Valvular Heart Disease

Question 1

Define hypertensive crisis.

Answer 1

hypertensive crisis is defined as arterial blood pressure greater than or equal to 180/120.

Question 2

Hypertensive crisis is further categorized as either hypertensive urgency or hypertensive emergency. What differentiates the two?

Answer 2

Based on the presence or absence of impending or progressive target organ damage.
Patients with chronic systemic hypertension can tolerate a higher systemic blood pressure than previously normotensive individuals and are more likely to experience urgencies rather than emergencies.

Question 3

What is the treatment goal for the patient in a hypertensive emergency?

Answer 3

Decrease the blood pressure promptly but gradually. A general guideline is to decrease arterial blood pressure by 20 to 25% within 30 to 60 minutes.

Question 4

What is the drug of choice for hypertensive emergency?

Answer 4

Sodium nitroprusside 0.5 to 10 mcg/kg/min IV is the drug of choice; however, treatment with SNP is complicated by cyanide toxicity and lactic acidosis. Other alternative treatments are nicardipine, fenoldopam, esmolol, and labetalol.

Question 5

What recently FDA approved drug may be the new drug of choice for treating a hypertensive emergency?

Answer 5

clevidipine, a third generation dihydropyridine calcium channel blocker with ultra short duration of action and selective arterial vasodilating properties has recently been approved.

Question 6

What is the leading cause of postoperative hospital admission?

Answer 6

inadequate pain relief

Question 7

Postoperative hypertension is common and multifactorial. What factors contribute to postoperative hypertension?

Answer 7

respiratory compromise or distress, stimulation of the sympathetic nervous system, visceral distention, volume overload