Investigations

• What causes BP to be different in different arms?

  Young person - muscle is compressing an artery too much or structural problem blocking the flow

  Elderly - atherosclerosis or health issues (e.g. diabetes)

  Peripheral artery disease - arteries clogged by cholesterol

  Heart defects

  Cognitive decline

  Kidney disease

  Aortic dissection
• What blood tests aid in the diagnosis of HTN?

  Electrolyte levels

  Blood glucose

  Thyroid function tests

  Kidney function tests

  Total cholesterol & triglycerides
• What is serum lipid profile?

  Assesses CV risk for the next 10 years

  Measures total cholesterol, HDL, LDL & triglycerides
• What is arterio-venous nicking?

  Chronic HTN stiffens & thickens arteries

  At AV crossing points (arrow on pic), arteries indent and displace veins

  
• How many electrodes are used in a 12-lead ECG?

  10
• What is sinus tachycardia?

  Sinus rhythm with a rate greater than 100 bpm
• What is a sinus rhythm?

  Normal heartbeat triggered by the SAN
• What does this fundoscopy image show?

  Opacification (silver or copper wiring) of arteriolar wall (white arrows)

  Opacification = cloudy

  
• Why is ambulatory BP monitoring used?

  Avoid 'white coat hypertension'

  Better assessment of HTN

  More accurate
• Why is there increased blood urea levels in HTN?

  Decreased eGFR -> less urea is filtered -> increased urea in blood
• What does this fundoscopy image show?

  A flame-shaped retinal haemorrhage (white arrow)

  
• What does this fundoscopy image show?

  A cotton-wool spot (white arrow), retinal haemorrhage & microaneurysms (black arrows)

  
• What does this fundoscopy image show?

  Swollen optic disc & macular exudate

  
• Why is BP taken in both arms?

  Difference between the arms (esp in systolic pressure) predicts further heart or stroke risks

  A difference greater than 10 mmHg suggests presence of an aortic or subclavian artery disease
• How many blood pressures need to be taken to diagnose HTN?

  At least 3 readings that are elevated or a 24 hour monitor
• What is the ambulatory blood pressure monitoring?

  24 hour monitoring to diagnose HTN

  Cuff attached to a machine on waist

  
• Why is a 12-lead ECG done in patients with HTN?

  Evaluate for presence of left ventricular hypertrophy or silent MI
• How can you see sinus tachycardia on an ECG?

  Mirror image of lead II & avR on ECG (upright lead II & inverted avR)

  Narrow QRS

  Upright P wave

  Fast HR

  
• How often should blood pressure be checked?

  If BP in healthy range -> every 5 years

  120/80 mmHg and 139/89 mmHg -> checked every year
• What is fundoscopy?

  Visual examination of fundus (back of the eye)
• What does this fundoscopy image show?

  Arteriovenous nicking (black arrows) and focal narrowing (white arrow)

  
• What does this fundoscopy image show?

  Exudates & flame haemorrhages

  
• What is another name for fundoscopy?

  Ophthalmoscopy
• What is the histopathology of HTN?

  Hyaline arteriosclerosis

  Hyperplastic arteriosclerosis ('onion-skinning')
• What is hyaline arteriosclerosis?

  Arteriolar wall is thickened with deposition of amorphous proteinaceous material

  Lumen in narrowed

  
• What is shown in the image? (black arrow)

  Hyperplastic arteriosclerosis (onion-skinning)

  
• What blood tests are done for HTN?

  Full lipid profile

  HbA1c

  eGFR

  Urea/creatinine

  Electrolytes
• Why is a full lipid profile done in HTN?

  Hypercholesterolaemia -> increased risk of atherosclerosis -> can lead to HTN
• Why are HbA1c levels investigated in HTN?

  Raised HbA1c suggests diabetes

  Diabetes is a risk factor for HTN
• Why is eGFR investigated in HTN?

  Assess kidney function

  Sustained HTN can interfere with autoregulation of blood flow at glomerulus

  Also, HTN can damage glomerulus -> CKD
• Why are urea/creatinine levels tested in HTN?

  Assess kidney function

  Low eGFR -> reduced ability to filter blood -> accumulation of urea & creatinine -> suggests end-organ damage
• In U&Es, what does unprovoked hypokalaemia suggest?

  Hyperaldosteronism (this can lead to secondary HTN)
• What is tested on urinalysis in HTN?

  Albumin : creatinine ratio

  Haematuria
• Why is albumin:creatinine ratio tested in HTN?

  Assess kidney function

  HTN damages glomerulus -> albuminuria -> kidney disease

  Presence of albumin in urine suggests end-organ damage
• What is haematuria associated with?

  Nephritic syndrome (can lead to secondary HTN)
• What is found on an ECG in HTN?

  Left Ventricular Hypertrophy - most common, increased voltage amplitudes in QRS complexes (wide QRS complexes) in lead I, aVL, V5, V6

  Left Atrial Enlargement - wide & notched P wave (in leads II, III, aVF)

  ST-T Changes - ST segment depression or T wave inversion (can be seen in other CV conditions)

  Arrhythmias - atrial fibrillation -> irregularly, irregular R-R intervals, absence of P waves