doc_friend_india
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HYPERTENSION :
why is there occipital headache in morning?
WHY PALPITATIONS?
what would be ecg findings of left ventricular strain ?
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| ELM
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Why occipital haedache....beats me. :cry:
Palpitation <----Heart has to work hard<---increased O2 demand throughout the body<---constriction of blood vessels including moycadial<----increased sympathetic/increased plasma volume=HTN
EKG--->LVH=LV ischemic manifestations ....T changes, ST elevation and whole bunch....
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| mdwannabe
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axis diviation and R wave progression would be some of early signs...t changes,,,come later, when ischemia persists
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| miky
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occipital headache - worse in the morning on waking up, better in the evening before going to bed.
I think that when you wake up in the morning and therefore adopt the orthostatic position, the very receptors that regulate BP feel the positional change and react accordingly to adjust BP to normal levels.
Unfortunately, in HTN there is a disregulation of vascular receptors, and I think there is a sudden vasodilation of cerebral vessels in response to increased venous return to heart (once you adopt the errect position, there is a physiological pooling of blood in the lower limbs - the heart will feel that and will try to suck in this peripheral blood to more central areas by well known mechanisms) :wink: .
The problems now is directly related to the brain vascular system 8) . As you know, the anterior cerebral circulation has many syphons (these are S - shaped curvings of the vessels inside your brain, so if, for instance, there is an sudden increase in BP, these syphons will accommodate the high BP by gradually lowering it so that it will not damage the smaller vessels; in fact these syphons are damaged by long standing hypertension, so in time they will be no more that capable of exerting their natural function; that is why you may develop CVE, hemorrhagic type, with a sudden increase in BP). I've read about this theory in a textbook of neuroanatomy :icon_study: .
So, taking the above theory as valid, I might dare to say that the anterior cerebral circulation is better protected against increased BP levels then the posterior circulation. That is why the posterior cerebral vessels don't cope very well with variations in BP, so they dilate more chaotically than the anterior cerebral vessels do (they actually dilate very little, due to previously mentioned syphons) 8) .
So, that is why, in my opinion, the headache in HTN is more severe in the occipital region than in other regions (most commonly the frontal one).
Hope I am not wrong. [-o<
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| scorpion
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For palpitation: HTN -----> high after load -----> harder work for the heart --> hyper dynamic --> palpitation
For ECG we see:
1- LVH [SV1 + RV5 > 35 mm] not LAD
[LVH does not cause LAD, the most common cause of it is LAFB]
2 -LV strain we see: ST depression and T wave flipped
[ST elevation we see in acute MI,prinzmetal angina and pericarditis not in ischemia]
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| mdwannabe
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Hypertrophy is the classic cause of axis diviation towards the hypertrified ventricle. Also it diviates away from infarcted one.
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| doc_friend_india
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thanks everyone ! 
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