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HEART SPECIALISTS IN GANGAMMA CIRCLE BANGALORE Assessment of patients with hypertension A patient with definite or possible newly diagnosed hypertension needs at least a basic clinical assessment to look for possible aetiology, severity and signs of complications. The history Questioning should be directed towards the following areas. 1 Past history. Has hypertension been diagnosed before? What treatment was instituted? Why was it stopped? 2 Secondary causes. Important questions relate to: • a history of renal disease in the patient or his or her family, recurrent urinary tract infec-­ tions, heavy analgesic use or conditions leading to renal disease (e.g. systemic lupus erythematosus (SLE)) • symptoms suggesting phaeochromocytoma (flushing, sweats, palpitations) • symptoms suggesting sleep apnoea • muscle weakness suggesting the hypokalaemia of hyperaldosteronism • Cushing’s syndrome (weight gain, skin changes) • family history of hypertension. 3 Aggravating factors: • high salt intake • high alcohol intake • lack of exercise • use of medications: NSAIDs, appetite suppressants, nasal decongestants, monoamine oxidase inhibitors, ergotamine, cyclosporin, oestrogen-containing contraceptive pills • other: use of cocaine, liquorice, amphetamines. 4 Target organ damage: • stroke or transient ischaemic attack (TIA) • angina, dyspnoea • fatigue, oliguria • visual disturbance • claudication. 5 Coexisting risk factors: • smoking • diabetes • lipid levels, if known • existing vascular disease • family history of ischaemic heart disease. 2• HYPERTENSION 6 Factors affecting choice of treatment: • diabetes (problems with thiazides and beta-blockers) • gout (problems with thiazides) • asthma (problems with beta-blockers) • heart failure (problems with verapamil, diltiazem, some beta-blockers, monoxidine) • severe peripheral arterial disease (problems with beta-blockers) • bradycardia or heart block (problems with beta-blockers, verapamil, diltiazem) • renovascular disease (problems with ACE inhibitors, angiotensin receptor antagonists (ARAs)) • problems with previous anti-hypertensive agents • allergies • likelihood of pregnancy (ACE inhibitors, diuretics and some calcium antagonists are contraindicated). The examination The physical examination should be undertaken with a view to establishing severity. 1 Measure the blood pressure. 2 Look for secondary causes. • Check the appearance for Cushing’s syndrome (central obesity, striae, muscle wasting), acromegaly, polycythaemia and uraemia. • Undertake abdominal palpation for renal masses (polycystic kidneys), occasionally adrenal mass, and auscultation for renal bruit (heard to the left or right of the mid-line above the umbilicus, often into the flanks). • Assess radiofemoral pulse delay and listen for mid
DIABETOLOGISTS IN JALLAHALLI BANGALORE. Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy.
the best diabetic clinics in silkboard bangalore. DKA can develop in less than 24 hours.3 Metabolic changes occur one and one half to two hours earlier in patients who are managed only with a short-acting insulin such as lispro (Humalog).22 Patients with DKA usually present with polyuria, polydipsia, polyphagia, weakness, and Kussmaul’s respirations. Nausea and vomiting are present in 50 to 80 percent of patients, and abdominal pain is present in about 30 percent..
THE MOST POPULAR DOCTORS NEAR ME Congenital Diseases and Childhood Nephrotic Syndrome Congenital nephrotic syndrome is rare and affects infants in the first 3 months of life. This type of nephrotic syndrome, sometimes called infantile nephrotic syndrome, can be caused by inherited genetic defects, which are problems passed from parent to child through genes infections at the time of birth More information about underlying diseases or infections that cause changes in kidney function is provided in the NIDDK health topic, Glomerular Diseases. What are the signs and symptoms of childhood nephrotic syndrome? The signs and symptoms of childhood nephrotic syndrome may include edema—swelling, most often in the legs, feet, or ankles and less often in the hands or face albuminuria—when a child’s urine has high levels of albumin hypoalbuminemia—when a child’s blood has low levels of albumin hyperlipidemia—when a child’s blood cholesterol and fat levels are higher than normal In addition, some children with nephrotic syndrome may have blood in their urine symptoms of infection, such as fever, lethargy, irritability, or abdominal pain loss of appetite diarrhea high blood pressure