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Hypertensive crises

Hypertensive crisis is a sudden significant increase in blood pressure from a normal or elevated level, which is almost always accompanied by the appearance or increase in disorders of the target organs or the autonomic nervous system.

Crisis classification

Depending on the presence or absence of target organ damage and the need for an urgent reduction in blood pressure, complicated and uncomplicated crises are isolated.

Complicated hypertensive crises. The course is characterized by clinical signs of acute or progressive damage to the target organs: MI, stroke, dissecting aortic aneurysm, unstable angina, acute LV failure, etc. (Table 1.8).

Table 1.8

Complicated hypertensive crises

1. IM

2. Stroke

3. Acute dissecting aortic aneurysm

4. Acute LV failure

5. Unstable Angina

6. Arrhythmias (paroxysms of tachycardia, atrial tachyarrhythmias, ventricular premature beats of high gradations)

7. Transient ischemic attack

8. Eclampsia

9. Acute hypertensive encephalopathy

10. Bleeding

Such crises are always accompanied by the appearance or increase in the severity of symptoms from target organs. They represent a threat to the life of the patient and require a decrease in blood pressure in the period from several minutes to 1 hour. The treatment is carried out in conditions of the intensive care unit using parenteral administration of antihypertensive drugs. This category also includes cases of a significant increase in blood pressure, when the threat to life arises not because of target organ damage, but because of bleeding, most often during the postoperative period.

Uncomplicated hypertensive crises are characterized by the absence of clinical signs of acute or progressive damage to target organs, however they pose a potential threat to the life of the patient, since late delivery of care can lead to complications and death.
Such crises are accompanied, as a rule, by the appearance or increase in the severity of symptoms from target organs (intense headache, heart pain, extrasystoles) or from the autonomic nervous system (vegetative-vascular disorders, tremors, frequent urination).

Depending on which organs are the source of the symptoms, cerebral and cardiac uncomplicated crises are isolated (Table 1.9). Hypothalamic paroxysms (in the old terminology - diencephalic vegetative crises) are a manifestation of the cerebral crisis. Increased GARDEN to 240 mm Hg. Art. or dad to 140 mmHg. Art. It should also be regarded as a hypertensive crisis, regardless of whether the symptoms on the part of the target organs appeared or not, since it is dangerous for each patient. A significant increase in pressure in the early postoperative period due to the risk of bleeding is also threatening.

Table 1.9

Uncomplicated hypertensive crises

1. Uncomplicated cerebral crisis

2. Cardiac uncomplicated crisis

3. Increase of the CAD to 240 mm Hg. Art. or dad to 140 mmHg. Art.

4. Significant increase in blood pressure in the early postoperative period

All these clinical manifestations require a decrease in blood pressure over several hours. Hospitalization is not required. The treatment is carried out by taking antihypertensive drugs orally or intramuscularly injections.
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Hypertensive crises

  1. Hypertensive crises
    A hypertensive crisis is a sudden significant increase in blood pressure, which is almost always accompanied by the appearance or intensification of disturbances on the part of target organs or the autonomic nervous system. The criteria for a hypertensive crisis are: • sudden onset; • a significant increase in blood pressure; • the appearance or intensification of symptoms on the part of target organs. The level of blood pressure during the crisis is much higher
  2. HYPERTENSIVE CRISES
    D-ka: Increased blood pressure (often acute and significant) with neurological symptoms: headache, "flies" or a veil before the eyes, paresthesia, nausea, vomiting, weakness and limbs, transient hemiparesis, aphasia, diplopia. In neurovegetative crisis (crisis type I, adrenal): sudden onset, agitation, hyperemia and moisture of the skin, tachycardia, frequent and abundant urination,
  3. Hypertensive crises
    The clinical picture Most often in the practice of ambulance there are patients with hypertensive crises on the background of neurocirculatory dystonia, hypertension and widespread atherosclerosis of blood vessels. However, the cause of a sharp rise in blood pressure can also be diseases of the kidneys, brain, various endocrine disorders, etc. The diagnosis of hypertonic (hypertensive)
  4. Hypertensive (hypertensive) heart disease
    Hypertensive heart disease develops in response to an increased need for blood supply to organs and tissues belonging to the large and (or) small circulation. Accordingly, systemic (left ventricular) and pulmonary (right ventricular) hypertensive heart diseases are distinguished. The first of these is associated with systemic hypertension, i.e. increased hydrostatic pressure in the artery system
  5. Hypertensive crisis
    Diagnostics. Increased blood pressure sudden and significant. Typical symptoms: headache, "flies" and "veil" in front of the eyes, paresthesias, crawling, nausea, vomiting, weakness, transient hemiparesis, aphasia, diplopia, chills. Hypertensive crises are divided into: 1- “uncomplicated” - a sudden increase in blood pressure without signs of rapid progressive lesions of target organs in
  6. Hypertensive (hypertensive) heart disease
    Hypertensive (hypertensive) heart disease - heart damage due to increased blood pressure in the circulatory system. Left ventricular and right ventricular forms of the disease are distinguished, which is associated with the presence of systemic arterial hypertension or only pulmonary hypertension, respectively. Systemic (left ventricular) hypertensive heart disease is diagnosed in the presence of arterial
  7. Vegetative crises
    Vegetative crises, or panic attacks, are paroxysmal emotional-affective states with polysystemic vegetative symptoms, characterized by a benign course. ETIOLOGY AND PATHOGENESIS The dysfunction of the hypothalamic-limbico-reticular complex is the basis of the vegetative crisis. Causes causing panic attacks: ¦ psychogenic - acute and chronic stress, in particular death
  8. TABETIC CRISES
    Clinic. Tabetic crises are attacks of the most severe pains in the region of any organ, combined with disorders of its functions, which occur during dorsalis, the late form of neuro-syphilis. When guttural crises paroxysmal pain occurs in the larynx and accompanied by disorders of phonation (dysphonia) and spasm of it. Gastric crises are characterized by severe pain in the epigastric
  9. Vegetative crises
    Vegetative crises - paroxysms of polymorphic vegetative disorders associated with activation of the central (suprasegmental) vegetative structures. In the past, their appearance was attributed to the pathology of the hypothalamus, but at the present time it is obvious that only a very small part of the crises can be explained by the organic lesion of the hypothalamus or the structures of the limbic-reticular complex, in which case they
  10. Maintaining a patient with hypertensive crises
    Indications for the implementation of the program of emergency reduction of blood pressure in a type 1 crisis according to Ferguson (MS Kushakovsky): hypertensive encephalopathy, cerebral strokes, dissecting aortic aneurysm, acute heart failure, myocardial infarction and preinfarction syndrome, a syndrome with a feochromomastoma, and ischemic motility, myocardial infarction; clonidine, crisis on the background of diabetes mellitus with severe angioretinopathy; pressure
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