario with rising burden of HTN posing a serious health threat to health care system of India, the present article makes a sincere attempt to present before its readers how to timely and effectively address a case of HTN at primary level health care set-up with homoeopathic medicines.
Author : The author has done her post-graduation from National Institute of Homoeopathy, Kolkata in the subject Homoeopathic Repertory. She is presently working as Medical Officer in Dept. of ISM &Homoeopathy under Govt. of NCT Delhi.
E-mail id: smita.brahmachari@rediffmail.com.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. 3. Cerebrovascular Accident
Hypertension 1. Relative Risk increases 1.84 for each
10 mmHg DBP
= Htn, Essential Hypertension
2. Midlife hypertension raises
1. See Also longterm CVA risk
1. Hypertension in Children
2. Hypertension in Infants 3. Seshadri (2001) Arch Intern Med
3. Hypertension in Pregnancy 161:2343
4. Hypertension in Athletes
5. Hypertension in the Elderly
4. Alzheimer's Disease
1. Increased SBP in middle age is
predisposing factor
2. Epidemiology
1. Demographics
1. White Adults in US: 20% are hypertensive
2. Black Adults in US: 30% are hypertensive
3. Of all hypertensives, >50% are over age 5. Reference
1. (1995) Lancet 346(8991):1647
65 years 2. Kivipelto (2001) BMJ 322:1447
2. Outcomes
1. BEST PREDICTOR TO OUTCOME
VARIES BY AGE 3. Hypertension Definition
1. Diastolic Blood Pressure best
1. See Hypertension Criteria
predictor <50 years
4. Types
1. Essential Hypertension (Primary
2. SBP and DBP predict outcomes
Hypertension)
equally ages 50-59
1. Stage 1-2 (DBP 90-104) in 80%
of cases
3. Pulse Pressure best predictor age
2. ACCELERATED MALIGNANT
>60 years HYPERTENSION
1. Recent substantial Blood Pressure
increase
2. Associated with retinal vessel damage
2. Coronary Artery Disease
1. Hypertension Causes 35-45% 1. Retinal Hemorrhages
morbidity and mortality 2. Retinal exudates
3. Papilledema
3. Diastolic Blood Pressure over 140
2. Hypertension Resources
3. ISOLATED SYSTOLIC HYPERTENSION
1. Dash Diet and other lifestyle change handouts
1. Systolic Blood Pressure: >160 mmHg 1. http://www.nhlbi.nih.gov/health/public/h
eart/hbp/dash
2. Diastolic Blood Pressure: <90 mmHg 2. NIH Patient Handout Order Forms (free
for single copy)
3. Risks 1. CvHtnNihPubOrders.pdf
1. Coronary Artery Disease
2. Cerebrovascular Accident
4. Onset: 5th decade
5. Affects 11% of those over age 75 years
6. Results from progressive fall in vessel
compliance
5. Causes of secondary
Hypertension
1. See Hypertension Causes
6. Diagnosis
1. See Hypertension Criteria
7. Hypertension Evaluation
1. Hypertension Evaluation History
2. Hypertension Evaluation Exam
3. Hypertension Evaluation Labs
8. Management
1. See Hypertension Management
3. Isolated Systolic
Hypertension = ISH 5. Management
1. USE LOWER ANTIHYPERTENSIVE
DOSAGES
1. See Also
1. Hypertension
2. FIRST CHOICE MEDICATION: Diuretic
1. Even better benefit in Diabetes Mellitus with ISH
2. Epidemiology
1. Most common type of Hypertension in adults
2. Study of 4736 type II diabetics
3. Criteria 1. Lower Incidence of cardiac events
1. Systolic Blood Pressure: >140 mmHg (previously >160)
1. Lower Incidence of
2. Diastolic Blood Pressure: <90 mmHg
Cerebrovascular
Accidents
2. Lower Incidence of
4. Complications: Cardiovascular Risk
1. GENERAL Myocardial Infarction
1. Systolic pressure predicts risk better than
2. Reference
diastolic
1. Curb (1996) JAMA 276:1886
2. Wide Pulse Pressure best predicts cardiovascular
risk
3. OTHER MEDICATIONS
1. Dihydropyridine Calcium Channel Blocker
2. Long Acting Nitroglycerin
3. ACE Inhibitor
2. ADVERSE EFFECTS
4. Labetalol
1. Doubles all cause mortality
2. Triples cardiovascular mortality
3. Increases cardiovascular morbidity 2.5 fold
4. Pulse pressure, widened: Excerpt
from Alarming Signs and
Symptoms: Lippincott Manual of
Nursing Practice Series
LABETALOL
Pulse pressure is the difference between systolic and diastolic
blood pressures. Normally, systolic pressure is about 40 mm
Hg higher than diastolic pressure. Widened pulse pressure — a Pharmacology
difference of more than 50 mm Hg — commonly occurs as a
Metabolism: liver extensively; CYP450: unknown
physiologic response to fever, hot weather, exercise, anxiety,
anemia, or pregnancy. However, it can also result from certain Excretion: urine 50% (<5% unchanged), feces 50%; Half-life:
neurologic disorders — especially life-threatening increased 5-8h
intracranial pressure (ICP) — or from cardiovascular disorders
that cause blood backflow into the heart with each contraction Subclass: Beta Blockers
such as aortic insufficiency. Widened pulse pressure can easily
be identified by monitoring arterial blood pressure and is Mechanism of Action
commonly detected during routine sphygmomanometric selectively antagonizes alpha1-adrenergic receptors;
recordings. antagonizes beta1- and beta2-adrenergic receptors (selective
alpha and non-selective beta blocker)
Act Now: Ifthe patient’s level of consciousness (LOC) is
decreased and you suspect that his widened pulse
pressure results from increased ICP, check his vital signs.
Maintain a patent airway, and prepare to hyperventilate
the patient with a handheld resuscitation bag to help
reduce partial pressure of carbon dioxide levels and,
thus, ICP. Perform a thorough neurologic examination
to serve as a baseline for assessing subsequent changes.
Use the Glasgow Coma Scale to evaluate the patient’s
LOC. (See Glasgow Coma Scale, page 196.) Also, check
cranial nerve (CN) function — especially in CNs III, IV,
and VI — and assess pupillary reactions, reflexes, and
muscle tone. (See Exit points for the cranial nerves.)
The patient may require an ICP monitor. If you don’t
suspect increased ICP, ask about associated symptoms,
such as chest pain, shortness of breath, weakness,
fatigue, or syncope. Check for edema and auscultate for
murmurs.
5. Hypertension Causes
2. Causes: Secondary Hypertension in age
= Secondary Hypertension Causes, Hypertension Causes in <18 years old
Children, Hypertension Causes in Adolescents 1. SEE HYPERTENSION IN INFANTS
1. Causes: Secondary Hypertension in
Adults
1. MEDICATIONS 2. Renal parenchymal disease
1. See Medication Causes of Hypertension 1. Most common cause in children (up to 70%)
2. PRIMARY ALDOSTERONISM 3. Renal vascular disease
1. Most common treatable secondary cause
of Hypertension
2. Evaluate as cause in Refractory 4. Aortic Coarctation
Hypertension where Hypokalemia or
borderline low potassium
5. Endocrine conditions
1. Metabolic Syndrome
3. RENOVASCULAR OR RENAL 2. Pheochromocytoma
PARENCHYMAL DISEASE
3. Hyperthyroidism
4. PHEOCHROMOCYTOMA
5. CUSHING'S DISEASE
6. Essential Hypertension
6. HYPERPARATHYROIDISM 1. Rare in age <10 years
7. AORTIC COARCTATION
2. Most common cause in adolescents and
8. SLEEP APNEA
adults
9. THYROID DISEASE 7. Medications
1. See Medication Causes of Hypertension
1. Hyperthyroidism causes systolic Hypertension
2. Hypothyroidism causes diastolic Hypertension
1. Dernellis (2002) Am Heart J 143:718
6. Hypertension Evaluation
1. Goals
1. Confirm Hypertension (see Hypertension Criteria)
2. Identify associated RISK FACTORS
3. Identify target organ disease
4. Evaluate for secondary Hypertension
2. Evaluation
1. Hypertension Evaluation History
2. Hypertension Evaluation Exam
3. Hypertension Evaluation Labs
3. Monitoring Protocol
1. MILD BLOOD PRESSURE INCREASE
1. Recheck in 1-2 months
2. MODERATE BLOOD PRESSURE
INCREASE
1. Recheck in 1-2 weeks
3. SEVERE OR ACCELERATED
MALIGNANT HYPERTENSION
1. Immediate Treatment
4. END ORGAN DAMAGE
1. Immediate Treatment
7. Hypertension Evaluation
History 6. History: Symptoms of Urinary tract
Disease
1. Urinary Tract Infection
1. History: Past Medical History
2. Nephrolithiasis (or Hypercalcemia)
1. Onset and severity of Hypertension
3. Benign Prostatic Hypertrophy
2. Average Blood Pressure
2. History: Family History
1. Hypertension
2. Kidney disease 7. Findings: Evidence of Endocrine
Disease
1. Diabetes Mellitus
2. Hyperthyroidism
3. History: Medications 3. Hypothyroidism
1. See Medication Causes of Hypertension
4. HYPERPARATHYROIDISM
4. History: Habits: (HYPERCALCEMIA)
1. Salt intake 1. Confusion
2. Fat intake 2. Major Depression
3. High caloric intake contributing to Obesity 3. Abdominal Pain
4. Alcohol use 4. Nephrolithiasis
5. Tobacco Use 5. Constipation
6. Recreational drugs of abuse
1. Cocaine
2. Methamphetamine
5. CUSHING'S DISEASE
1. Acne Vulgaris
2. Osteoporosis
3. Bone Fractures
5. History: Lead Exposure Risk
4. Glucose Intolerance
1. Lead paints
2. Printer inks
3. Inhalation risks
4. Postmenopausal women
6. ALDOSTERONISM
1. Lead increases due to skeletal lead 1. Hypokalemia
mobilization 2. Muscle Weakness
2. Nash (2003) JAMA 289:1523
3. Paresthesias
4. Tetany
9. Blood Lead, Blood Pressure, and Hypertension in
Perimenopausal and Postmenopausal Women
Denis Nash; Laurence Magder; Mark Lustberg; et al.
Online article and related content
current as of January 3, 2010. JAMA. 2003;289(12):1523-1532 (doi:10.1001/jama.289.12.1523)
http://jama.ama-assn.org/cgi/content/full/289/12/1523
Correction Contact me if this article is corrected.
Citations This article has been cited 60 times.
Contact me when this article is cited.
Topic collections Occupational and Environmental Medicine; Women's Health; Women's Health,
Other; Hypertension
Contact me when new articles are published in these topic areas.
Related Letters Blood Lead Levels and Hypertension
Hans W. Hense. JAMA. 2003;290(4):460.
Robert P. Heaney. JAMA. 2003;290(4):460.
Subscribe Email Alerts
http://jama.com/subscribe http://jamaarchives.com/alerts
Permissions Reprints/E-prints
permissions@ama-assn.org reprints@ama-assn.org
http://pubs.ama-assn.org/misc/permissions.dtl
Downloaded from www.jama.com by guest on January 3, 2010