Re: High blood pressure in hyperaldosteronism

[Guest guest]

Could they have done something during her dental appointments that caused a

blood clot?

> > >

> > > Yes CTs dont look at renal artries unless injection is done. MRI is

> > > better but in your case you want a real arteriogram which is the only

> > > way to exclude this as the cause of sudden onset HTN.

> >

>

[Guest guest]

If someone has renal artery stenosis dose this mean that ony one kidney is now

working? And does this mean there is risk the the other kidney could stop

working as well?

> > > >

> > > > Yes CTs dont look at renal artries unless injection is done. MRI is

> > > > better but in your case you want a real arteriogram which is the only

> > > > way to exclude this as the cause of sudden onset HTN.

> > >

> >

>

[Guest guest]

No, she doesn't think they go up at the same time.

>

> Does BP and heart rAte go up at same time.

>

[Guest guest]

What would it mean if BP and heart rate go up at the same

time? Mine do.

Val

> Does BP and heart rAte go up at same time.

..

[Guest guest]

Usually means the increase in heart rate is driving the BP and this is normal.Recall that- Blood pressure = flow x resistance to flowBP = Cardiac output x resistance to flowCardiac output = heart rate x stroke volume (SV amount of blood ejected from the left ventricle with each beat) = R x VResistance to flow = C (constant which we ignore here)/(radius of the tube thru which flow is going raised to the 4th power)Therefore BP = R x SV x 1/(r*r*r*r) So BP can go up because heart rate goes up or stroke volume goes up or the radius of the arterial system shrinks AKA vasoconstricts. BP can go down because heart rate goes down or SV goes down or the blood vessels relax (vasodilates). This may happen after taking a BP pill that makes blood vessels dilate quickly: CCBs, ACEs, ARBs, direct acting vasodilators (apresoline, minoxidil) For more details recommend all get a new or used copy of Guyton's Medical Physiology or the newer (Hall and Guyton) and review the regulation of the circulation. Also can start with the AHA Hypertension Manual free at Americanheart.org or used to be after you pay mailing. If you buy it is is only $35 and well worth the investment IMHO. This details everything a medical student should learn about high blood pressure before they graduate. Hopefully they read it and remember it. On Oct 31, 2009, at 9:03 AM, Valarie wrote: What would it mean if BP and heart rate go up at the same time? Mine do. Val > Does BP and heart rAte go up at same time. .

[Guest guest]

Thanks.

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Clarence Grim

Usually means the increase in heart rate is driving the BP and this is

normal.

Recall

that-

Blood

pressure = flow x resistance to flow

BP =

Cardiac output x resistance to flow

Cardiac

output = heart rate x stroke volume (SV amount of blood ejected from the left

ventricle with each beat) = R x V

Resistance

to flow = C (constant which we ignore here)/(radius of the tube thru which flow

is going raised to the 4th power)

Therefore

BP =

R x SV x 1/(r*r*r*r)

So

BP can go up because heart rate goes up or stroke volume goes up or the radius

of the arterial system shrinks AKA vasoconstricts.

BP

can go down because heart rate goes down or SV goes down or the blood vessels

relax (vasodilates). This may happen after taking a BP pill that

makes blood vessels dilate quickly: CCBs, ACEs, ARBs, direct acting vasodilators

(apresoline, minoxidil)

For

more details recommend all get a new or used copy of Guyton's Medical

Physiology or the newer (Hall and Guyton) and review the regulation of

the circulation. Also can start with the AHA Hypertension Manual free at

Americanheart.org or used to be after you pay mailing. If you buy it is

is only $35 and well worth the investment IMHO. This details everything a

medical student should learn about high blood pressure before they graduate.

Hopefully they read it and remember it.

On

Oct 31, 2009, at 9:03 AM, Valarie wrote:

What would it mean if BP

and hea rt rate go up at the same time? Mine do.

Val

> Does BP and heart rAte go up at same time.

..

[Guest guest]

A little off-topic: I wonder to what extent can psychological factors (like

depression or stress) influence the secretion of adrenal hormones in one's body

(maybe via the pituitary gland?). If hypertension sometimes persists even after

removing an adenoma, would the hormonal imbalance have also other causes?

> > >

> > > Yes CTs dont look at renal artries unless injection is done. MRI is

> > > better but in your case you want a real arteriogram which is the only

> > > way to exclude this as the cause of sudden onset HTN.

> >

>

[Guest guest]

I recommend you go see Dr. Calhoun at the Univ of Alabama, Birmingham ASAP for evaluation.

Tell his office Dr. Grim is referring you.

A CT does NOT rule out renal artery stenosis causing HTN in a young woman. This can only be done by an trasfemoral and selective renal angiogram.

Clarence E. Grim, BS, MS, MD

Specializing in Difficult High Blood Pressure and recent evolutionary forces on high blood pressure in population's today.

On Thursday, October 29, 2009, at 11:50PM, "szurcio" <jszurek@...> wrote:

>

If I understand correctly, her renin level seems to be OK: 3.93 ng/mL/hr (maybe a little bit elevated, if the test was taken in a supine position)

Metabolic panel - everything in the normal range (creatinine a little bit lower than normal: 0.7 (abn) mg/dL)

Potassium 4.3 mmol/L

She doesn't smoke or drink any alcohol.

She also had a chest X-ray, EKG, echocardiogram, urinalysis, lipid panel, abdominal ultrasound (which showed that one of her kidneys is smaller than the other: right 11.04 cm, left 9.47 cm), and abdominal CT scan to evaluate for renal artery stenosis (everything came up normal). The only result out of the normal range was her aldosterone level. It came already after her abdominal CT scan so the doctor couldn't send her for another one to evaluate only her adrenal glands because he said 2 CT scans in a row might not be very safe. So he asked the radiologist to check the size of her adrenal glands based on the CT scan she already had. There were no growths visible and the size and shape of her adrenals was normal so the doctor assumed it must be hyperplasia in the beginning stage. I thought there should be some other - more detailed - tests done to distinguish between hyperplasia or adenoma but this is where we are now. Her BP is still very high.

She often has migraines (ever since she had a car accident 8 years ago) and they may now aggravate her hypertension but, as I said in my first e-mail, her BP was perfect until the end of August (she had it checked during her 2 dental appointments). Her hypertension came all of a sudden (discovered during her annual checkup in September).

I think the next step is finding a good endocrinologist (we're in Alabama).

[Guest guest]

Thank you, Dr. Grim! We were able to make an appointment with Dr. Calhoun

for Friday, Nov. 13th. They asked me for the referring doctor's phone number and

I gave them the one I found next to your bio on the ISHIB website (which is in

Georgia and you are in Wisconsin) but maybe it would suffice.

> >

>

[Guest guest]

Thank you, Dr. Grim! We were able to make an appointment with Dr. Calhoun

for Friday, Nov. 13th. They asked me for the referring doctor's phone number and

I gave them the one I found next to your bio on the ISHIB website (which is in

Georgia and you are in Wisconsin) but maybe it would suffice.

> >

>

[Guest guest]

I think this information is somewhere in files. last time I tried to find it

couldn't find it. but this is what I have for contact information. Business

Phone: (414)-916-0841)

FAX Number: (414)-755-0800

e-mail lowerbp2@...

Home Address: 2203 East Newberry Boulevard

Milwaukee, WI 53211

Home Telephone: (414) 967-9891

> > >

> >

>

[Guest guest]

OK, great - I called them again and gave them his business phone number. Thanks!

> > > >

> > >

> >

>

[Guest guest]

Excellent. Keep us posted. Mention our site all the others you meet there with PA and to the Drs you see.CE Grim MDOn Nov 4, 2009, at 9:37 AM, szurcio wrote: Thank you, Dr. Grim! We were able to make an appointment with Dr. Calhoun for Friday, Nov. 13th. They asked me for the referring doctor's phone number and I gave them the one I found next to your bio on the ISHIB website (which is in Georgia and you are in Wisconsin) but maybe it would suffice. > > >

[Guest guest]

Those are correct. But for personal PA management (working with you and your Drs) I charge $500 per year. CE Grim MD.On Nov 4, 2009, at 10:11 AM, Francis Bill wrote: I think this information is somewhere in files. last time I tried to find it couldn't find it. but this is what I have for contact information. Business Phone: (414)-916-0841) FAX Number: (414)-755-0800 e-mail lowerbp2mac Home Address: 2203 East Newberry Boulevard Milwaukee, WI 53211 Home Telephone: (414) 967-9891 > > > > > >