Hypertensive Emergencies Flashcards
Medications used for HTN Urgency
Clonidine
Labetolol
Captopril
Screening for End Organ Damange
ECG UA: proteinuria, casts, & RBCs Creatinine/GFR Potassium/glucose Hematocrit
Disposition for HTN Urgency
Discharge with 24-48 hrs f/u with PCP
HTN Urgency
severe increase of BP (DBP>115) WITHOUT evidence of target organ damage (TOD)
HTN Emergency/ Malignant HTN
severely elevated blood pressure (usually >180/110) WITH end organ damage or dysfunction
Neurologic S/Sx’s of HTN emergency
HA, N/V, diplopia, blurred vision, confusion, hemiparesis, seizures
Cardiac s/sx’s of HTN emergency
Chest pain, dyspnea, tachycardia, pulmonary edema, palpitations
Renal S/Sx’s of HTN emergency
Hematuria, oliguria, anuria or edema
PE for HTN emergency
BP
CV exam: focus for HEART FAILURE
Neuro: LOC, focal neurologic signs
Fundoscopy
Diagnostics for HTN emergency
EKG: look for ischemia or LVH
CXR: check for CHF, aortic dissection
CT Head: CVA or hemorrhage
Tx goal for HTN emergency
reduce MAP by 25% within 1 hour
Conditions Defining Hypertensive Emergency
HYPERTENSIVE ENCEPHALOPATHY Stroke Syndrome Catecholamine Induced (Cocaine & Pheochromocytoma) Left ventricular failure/Acute Pulmonary Edema Acute Coronary Syndrome Aortic Dissection Acute Renal Failure GESTATIONAL HTN & PREECLAMPSIA
Most common clinical presentations of hypertensive emergencies
Cerebral infarction (24.5%) Pulmonary edema (22.5%) Hypertensive encephalopathy (16.3%) Congestive heart failure (12%)
Hypertensive encephalopathy findings
Usually acute in onset & reversible
Neurologic symptoms:
H/A, nausea/vomiting, confusion, or coma.
PE findings:
Papilledema
Neurologic deficits that do not fit a stroke pattern
Management of Hypertensive Encephalopathy
- Immediate IV drug therapy
- Start therapy FIRST, then CT head
- Admission to ICU