Hypertensive emergencies treatment
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sudden spike in blood pressure to 180/120 or higher abt how we deal with it what we need to do immediate action maintain ASAP blood pressure in order to save the patients
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Hypertensive emergencies
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Hypertensive Emergencies & ICU
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
HTN EMERGENCIES AND URGENCIES
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
Hypertensive crisis
This document discusses hypertensive crisis, including its definition, clinical presentation, management, and targets of organ damage. It presents a case study of a patient with chest tightness and shortness of breath who is found to have severely high blood pressure and signs of organ damage. The diagnosis is hypertensive emergency. Treatment involves rapid intravenous blood pressure reduction in the hospital. Guidelines recommend lowering mean arterial pressure no more than 25% within the first hour for hypertensive emergencies. Exceptions are made for certain conditions like ischemic stroke and aortic dissection that require more aggressive blood pressure control.
HYPERTENSIVE EMERGENCY
Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis.
Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies.
Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction.
Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury.
A hypertensive emergency is hypertension with acute impairment of one or more
organ systems that can result in irreversible organ damage. Especially:-
Central nervous system
Cardiovascular system
Renal system.
The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120mmHg and/or systolic blood pressure greater than or equal to 180mmHg.
Hypertensive emergency differs from hypertensive crisis in that, in the former, there is evidence of acute organ damage.
Hypensive urgency and emergency
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
Hypertensive emergencies management
This document discusses the management of hypertensive emergencies and urgencies. It defines hypertensive emergencies as marked blood pressure elevation with acute life-threatening organ damage, requiring rapid BP reduction in an ICU. Hypertensive urgencies involve significant but not life-threatening BP elevation without acute organ dysfunction, allowing gradual oral medication-based BP reduction over hours. The document reviews ideal intravenous antihypertensive agents, special considerations for neurological, cardiovascular and other emergencies, and the treatment of hypertensive urgencies.
Hypertensive Emergencies
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
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Hypertensive emergencies
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Hypertensive Emergencies & ICU
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
HTN EMERGENCIES AND URGENCIES
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
Hypertensive crisis
This document discusses hypertensive crisis, including its definition, clinical presentation, management, and targets of organ damage. It presents a case study of a patient with chest tightness and shortness of breath who is found to have severely high blood pressure and signs of organ damage. The diagnosis is hypertensive emergency. Treatment involves rapid intravenous blood pressure reduction in the hospital. Guidelines recommend lowering mean arterial pressure no more than 25% within the first hour for hypertensive emergencies. Exceptions are made for certain conditions like ischemic stroke and aortic dissection that require more aggressive blood pressure control.
HYPERTENSIVE EMERGENCY
Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis.
Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies.
Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction.
Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury.
A hypertensive emergency is hypertension with acute impairment of one or more
organ systems that can result in irreversible organ damage. Especially:-
Central nervous system
Cardiovascular system
Renal system.
The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120mmHg and/or systolic blood pressure greater than or equal to 180mmHg.
Hypertensive emergency differs from hypertensive crisis in that, in the former, there is evidence of acute organ damage.
Hypensive urgency and emergency
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
Hypertensive emergencies management
This document discusses the management of hypertensive emergencies and urgencies. It defines hypertensive emergencies as marked blood pressure elevation with acute life-threatening organ damage, requiring rapid BP reduction in an ICU. Hypertensive urgencies involve significant but not life-threatening BP elevation without acute organ dysfunction, allowing gradual oral medication-based BP reduction over hours. The document reviews ideal intravenous antihypertensive agents, special considerations for neurological, cardiovascular and other emergencies, and the treatment of hypertensive urgencies.
Hypertensive Emergencies
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
HYPERTENSION EMERGENCY & URGENCY
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
Hypertensive crisis
Hypertensive emergencies require rapid blood pressure reduction to prevent target organ damage, while hypertensive urgencies only require gradual reduction over 24 hours without end organ involvement. The case study describes a patient presenting with acute pulmonary edema secondary to hypertensive emergency and acute kidney injury. He was intubated and given intravenous nitrates, frusemide and morphine to rapidly reduce blood pressure and relieve pulmonary congestion over several hours.
Malignant hypertension
Malignant hypertension is a rare but serious form of high blood pressure characterized by a sudden onset of very high blood pressure along with damage to the eyes and kidneys. It occurs when blood pressure in the arteries rises quickly to severely high levels, with diastolic pressure often over 130 mmHg. Common causes include essential hypertension, kidney disease, and pregnancy-related issues. Symptoms may include blurred vision, chest pain, seizures, reduced urine output, and headaches. Diagnosis involves examining physical signs of organ damage and testing for complications affecting the eyes, kidneys, heart, and brain. Treatment aims to lower blood pressure gradually over hours to days to avoid dangerous drops, using short-acting intravenous drugs like nitroprusside
Hypertensive emergencies
The document discusses hypertensive emergencies, which are acute, severe elevations in blood pressure that can cause target organ damage. It notes key risk factors and various potential causes. It outlines goals for lowering blood pressure during hypertensive emergencies, which depend on the specific target organ(s) affected and time since presentation. Common medications used for treatment are discussed along with their indications and special considerations. Treatment goals differ for conditions like pregnancy, stroke, and aortic dissection. The importance of determining whether target organ damage is present and tailoring treatment accordingly is emphasized.
Hypertensive Crises
This document discusses the classification, evaluation, and management of hypertensive crises. It defines hypertensive emergency as severe hypertension with acute end-organ damage requiring immediate treatment to lower blood pressure, while hypertensive urgency involves severe hypertension without end-organ damage that usually allows for gradual blood pressure reduction over 24-48 hours. It provides guidelines for initial evaluation, laboratory testing, goals of therapy, recommended antihypertensive agents, and dosing for treating different types of hypertensive crises.
Hypertensive emergency and urgency
A 45-year-old man presented with headache, visual disturbances, and papilledema with a blood pressure of 200/115 mmHg. He was admitted to the CCU/ICU. This case represents a hypertensive emergency characterized by severe hypertension (grade 3) associated with acute hypertensive emergency organ damage (HMOD) including papilledema, which requires immediate but careful intervention to lower blood pressure, usually with intravenous therapy. Hypertensive emergencies typically present with severe hypertension, funduscopic changes, microangiopathy, and can be associated with encephalopathy, acute heart failure, and acute renal deterioration. The goal of treatment is to reduce blood pressure to prevent further organ damage.
Hypertensive emergencies
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined to treat specific emergencies. Careful titration is needed due to the risk of overtreatment.
Hypertensive crisis
Hypertensive crisis is defined as a severe increase in blood pressure that requires prompt treatment to prevent end organ damage. There are two categories: hypertensive urgency, where blood pressure is elevated but there is no acute organ damage; and hypertensive emergency, where elevated blood pressure is associated with acute organ damage. Patients with hypertensive urgency can be treated orally to lower blood pressure by 25% over 24 hours, while those with emergency require rapid intravenous treatment to lower it by 10-25% within minutes to hours. Rapid reduction of blood pressure should be avoided to prevent ischemic events.
Hypertensive urgency
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Hypertensive emergency
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
Hypertensive crisis : Detection and management in Ed
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secondary hypertension
This case report describes a 17-year-old male college student presenting with occipital headache, blurred vision, and vomiting for two days. His history revealed similar complaints three months prior when he was diagnosed with hypertension but did not take medications regularly. On examination, his blood pressure was elevated at 210/120 mmHg and fundoscopy showed grade 1 hypertensive retinopathy. Investigations showed abnormal renal function and echocardiogram revealed left ventricular hypertrophy. CT brain showed findings suggestive of posterior reversible encephalopathy syndrome. Based on his history of poorly controlled hypertension, family history, examination findings, and investigation results, he was diagnosed with secondary hypertension likely due to chronic kidney disease.
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Hypertensive emgerencies
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
Hypertensive Crisis
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
Hypertensive Crisis.ppt
This is a comprehensive approach to a hypertensive patient presenting to the emergency department.
Discussing:-
- Hypertensive emergency
- Hypertensive Urgency
- Hypertensive Crisis
- Hypertensive encephalopathy and retinopathy
- Accelerated Hypertension
- Malignant hypertension
Hypertensive crisis
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
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1. The document discusses cardiovascular pharmacology, focusing on drugs used to treat hypertension and heart failure.
2. Several classes of antihypertensive drugs are described, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, and vasodilators.
3. Drugs used to treat heart failure that are mentioned include diuretics, ACE inhibitors, beta-blockers, and vasodilators.
Antihypertensive drugs
This document provides an overview of hypertension including its classification, types, signs and symptoms, causes, and treatment. It defines hypertension as having a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. The document classifies hypertension and discusses the types of essential and secondary hypertension. It outlines the signs and symptoms of hypertension and discusses its causes. The document then describes the classification and mechanisms of antihypertensive drugs and provides details on drug classes including diuretics, ACE inhibitors, calcium channel blockers, and others. It discusses treatment approaches for hypertension and managing hypertensive emergencies.
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HYPERTENSION EMERGENCY & URGENCY
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
Hypertensive crisis
Hypertensive emergencies require rapid blood pressure reduction to prevent target organ damage, while hypertensive urgencies only require gradual reduction over 24 hours without end organ involvement. The case study describes a patient presenting with acute pulmonary edema secondary to hypertensive emergency and acute kidney injury. He was intubated and given intravenous nitrates, frusemide and morphine to rapidly reduce blood pressure and relieve pulmonary congestion over several hours.
Malignant hypertension
Malignant hypertension is a rare but serious form of high blood pressure characterized by a sudden onset of very high blood pressure along with damage to the eyes and kidneys. It occurs when blood pressure in the arteries rises quickly to severely high levels, with diastolic pressure often over 130 mmHg. Common causes include essential hypertension, kidney disease, and pregnancy-related issues. Symptoms may include blurred vision, chest pain, seizures, reduced urine output, and headaches. Diagnosis involves examining physical signs of organ damage and testing for complications affecting the eyes, kidneys, heart, and brain. Treatment aims to lower blood pressure gradually over hours to days to avoid dangerous drops, using short-acting intravenous drugs like nitroprusside
Hypertensive emergencies
The document discusses hypertensive emergencies, which are acute, severe elevations in blood pressure that can cause target organ damage. It notes key risk factors and various potential causes. It outlines goals for lowering blood pressure during hypertensive emergencies, which depend on the specific target organ(s) affected and time since presentation. Common medications used for treatment are discussed along with their indications and special considerations. Treatment goals differ for conditions like pregnancy, stroke, and aortic dissection. The importance of determining whether target organ damage is present and tailoring treatment accordingly is emphasized.
Hypertensive Crises
This document discusses the classification, evaluation, and management of hypertensive crises. It defines hypertensive emergency as severe hypertension with acute end-organ damage requiring immediate treatment to lower blood pressure, while hypertensive urgency involves severe hypertension without end-organ damage that usually allows for gradual blood pressure reduction over 24-48 hours. It provides guidelines for initial evaluation, laboratory testing, goals of therapy, recommended antihypertensive agents, and dosing for treating different types of hypertensive crises.
Hypertensive emergency and urgency
A 45-year-old man presented with headache, visual disturbances, and papilledema with a blood pressure of 200/115 mmHg. He was admitted to the CCU/ICU. This case represents a hypertensive emergency characterized by severe hypertension (grade 3) associated with acute hypertensive emergency organ damage (HMOD) including papilledema, which requires immediate but careful intervention to lower blood pressure, usually with intravenous therapy. Hypertensive emergencies typically present with severe hypertension, funduscopic changes, microangiopathy, and can be associated with encephalopathy, acute heart failure, and acute renal deterioration. The goal of treatment is to reduce blood pressure to prevent further organ damage.
Hypertensive emergencies
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined to treat specific emergencies. Careful titration is needed due to the risk of overtreatment.
Hypertensive crisis
Hypertensive crisis is defined as a severe increase in blood pressure that requires prompt treatment to prevent end organ damage. There are two categories: hypertensive urgency, where blood pressure is elevated but there is no acute organ damage; and hypertensive emergency, where elevated blood pressure is associated with acute organ damage. Patients with hypertensive urgency can be treated orally to lower blood pressure by 25% over 24 hours, while those with emergency require rapid intravenous treatment to lower it by 10-25% within minutes to hours. Rapid reduction of blood pressure should be avoided to prevent ischemic events.
Hypertensive urgency
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Hypertensive emergency
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
Hypertensive crisis : Detection and management in Ed
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
Takayasu's arteritis
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
ST-Elevation Myocardial Infarction
This document provides an overview of ST-elevation myocardial infarction (STEMI) including its epidemiology, etiology, pathophysiology, risk factors, diagnosis, and current guideline-directed management. It begins with definitions of STEMI and acute coronary syndrome. Key points include that STEMI accounts for 30-40% of myocardial infarctions in the US with a mortality rate of 8.8-18.4%. Risk factors include age, gender, family history, hypertension, diabetes, hyperlipidemia, and tobacco use. Diagnosis is made through ECG showing ST elevations and elevated cardiac biomarkers. Current treatment involves prompt reperfusion therapy with either primary percutaneous coronary intervention or fibrinolytic therapy to restore blood flow to the
secondary hypertension
This case report describes a 17-year-old male college student presenting with occipital headache, blurred vision, and vomiting for two days. His history revealed similar complaints three months prior when he was diagnosed with hypertension but did not take medications regularly. On examination, his blood pressure was elevated at 210/120 mmHg and fundoscopy showed grade 1 hypertensive retinopathy. Investigations showed abnormal renal function and echocardiogram revealed left ventricular hypertrophy. CT brain showed findings suggestive of posterior reversible encephalopathy syndrome. Based on his history of poorly controlled hypertension, family history, examination findings, and investigation results, he was diagnosed with secondary hypertension likely due to chronic kidney disease.
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Mitral Regurgitation
Etiology
Pathology
Primary mitral regurgitation
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Functional Classification
Pathophysiology
Acute phase
Chronic compensated phase
Clinical Manifestations
Physical examination
Investigations
classification of severity
Indication for surgery
MV operations for correction of MR
Hypertensive emgerencies
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
Hypertensive Crisis
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
Hypertensive Crisis.ppt
This is a comprehensive approach to a hypertensive patient presenting to the emergency department.
Discussing:-
- Hypertensive emergency
- Hypertensive Urgency
- Hypertensive Crisis
- Hypertensive encephalopathy and retinopathy
- Accelerated Hypertension
- Malignant hypertension
Hypertensive crisis
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
Acute coronary syndrome
Acute Coronary Syndrome (ACS) refers to a range of conditions caused by reduced blood flow in the coronary arteries. It includes Unstable Angina (UA), Non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). ACS is diagnosed based on electrocardiogram (ECG) findings and cardiac enzyme levels. STEMI shows ST elevations and enzyme elevations, while NSTEMI shows ST depressions/inversions and enzyme elevations without ST elevations. UA shows non-specific ECG changes and normal enzymes. Risk stratification systems like the TIMI score are used for NSTEMI/UA patients to guide management, which may
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This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined for treating hypertensive emergencies based on the target organ involved.
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This document provides guidelines on the management of severe hypertension, including hypertensive urgencies and emergencies. It defines severe hypertension as a systolic BP over 180 mmHg and/or diastolic BP over 110 mmHg. Hypertensive urgency is severe hypertension without acute organ damage, while hypertensive emergency involves new organ damage. Treatment for urgency aims to lower BP by 25% over 24 hours, while emergency requires faster 10-25% reduction. Various oral agents and intravenous drugs are outlined for acute reduction. Resistant hypertension is defined as uncontrolled BP on 3-4 drugs including a diuretic. Refractory hypertension involves lack of control on 5 or more drugs.
Drugs not in common use in cardiac ER
A 28-year-old female presented with palpitations, presyncope and an abnormal ECG strip. The ECG shows a narrow complex tachycardia. Adenosine can be used both diagnostically and therapeutically to help determine if the arrhythmia is dependent on the atrioventricular node by attempting to terminate or cause transient heart block. If the arrhythmia terminates or heart block occurs, it suggests the arrhythmia involves the AV node and is likely a supraventricular tachycardia. If adenosine has no effect, it makes ventricular tachycardia more likely.
Antihypertensive drugs and hypertension management
This document discusses antihypertensive drugs and hypertension management. It begins with an introduction to hypertension and outlines types of hypertension like primary or essential hypertension. It then discusses risk factors, diagnosis, and management of hypertension including both non-pharmacological lifestyle changes and various classes of pharmacological treatments. Specific drug classes are explained like ACE inhibitors, calcium channel blockers, diuretics, and others. The document also covers hypertension during pregnancy and hypertensive emergencies. It concludes with precautions for using antihypertensive drugs.
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1. The document discusses how stress and anxiety can trigger a "fight or flight" response leading to increased blood pressure and heart rate in patients prior to dental surgery.
2. It provides guidelines for evaluating hypertensive patients before dental treatment, including assessing cardiovascular risk factors, functional capacity, and blood pressure levels to determine safety.
3. For hypertensive patients requiring emergency dental treatment, it recommends precautions like using local anesthetics without vasoconstrictors or employing hypotensive anesthesia to control blood pressure and minimize risks of complications like heart attack or stroke.
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This document discusses antihypertensive drugs used to treat hypertension. It defines hypertension and its causes. It then classifies and describes the mechanisms and properties of major classes of antihypertensive drugs, including diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, and others. For each class, it provides details on representative drugs, dosages, effects, advantages, and disadvantages in treating hypertension.
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Hypertensive emergencies treatment
- 1. HYPERTENSIVE EMERGENCIES TREATMENT ABHISHEK JHA A Hypertensive Emergency is a sudden spike in blood pressure to 180/120 or higher, and is a medical emergency. It could lead to organ damage or be life-threatening. A hypertensive crisis is divided into two categories: urgent and emergency. In an urgent hypertensive crisis, blood pressure is extremely high, but no organ damage. In an emergency hypertensive crisis, blood pressure is extremely high and has caused organs damage. An emergency hypertensive crisis is associated with life- threatening complications Causes of a hypertensive emergency include: Forgetting to take your blood pressure medication Stroke Heart attack Heart failure Kidney failure Rupture of your body's main artery (aorta) Interaction between medications Convulsions during pregnancy (eclampsia) Signs and symptoms of a hypertensive crisis that may be life–threatening may include: Severe chest pain Severe headache, accompanied by confusion and blurred vision Nausea and vomiting
- 2. Severe anxiety Shortness of breath Seizures Unresponsiveness PREFERRED PARENTERAL DRUGS FOR SELECTED HYERTENSIVE EMERGENCIES DOC FOR HYPERTENSIVE ENCEPHALOPATHY = 1. SODIUM NITROPRUSSIDE 2. NICARDIPINE 3. LABETALOL DOC FOR MALIGNANT HYPERTENSION (WHEN IV THERAPY INDICATED) = 1. LABETALOL 2. NICARDIPINE 3. SODIUM NITROPRUSSIDE 4. ENALAPRILAT DOC FOR STROKE = 1. NICARDIPINE 2. LABETALOL 3. NITROPRUSSIDE DOC FOR MYOCARDIAL INFARCTION/UNSTABLE ANGINA = 1. ESMOLOL 2. NITROGLYCERIN 3. NICARDIPINE 4. LABETALOL DOC FOR ACUTE LEFT VENTRICLE FAILURE = 1. NITROGLYCERIN 2. LOOP DIURETICES
- 3. 3. ENALAPRILAT DOC FOR AORTIC DISSECTION = 1. NITROPRUSSIDE 2. ESMOLOL 3. LABETALOL DOC FOR ADRENERGIC CRISIS/PHEOCHROMOCYTOMA = 1. NITROPRUSSIDE 2. PHENTOLAMINE DOC FOR POSTOPERATIVE HYPERTENSION = 1. NITROGLYCERIN 2. NITROPRUSSIDE 3. NICARDIPINE 4. LABETALOL DOC FOR PREECLAMPSIA/ECLAMPSIA OF PREGNANCY= 1. HYDRALAZINE 2. LABETALOL 3. NICARDIPINE NON-PHARMACOLOGICAL TREATMENT Considered in cases of resistant malignant hypertension due to end stage renal failure, such as: surgical nephrectomy, laparoscopic nephrectomy and renal artery embolization in cases of anesthesia risk. Controlled bloodletting is an effective salvage therapy in the interim when nitroprusside is unavailable, and aggressive oral therapy has not yet taken effect. BLOOD PRESSURE should be lowered smoothly, not too abruptly. The initial goal in hypertensive emergencies is to reduce the mean arterial blood pressure by no more than 25% (within minutes to 1 or 2 hours), accomplished IV Nitroprusside and then toward a level of 160/100 mmHg within a total of 2–6 hours. Excessive reduction in blood pressure can precipitate coronary, cerebral, or renal ischemia and infarction.
- 4. NITROPRUSSIDE = Acts as a drug by releasing nitric oxide; it belongs to the class of NO-releasing drugs. This drug is used as a vasodilator to reduce blood pressure. INTRAVENOUS DOSE: initial 0.3(ug/kg)/min, usual 2-4(ug/kg)/min, max 10(ug/kg)/min.. Due to its cyanogenic nature, overdose may be particularly dangerous. Treatment of sodium nitroprusside overdose includes the following: Discontinuing sodium nitroprusside administration buffering the cyanide by using sodium nitrite to convert hemoglobin to methaemoglobin as much as the patient can safely tolerate. Infusing sodium thiosulfate to convert the cyanide to thiocyanate. NICARDIPINE = Dihydropyridine calcium-channel blocking agent used for the treatment of vascular disorders. More selective for cerebral and coronary blood vessels Intravenous Dose: initial 5mg/h; titrate by 2.5 mg/h at 5-15 min intervals, max 15mg/h LABETALOL: Cause postural hypotension, there is a substantial drop in blood pressure when standing up. In short term, acute situations, labetalol decreases BP by decreasing systemic vascular resistance with little effect on stroke volume, heart rate and cardiac output. During long term use, labetalol can reduce heart rate during exercise while maintaining cardiac output by an increase in stroke volume Intravenous Dose: 2mg/min up to 300mg/min or 20mg over 2 min, 40-80mg at 10 min intervals up to 300mg total. NITROGLYCERIN: Initial 5ug/min then titrate by 5ug/min at 3-5 min intervals; if no response is seen at 20ug/min, incremental increase of 10-20ug/min may be used. HYDRALAZINE: 10-50mg at 30 min intervals. ENALAPRILAT: Usual 0.62-1.25mg over 5 min every 6-8hr; max 5mg/dose.
- 5. ESMOLOL: Initial 80-500ug/kg over 1 min, thn 50-300(ug/kg)/min. PHENTOLAMINE: 5-15 mg bolus.