fongch
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This is a question from UW. Please refer to the attached file.
Attached Files:
065.GIF (13 KB, 76 downloads)
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| snake0613
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c?
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| vradojc1
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d - primary hyperaldosteronism (adenoma/hyperplasia)
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| Justice
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My guess is (D);
Also like (B)
Both of them are due to atherosclerosis
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| vradojc1
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I agree with you Justice.
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| doyoudig
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Its Renll Artery Stenosis esp if Bilateral Plus Pt has all RF for Athersclerosis
I am just not sure if B or D is more specific/sensitive?
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| dr.wad
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i checked my mind >>> i think it is ( B )
Edited by dr.wad on 04/25/07 - 05:53 AM
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| Justice
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This is (B), guys...
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| sridevibandaru24
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Why can't it be A. His BP in both Upper limbs is different indicating Coarctation of Aorta. Thats why his Hypertension is resistant to control.
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| Justice
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sridevibandaru24 wrote:
Why can't it be A. His BP in both Upper limbs is different indicating Coarctation of Aorta. Thats why his Hypertension is resistant to control.
That is not of a big difference to say that the HTN is due to co-arctation of thoracic aorta... In addition, the bruit would be heard on a back with irradiation onto neck vessels (with some variety).
This Pt has his bruit in para umbilical area where renal vessels brunch off... So, the Pt has atherosclerosis of abdominal aorta and renal arteries ===> activation of renin-AGTN...
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| sridevibandaru24
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Oh OK! Igot your point.Thank you Justice
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| doc_clotaire
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Totally and unequivocally B 
This is Renal Stenosis secondary to ATHEROSCLEROSIS .
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| fongch
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So it is OK to have a 20mmHg difference between two arm?
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| vradojc1
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But that is not specific for coarctation. What type would that be? Preductal (and in very weird location, prior to origin of left subclavian, and in that case he would have had manifestations much earlier.
So fongchi, what is the answer?
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| sachida
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B to me. Multiple risk factors for atherosclerosis (HTN,Dm,Hypercholesteremia), MI suggest renal stenosis is more likely cause of resistant hypertension.
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| doyoudig
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fongch I think if you put this question here from UW pls provide the answer so that everyone knows
I have this question in UW and the answer is B
RAS can be d/t 2 things
-Atherosclerosis - Mainly in elderly w/ Risk Factors (as this Pt has) or
-Fibromuscular D -Mainly seen in Younger Pts
The Incr in BP is d/t neurohumoral activ of the Renin-Angio Sytem b/c of Low Blood Flow to the Kidney, since this Pt has Athersclerotic Dis it would explain the difference in BP Values btw the Upper Extremities as well
Coarctation of the Aorta in Adults is MCly would give a different Cllinical Picture besides ,
BP Values could be Greatly different btw the Upper Extr or High w/ same Values btw them, but you would also observe Lower pressures in the Lower Extremities
In adittion in adults Coarct is mostly distal to the Subclavian Artery hence Pt with this Obstruction have well developed upper extr (Muscular) compared to the Lower extr. You would also see notching of the Ribs, when the obstruction is dital b/c of increased blood supply to the collateral arteries, the incr in blood flow causes erosion.
Complications of Coarct are, AR or Cardiac Tamponade
So as you can see the majority of the clinical Sx's in this Pt point toward athersclerosis rather than coarct
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