Addressing hypertensive emergencies

Question 1

When considering the risks of malignant hypertension, the big question is?

Answer 1

Do we see signs or symptoms of end-organ dysfunction?

Question 2

3 signs and symptoms to watch for:

Answer 2

1. Chest pain - ischemia or aortic dissection
2. SOB - pulmonary edema
3. Neurologic deficits - stroke or encephalopathy

Question 3

How to break down HPT emergencies:

Answer 3

1. Non-stroke HPT emergencies - Aortic Dissection vs Pheochromocytoma vs Other Cardio HPT Emergencies
2. Stroke HPT emergencies - haemorrhagic vs ischaemic

Question 4

Mx of Aortic Dissection:

Answer 4

First hour: reduce the SBP to < 120

Question 5

Mx of Pheochromocytoma:

Answer 5

First hour: reduce the SBP to < 140

Question 6

Mx of Other cardiology-related hypertensive emergencies:

Answer 6

1. First hour: reduce BP by 25%
2. Next 2–6 hours: try to keep it in the 160/110 range
3. Next 24–48 hours: slowly bring it down to the normal range - 120/80

Question 7

Hemorrhagic stroke - w/in 6 hours of the onset of symptoms - Systolic BP is 150–220 mmHg:

Answer 7

**Do nothing **

Question 8

Hemorrhagic stroke - w/in 6 hours of the onset of symptoms - Systolic BP is > 220 mmHg::

Answer 8

1. IV antihypertensives
2. Lower SBP to 150–220

Question 9

Ischemic stroke - If you’re seeing a patient within 72 hours of the onset of symptoms, the first thing you want to do is?

Answer 9

Check whether they qualify for IV thrombolytics

Question 10

Mx - Ischemic stroke w/in 72 hours of Sx onset - Qualifies for thrombolytcis - Yes:

Answer 10

1. IV antihypertensives
2. Reduce BP to < 185/110
3. Give Thrombolytics
4. Maintain BP at < 185/110

Question 11

Mx - Ischemic stroke w/in 72 hours of Sx onset - Qualifies for thrombolytcis - NO - BP < 220/110:

Answer 11

1. Do nothing
2. Monitor BP for first ** 48–72 hours**

Question 12

Mx - Ischemic stroke w/in 72 hours of Sx onset - Qualifies for thrombolytcis - NO - BP < 220/110:

Answer 12

Do nothing (monitor BP) for first ** 48–72 hours**

Question 13

Mx - Ischemic stroke w/in 72 hours of Sx onset - Qualifies for thrombolytcis - NO - BP > 220/110:

Answer 13

1. IV antihypertensives
2. Lower BP by 15% in first 24 hours