Page 69 - Clinical Pearls in Cardiology

Arterial Pulse and Blood Pressure 57

and facilitate the formation of flash pulmonary edema.
Renal artery stenosis, particularly when bilateral, has
been identified as a common cause of FPE. However,
flash pulmonary edema rarely occurs among patients
with chronic dilated cardiomyopathies. In addition to
standard therapies for cardiogenic pulmonary edema,
this condition responds well to combined venous and
arterial vasodilators such as intravenous nitroglycerin.
42. What are the important endocrine causes for
hypertension?
Essential or primary hypertension constitutes about
94% of all cases of hypertension. Among the remaining
6%, renal parenchymal and renovascular diseases
account for about 4% of cases, and endocrine diseases
account for about 1% of cases. A search for secondary
forms of hypertension is usually considered in patients
with moderate or severe hypertension that does not
respond to antihypertensive agents. Another situation
where secondary hypertension has to be ruled out is in
the case of hypertensive patients who are younger than
25 years of age. The important endocrine causes for
hypertension are the following:
• Acromegaly
• Hyperthyroidism (usually systolic hypertension)
• Hypothyroidism (usually diastolic hypertension)
• Hyperparathyroidism
• Cushing’s syndrome
• Conn’s syndrome due to aldosterone producing
adrenal adenoma (usually associated with
hypokalemia)
• Liddle syndrome (young hypertensives with
hypokalemia)
• Pheochromocytoma.