HYPERTENSION

HYPERTENSION

Ques. 1     What is meant by Hypertension?

Ans.          Hypertension may be systemic or pulmonary. Systemic hypertension is the persistent rise of basal blood pressure above the arbitrary level of 150/90 mm of Hg. Irrespective of age.

Ques. 2     Classify hypertension on different grounds.

Ans.          Aetiological classification :

  1. Primary or Idiopathic or essential by far majority of cases (90%)
  2. Secondary :
  3. Extra renal- Cohn’s syndrome, Cushing’s syndrome, Phacechromocytoma, Climacteric hypertension, Diabetes mellitus, Thyrotoxicosis, A ortic stenosis, A ortic incompetence, Gout and osteoarthritis, Lead poisoning, chronic alcoholism. Enlarged prostate, Brain tumour, Polycythemia, Arteriosclerosis of pancreatic vessels.
  4. Renal – Acute and chronic glome rulonephritis, chronic pyelonephritis, polycystic kidneys, renal stones tuberculosis tumours of the kidney, injury, toxaemia of pregnancy.

III. Pathological :

  1. Malignant : when the blood pressure above the level of 220/130 mm of Hg. (Tetinopathy with papilloedema, Encephalopathy).
  2. Predisposing factors :

obesity, Heredity, emotional upset, Psychological disturbances.

Clinical Features : Symptoms –

  1. Insomnia and headache, vertigo.
  2. Easy fatigue.
  • Dizziness, impairment of memory, mental deterioration.
  1. Breathlessness on exertion.
  2. Transient paralysis, C.V.A.
  3. Dimness of vision, blindness.
  • May be asymptomatic,
  • Nervousness & irritability (palpitation).

Ques. 3     What are the Various signs of Hypertension?

Ans.          Signs –

  • Age – usually above 40 years, Sex-commonly males, Build-usually robust.
  • Blood pressure, grades depend upon the diastolic pressure :

 

 

Diastolic pressure

Systolic pressure

(i)

Mild

95-110 mm. Hg.

150-200 mm. Hg.

(ii)

Moderate

110-125 mm. Hg.

180-230 mm. Hg.

(iii)

Severe

125-140 mm. Hg.

210-260 mm. Hg.

(iv)

Gross

Beyond 140 mm. Hg.

240-300 mm. Hg.

 

3) Hypertensive Retinopathy which consists of 4 types :

(i)

Type

I

Narrowing of retinal vessles

(ii)

Type

II

(Type I) + exudates.

(iii)

Type

III

(Type I and Type II) + Heamorrhage

(iv)

Type

IV

(Type I, Type II and Type III) + papilloedema.

 

4)   Renal – Oliguria, uraemia, haematuria, polyuria also may be anuria.

5)   Haemorrhage- Haematuria, heamatemesis and melaena, epistaxis, haemoptysis, menorrhagia etc.

6)   Cardiac findings – (i) cardiac impulse heaving, (ii) presystolic gallop rhythm, (iii) second sound at the base accentuated and high pitched. (iv) apex beat shifted slightly to the left and downwards (left ventricular hypertrophy),

Ques. 4     How can you Diagnose Hypertension?

Ans.          Diagnosis : (or Assessment) – By considering the presence of

  1. cerebral symptom,
  2. cardiovascular symptoms,
  • eye & renal symptoms.
  1. neurasthenic symptoms,

Ques. 5     What are the Complication of Hypertesion?

Ans.          Complications:

  1. Cerebral haemorrhage, subarachnoid haemorrhage, cerebral thrombosis.
  2. Hypertensive encephalopathy.
  • Epistaxis, haemoptysis.
  1. Detachment of retina, dimness of vision.
  2. Angina Pectoris.
  3. Nephro-sclerosis.

Mode of Termination:

  1. Cerebral haemorrhage and other episodes.
  2. Acute left ventricular failure.

Ques. 6     What is the Prognosis?

Ans.          Prognosis : It depends on some factors, viz,.

  1. Degree of renal impairment.
  2. Family history.
  • Age.
  1. Results after therapy, etc.
  2. Degree of hypertension.
  3. H/O. cardiac failure.
  • Occular changes.

Ques. 7     What is the treatment of hypertension?

Ans.          The Treatment of hypertension is:

Treatment :

  1. Salt restricted diet, over eating should be avoided,
  2. Sedative,
  3. Anti-hypertensive.
  4. Treatment of complications.
  5. In case of malignant – Above (i.e. serial Nos. 2 to 7) plus the management should be very active and immediate.
  6. In case of asymptomatic – (i) if diastolic pressure is below 120 mm. of Hg.- No treatment. (ii) if diastolic pressure is above 120 mm. of Hg. –Treatment is necessary. (iii) not to inform the patient.
  7. Rest-physical, mental.
  8. Homoeopathic Remedies.

Ques. 8     Which Homoeopathic Remedies are useful?

Ans.          The Homoeopathic Remedies are :

(i) DIGITALIS – Sensation as if heart would stop beating if one moved. Palpitation excited by talking, motion or on lying down. Short, hurried breathing.

(ii) GELSEMIUM – Desires to be alone. Dullness, drowsiness and dizziness trembling are the keynotes of this remedy. Vertigo and giddiness. Excessive action of the heart, palpitation, Sensation as if heart’s action would ceases. Pulse slow & full, frequent soft and weak, almost imperceptible, intermittent. Fear of death.

(iii) CONIUM – Especially for old people. Weak memory, forgetfulness, vertigo. Headache. Violent palpitation of heart, irregular pulse. Trembling gait. Want of sound sleep, sleep full of frightful dreams.

(iv) CACTUS GR, - Palpitation with vertigo, loss of consciousness. Dyspnoea ; worse at night, lying on left side, from exertion. Sensation of constriction in heart, as if an iron hand prevented its normal action.

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