Hypertensive crisis
Introduction
Introduction to hypertensive crisis Hypertensive crisis refers to the occurrence of temporary systemic fine arteries on the basis of hypertension, resulting in a sharp rise in blood pressure and a series of clinical symptoms. The causes include overwork, trauma, cold and endocrine disorders. It can occur in patients with moderate-grade hypertension at all levels, and can also be seen in various acute hypertension. Clinical manifestations include mental changes, severe headaches, nausea and vomiting, tachycardia, pale complexion, difficulty breathing, etc., and their condition is dangerous. If the rescue measures are not effective, it can lead to death. basic knowledge The proportion of the disease: the probability of the population is 0.27% Susceptible people: occur in patients with hypertension Mode of infection: non-infectious Complications: Hypertensive encephalopathy Acute heart failure Acute renal failure
Cause
Hypertensive crisis
The main causes of this disease are trauma, emotional changes, excessive fatigue, cold stimuli, climate change and endocrine disorders (such as menopause or menstrual period), including the following:
(1) Hypertensive encephalopathy.
(2) small arterial lesions.
(3) Kidney damage.
(4) Microvascular coagulation.
(5) Pregnancy-induced hypertension syndrome.
Prevention
Hypertensive crisis prevention
Hypertensive crisis is a highly dangerous cardiovascular critical illness. It must be promptly and effectively treated. If there is a sudden increase in blood pressure in patients with hypertension, it is accompanied by vital organ dysfunction such as heart, brain and kidney. Those who should go to the hospital immediately, receive specialist treatment to prevent the occurrence of serious complications, systemic antihypertensive treatment, avoid overwork and mental stimulation and other preventive measures can greatly reduce the occurrence of hypertensive crisis. To regular antihypertensive treatment and long-term adherence.
On cold days, patients with hypertension should pay attention to self-care, pay attention to keeping warm, have a life, save smoking, and drink less. It should be reminded that: Do not stop taking antihypertensive drugs without authorization, so as not to cause blood pressure to rebound, hypertension is a must For lifelong treatment, even if the blood pressure has been stabilized for a long time, you should take appropriate maintenance under the guidance of a doctor.
Complication
Hypertensive crisis Complications hypertensive encephalopathy acute heart failure acute renal failure
Hypertensive crisis is a serious symptom in the process of hypertension. The condition is dangerous, especially when complicated with hypertensive encephalopathy, acute heart failure or acute renal failure. Once the symptoms occur, effective measures should be taken in time, otherwise it may lead to death.
Symptom
Hypertensive crisis symptoms Common symptoms Headache and vomiting Drowsiness, nausea, irritability, basal ganglia, blood pressure, high neck, palpitations, palpitations, hypertension, papilledema, visual impairment
The patient has a sudden onset of illness, the condition is dangerous, usually manifested as severe headache, accompanied by nausea and vomiting, visual impairment and abnormal changes in mental and nervous aspects.
Main features:
1. The blood pressure is significantly increased: the systolic blood pressure can be increased by more than 200mmHg, and the diastolic blood pressure is also significantly increased in severe cases, up to 117mmHg.
2, signs of autonomic dysfunction: fever, sweating, dry mouth, chills, hand and foot tremors, palpitations and so on.
3. Performance of acute damage to target organs:
(1) blurred vision, loss of vision, retinal hemorrhage, exudation, papilled edema.
(2) chest tightness, angina pectoris, palpitations, shortness of breath, cough, and even foaming.
(3) frequent urination, less urine, increased plasma creatinine and urea nitrogen.
(4) transient sensory disturbance, hemiplegia, aphasia, severe irritability or lethargy.
(5) Gastrointestinal tract: nausea and vomiting.
(6) Heart: The heart is enlarged and acute left heart failure may occur.
Examine
Examination of hypertensive crisis
(1) There is no abnormality in blood red blood cells and hemoglobin. However, acute hypertensive patients may have microvascular hemolytic anemia with negative Coombs test. The blood viscosity of patients with abnormal red blood cells and high hemoglobin is increased, and thrombosis complications are easy. Cerebral infarction) and left ventricular hypertrophy.
(2) When the urine concentration of kidney is impaired, the specific gravity of urine gradually decreases, and there may be a small amount of urine protein, red blood cells, and occasionally tube type.
(C) renal function using blood urea nitrogen and creatinine to estimate renal function. Damage to the renal parenchyma can begin to rise to a certain extent. Adult creatinine >114.3mol/L, suggesting renal damage in the elderly and pregnant >91.5mol/L. The phenol red excretion test, the urea clearance rate, and the endogenous creatinine clearance rate may be lower than normal.
(4) The chest X-ray examination shows that the aorta, especially the ascending and arching, is prolonged, and the ascending, arching or descending part can be expanded. Left ventricular enlargement occurs in hypertensive heart disease, left ventricular enlargement is more pronounced in left heart failure, and left and right ventricles increase in whole heart failure, and signs of pulmonary congestion. When the pulmonary edema is seen, the lungs are obviously congested with a butterfly-shaped blurred shadow. It should be checked by routine photography for comparison before and after inspection.
(5) Electrocardiogram ECG of left ventricular hypertrophy may show left ventricular hypertrophy or both strain. There may be arrhythmia such as ventricular premature beats, atrial fibrillation, and the like.
(6) Echocardiography At present, echocardiography is the most sensitive and reliable method for diagnosing left ventricular hypertrophy compared with chest X-ray and ECG. In the presence of left heart failure, echocardiography revealed an enlargement of the left ventricle, left atrium, and decreased left ventricular wall contraction.
(7) Fundus examination The central arterial pressure of the retina is observed to increase, and fundus changes can be seen at different stages of the development of the disease.
Diagnosis
Differential diagnosis of hypertensive crisis
Diagnose based on
1. History of hypertension.
2. The blood pressure suddenly rises sharply.
3. With cardiac dysfunction / hypertensive encephalopathy / renal insufficiency / papilledema, exudation, hemorrhage and other target organs severe dysfunction.
Differential diagnosis
The disease needs to be differentially diagnosed with some of the following diseases:
(1) pheochromocytoma
There is a history of typical paroxysmal hypertension, the blood pressure can be normal during the intermittent period, the blood pressure test is positive, the urinary catecholamine 3 methoxy-4-hydroxy bitter apricot acid (VMA) content is increased, pyelography and retroperitoneal inflation imaging can be Help identification.
(2) Brain tumor
Hypertensive encephalopathy is similar to brain tumors and needs to be identified. Patients with brain tumors have edema of the optic nerve head and signs of intracranial space-occupying lesions. X-ray examination and CT examination can help identify.
(3) intracranial hemorrhage
Often sudden onset, mental disorder, deep breathing, with voice, slanting mouth, limb paralysis, fundus examination may have papilledema, but the fundus artery is innocent.
