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Flashcards in Hypertensive Encephalopathy Deck (18):
0

Possible etiology of hypertensive encephalopathy?

Pheochromocytoma

1

Differential diagnosis for patient with elevated blood pressures and altered mental status?

Pheochromocytoma, illicit drugs (cocaine and amphetamines)

2

Hypertensive encephalopathy can present with what symptoms?

1. Elevated blood pressure
2. Confusion
3. Increased intracranial pressure
4. Seizures

3

Patient with hypertensive encephalopathy: goal of treatment?

Lower diastolic blood pressure between 100-110

4

MEN 2A versus MEN 2B

medullary thyroid cancer, hyperparathyroid, Pheochromocytoma

Mucosal neuromas, medullary thyroid cancer, pheochromocytoma

5

Hypertensive urgency versus hypertensive emergency

No acute end- organ damage versus acute end-organ damage

6

Acute end-organ damage includes?

Hypertensive encephalopathy, myocardial ischemia or infarction, aortic dissection, pulmonary edema

7

Hypertensive crisis? Maybe precipitated by?

Occurs in patients with established history of essential hypertension.

Precipitated by
1. simpathomimetic agents (cocaine)
2. conditions that produce excess sympathetic discharge (clonidine withdrawal)
3. Renovascular disease
4. Pheochromocytoma

8

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

9

Effective treatment of hypertensive emergency is determined by?

Based on SYMPTOMS, not numerical values

10

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

11

Drugs given to decrease acute pulmonary edema?

loop diuretics and vasodilators such as nitroglycerin (to decrease preload)

12

Pheochromocytoma?

Catecholamine producing tumors that arise from chromaffin cells of the adrenal medulla

13

Diagnosed pheochromocytoma by?

24 hour urine collection assayed for metanephrines, Vanillylmandelic acid, free catecholamines

14

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)

15

Clonidine mechanism of action? Problem with stopping clonidine?

a2-adrenergic agonist used to treat hypertension. Rebound hypertension.

16

Treatment of hypertension stroke patients?

Do not treat due to concern of cerebral hypoperfusion

17

Patient with coronary disease with orthopnea and pedal edema. Hospitalized with a blood pressure of 190/105. Normal ECG and cardiac enzymes. Intravenous Furosemide has been administered. Next step?

Give ACE inhibitor as patient likely has congestive heart feeling. Avoid beta blockers because they will decrease ejection fraction further

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