Chronic hypertension physical examination: Difference between revisions
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* Abdominal examination for enlarged kidneys, masses, distended urinary bladder, and abnormal aortic pulsations | * Abdominal examination for enlarged kidneys, masses, distended urinary bladder, and abnormal aortic pulsations | ||
* | ===Pulses=== | ||
The presence of coarctation is suggested by a radial femoral delay, a difference in the strength of the pulse in the upper extremities (right stonger than left) and the following detailed findings: | |||
* Left subclavian proximal to coarctation: [[hypertension]] and normal [[pulses]] in both arms and [[hypotension]] and diminished pulses in lower extremities (differential [[hypertension]]). Synchronous radial pulses, but radial-femoral delay will be present under palpation in either arm. This may be appreciated best by simultaneous arm and leg pulse palpation. | |||
* Left subclavian distal to coarctation: [[hypotension]] and diminished pulses in left arm and lower extremities. Asynchronous radial pulses will be detected in the right and left arms. A brachial-femoral delay between the right arm and the [[femoral artery]] may be apparent, while no such delay may be observed with left arm brachial-femoral palpation. | |||
* Both right and left subclavian artery originate below coarctation: [[blood pressure]] and [[pulses]] decreased in all four extremities. | |||
* In mild cases though the [[pulses]] are palpable in all for extremities a brachial-femoral delay can be appreciated. | |||
** Femoral pulses are often diminished in strength. [[Exercise]] exacerbates this gradient. | |||
* Neurological assessment | * Neurological assessment | ||
Revision as of 23:13, 10 May 2014
|
Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian
Overview
A thorough physical examination should be performed in the hypertensive patient to identify signs of end organ damage (retina) as well findings that might suggest that the hypertension is secondary to another disorder (secondary hypertension) such as renal artery stenosis.
Physical Examination
The physical examination should include:[1]
- Measurement of vital signs (temperature, pulse, respiratory rate, blood pressure). Blood pressure should be measured according to appropriate technique.
- Measurement of height, weight, waist and abdominal circumferences. Calculation of BMI is required.
- Examination of optic fundi
- Auscultation of carotid, abdominal, and femoral bruits
- Palpation of thyroid gland
- Thorough examination of the heart and lungs
- Abdominal examination for enlarged kidneys, masses, distended urinary bladder, and abnormal aortic pulsations
Pulses
The presence of coarctation is suggested by a radial femoral delay, a difference in the strength of the pulse in the upper extremities (right stonger than left) and the following detailed findings:
- Left subclavian proximal to coarctation: hypertension and normal pulses in both arms and hypotension and diminished pulses in lower extremities (differential hypertension). Synchronous radial pulses, but radial-femoral delay will be present under palpation in either arm. This may be appreciated best by simultaneous arm and leg pulse palpation.
- Left subclavian distal to coarctation: hypotension and diminished pulses in left arm and lower extremities. Asynchronous radial pulses will be detected in the right and left arms. A brachial-femoral delay between the right arm and the femoral artery may be apparent, while no such delay may be observed with left arm brachial-femoral palpation.
- Both right and left subclavian artery originate below coarctation: blood pressure and pulses decreased in all four extremities.
- In mild cases though the pulses are palpable in all for extremities a brachial-femoral delay can be appreciated.
- Femoral pulses are often diminished in strength. Exercise exacerbates this gradient.
- Neurological assessment
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[2]
Summary of Recommendations on Physical Examination (DO NOT EDIT)[2]
| Class I |
| "1. It is recommended that all hypertensive patients undergo palpation of the pulse at rest to determine heart rate and to search for arrhythmias, especially atrial fibrillation. (Level of Evidence: B)" |
References
- ↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
- ↑ 2.0 2.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.