Discussions that mention potassium

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what's with all the knock against primary care docs ...

other thing to keep straight is the terminology(not to be antagonistic) ... but, primary hypertenstion, otherwise known as essential or idiopathic hypertension, is not an age related phenomenon, it's onset is usually anywhere from 25-55 y/o ... primary refers to the fact that there's no identifiable organic/medical cause for elevated blood pressure ... 2ndary hypertension refers to the elevated BP's related to an identifiable medical/organic cause of which there are many, some have been mentioned such as OSA(obstructive sleep apnea) and pheochromocytoma(which is basically a tumor, whether it be from the adrenal glands directly or rarer non-adrenal sources, which secretes your fight/flight hormones ... good ole epinephrine/norepinephrine), but renal disease(either vascular like renal artery stenosis or actually damage to the kidney tissue itself), meds like oral contraceptive, cushing's syndrome(elevated cortisol level, a stress hormone too), hyperaldosteronism(excess aldosterone secretion, which is a hormone from the adrenal glands)

with your symptoms(and I only know the brief hx you provided), I would worry about a pheo too, classically seen as episodes(paroxysms) of elevated blood pressure, with chest pain/headaches, palpitation, shakes(tremors), so hope you eventually get a blood check for metanephrines, and urine test for the same +/- catechols; those are the classic screening test they look at ... interesting to note BB therapy alone(metoprolol) is dangerous if a pheo is really suspected ... epi/norepi work by several different mechanisms, the problems is if you only block one(in this case the beta receptor) the other mechanism can predominate(in this case alpha receptor), this can lead to hypertensive crisis .. so if you're seeing a cardiologist and he/she has really taken your hx I can't imagine that they really think a pheo is likely .. sounds like they are more concerned about an arrhythmia(would be interesting to see your ECG's during your hypertensive episodes)

as a forewarning, because of the nature of anxiety attacks, which are states with high circulating fight/flight hormones(epi/norepi again, like you see in a pheochromocytoma), all your symptoms could also be from anxiety

but I trust that you have astute docs ...

... by the way, any PCP worth her/his weight, can work-up, treat/manage hypertesion with ease ... only a small % of patients are referred to a cardiologist or nephrologist to manage "refractory" hypertension

it would be interesting to here what your potassium, creatinine, blood glucose have been while at the ER ...

best of luck with all