Hypertension Target Organ Exam

Vitals:

  • Blood pressure
  • Heart rate
  • Weight and height (obesity), ideal body weight or BMI

Eyes: fundoscopy

  • Arteriolar narrowing
  • AV nicking
  • Hemorrhages
  • Exudates
  • Papilledema
  • Grading of changes
    • 1. Spasm of retinal vessels
    • 2. Constriction and sclerosis of retinal arterioles (AV nicking- increased venous compression at retinal arterio-venous crossings), silver or copper wiring
    • 3. Vascular changes, hemorrhages (flame shaped or retinal), cotton wool spots, exudates
    • 4. Above changes and papilledema



 

Head and neck:

  • Thyroid: enlargement (bruits)
  • Neck vessels: carotid bruits, JVP elevation

Cardiovascular exam: LV hypertrophy or CHF

  • Auscultate lungs
  • ↑HR
  • Peripheral edema
  • Displaced or sustained apex beat
  • S4 gallop (decreased LV compliance)
  • Murmurs (MR in CHF)
  • Coarctation of aorta murmur (medial border of left scapula)

Abdominal exam:

  • Abdominal bruits
  • Renal bruits (renovascular HTN)
  • Renal mass (PCKD)
  • Abnormal aortic pulsations
  • Striae of Cushing’s (2o)
  • Radio-femoral delay (coarctation)

Extremities:

  • Femoral bruits (PVD)
  • ↓ or no peripheral pulses, symmetrical pulses in UE and LE
  • Signs of arterial insufficiency – ABI (PVD, coarctation), skin or hair changes
  • Radiofemoral delay (coarctation)

Skin exam:

  • Cushing’s (red striae, acne, hirsuitism)
  • Pheochromocytoma (flushed, clammy, diaphoretic) – Pain, Pallor, Perpirations, Pressure, Papitations

Stroke: neurological exam
Risks for CAD (known disease, smoking, DM, FHx, dyslipidemia)

Differential diagnosis for 2O HTN

  • Medications: BCP, steroids
  • Renovascular or renal parenchymal disease
  • Endocrinopathies
    • Pheochromocytoma
    • Cushing’s
    • 1O aldosteronism
    • Hyperparathyroidism
  • Aortic coarctation
  • Sleep apnea
  • Thyroid disease (Hyperthyroid – systolic HTN; Hypothyroid – diastolic HTN)

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