Flashcards in Hypertensive Encephalopathy Deck (18):
Possible etiology of hypertensive encephalopathy?
Differential diagnosis for patient with elevated blood pressures and altered mental status?
Pheochromocytoma, illicit drugs (cocaine and amphetamines)
Hypertensive encephalopathy can present with what symptoms?
1. Elevated blood pressure
3. Increased intracranial pressure
Patient with hypertensive encephalopathy: goal of treatment?
Lower diastolic blood pressure between 100-110
MEN 2A versus MEN 2B
medullary thyroid cancer, hyperparathyroid, Pheochromocytoma
Mucosal neuromas, medullary thyroid cancer, pheochromocytoma
Hypertensive urgency versus hypertensive emergency
No acute end- organ damage versus acute end-organ damage
Acute end-organ damage includes?
Hypertensive encephalopathy, myocardial ischemia or infarction, aortic dissection, pulmonary edema
Hypertensive crisis? Maybe precipitated by?
Occurs in patients with established history of essential hypertension.
1. simpathomimetic agents (cocaine)
2. conditions that produce excess sympathetic discharge (clonidine withdrawal)
3. Renovascular disease
Pathophysiology of a hypertensive emergency?
1. Increase blood pressure usually leads to endothelial cells releasing nitric oxide to vasodilate
2. Persistent increases in arterial pressure overwhelm endothelial response, leading to decompensation and endothelial injury
3. Cerebral autoregulation is unable to maintain constant pressure leading to edema and microhemorrhages in the brain
4. Symptoms such as lethargy, confusion, headache or vision changes manifest
Effective treatment of hypertensive emergency is determined by?
Based on SYMPTOMS, not numerical values
Medications used hypertensive emergency? Pros? Cons?
Nitroprusside. Instantaneous and easily titrated. Metabolite may accumulate resulting in cyanide toxicity if given for more than 2 to 3 days
Drugs given to decrease acute pulmonary edema?
loop diuretics and vasodilators such as nitroglycerin (to decrease preload)
Catecholamine producing tumors that arise from chromaffin cells of the adrenal medulla
Diagnosed pheochromocytoma by?
24 hour urine collection assayed for metanephrines, Vanillylmandelic acid, free catecholamines
Treatment of pheochromocytoma?
1. 24 hour urine collection
2. CT or MRI (or octreotide scan)
3. Give alpha-adrenergic blocking agents (phenoxybenzamine) one week prior to surgery
4. Eat a lot of salt to increase blood volume
Optionally: give beta blocker (although this can result in the pulmonary edema)
Clonidine mechanism of action? Problem with stopping clonidine?
a2-adrenergic agonist used to treat hypertension. Rebound hypertension.
Treatment of hypertension stroke patients?
Do not treat due to concern of cerebral hypoperfusion