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)