Caused by another medical condition.
Less common, more dramatic onset, can happen at any age
Suspect secondary if:
Severe or refractory HTP
Acute rise in BP although previously was stable
Onset before puberty
Onset <30, non-obese, non-black, negative FH
Can be caused by:
OSA, drugs, thyroid dz, CKD, RAS, Cushings/steroids, pheochromocytoma, coarctation
stroke volume, distensibility of large arteries, PVR, volume, life, OSA, kidneys, adrenals, thyroid, congenital defects, meds, chronic alcohol use Usually is already pretty bad when symptoms appear
HA, fatigue, visual disturbances, TIA, angina, dyspnea, irregular heartbeat, nosebleeds, tinnitus, frequent urination, foamy urination and edema, hematuria, changes in urine color.
Most symptoms are related to end-organ damage (heart, stroke, kidney, PAD, retinopathy)
If these symptoms are present, rule out secondary cause:
tachy/sweating/tremor (pheo), thin skin (steroids), flank pain (kidneys), daytime somnolence (OSA)
Depends on underlying cause, comorbidities, age, etc.
Lightheadedness, dizziness, syncope, N/V, confusion, fatigue, reflex tachy, flushing, diaphoresis, clammy, pallor, prolonged capillary refill, altered LOC
Volume depletion (diuretics, hemorrhage, vomiting, DI, etc.), medications, age (elderly), vasodilation (prolonged standing, fever), neurologic (failure of ANS), neurodegenerative dz (Parkinson's, dementia with Lewy bodies), neuropathies, cardiac impairment (bradycardia, AS, tachycardia, MI, pericarditis), carotid stenosis age, male, race (AA, mexican, indian, hawaiian), FH (male <55, female <65), hyperlipidemia, HTN, smoking, DM, obesity, physical inactivity, unhealthy diet
High levels CRP, high TG, OSA, stress, alcoholism
Quality: aching, burning, pressure, squeezing
Location: substernal, radiating (neck/jaw/arms)
Timing: intermittent or gradual
Provocative factors: exercise, meals, stress/emotions, cold, morning, supine position
Palliative factors: nitro, cessation fo activity, rest
Associated S/S: SOB, N/V, diaphoresis, fatigue, weakness, feeling of impending doom, paresthesias, dizziness, fever
Hypotension, HTN, HOCM, severe AS/AR, pericarditis, hyperthyroid, etc.
MI, GI, psychiatric, pulmonary, chest wall (costochondritis)
How we differentiate unstable angina from a NSTEMI, also needed to make a diagnosis of STEMI
These are only drawn inpatient
Myoglobin: earliest released (as early as 2 hours)
Troponin-I: Preferred biomarker
Biomarkers rise with: MI, post-PCI, post-CABG, CHF, sepsis, PE, CKD, myocarditis, aortic dissection, etc.
Chest pain, SOB, nausea, etc.
Patient may often be confused/obtunded
Altered mental status, decreased urine output, hypotension (<90 SBP), tachycardia, tachypnea, cool/mottled extremities, acute HF (rales, JVD)