Hypertensive crisis symptoms
Hypertensive crisis - sudden marked increase in blood pressure (up to 220/120 mm Hg or higher..), Accompanied by not only a transient neurovegetative disorders, but serious, sometimes organic changes in the body, primarily in the central nervous system, heart,and large vessels.
crisis develops in approximately 1% of hypertensive patients.The duration of a hypertensive crisis can be from several hours to several days.
diagnosis of hypertensive (hypertensive) crisis is put under considerable disorder patient well-being and his general condition, blood pressure figures are not decisive.
average rate of blood pressure is considered to be 120-130 and 70-80 mmHg.Art., but it can be attributed only to the young healthy people.Each person has their own rule - "a working AD", in which he feels well and is relatively healthy.
In young women, often asthenic and normosthenic body (less often in men), work is sometimes a blood pressure of 100-110 mmHg and 60-70.Art., even small improvements they suffer badly.
in elderly chronic patients with hypertension II-III art.and atherosclerosis of the aorta, coronary and cerebral vessels may be working to AD 150-170 and 80-90 mmHg.Art., and lowering it below these values, they suffer just as bad as a significant increase.It is necessary to clarify during the anamnesis, as well as view the current patient medical records (patient card, extracts from the hospital, and others.).
characteristic features of a hypertensive crisis are:
• redness of the face;
• severe headache, pain in the back of his head;
• weakness, dizziness;
• hearing impairment and tinnitus;
• blurred vision and flashing flies before his eyes;
• discomfort, sometimes pain in the heart;
• shortness of breath;
• nausea, vomiting;
• increase in blood pressure to very high values,
• violation of the sensitivity of the limbs:. Tingling, numbness, etc.
most common disease in which the developing hypertensive crises is especially hypertension with malignant course.Approximately 1/3 of patients for hypertensive disease complicated by hypertensive crisis.Most often they are women in menopause.
reason for the development of hypertensive crisis are factors such as emotional stress (anxiety), a sharp change in weather conditions, alcohol and large amounts of salt and water, tea, coffee, cancellation of antihypertensive drugs (especially ß-blockers, clonidine).
Hypertensive crisis is often accompanied by feelings of fear, anxiety, tremors, chills, flushing, and sometimes swelling of the face, blurred vision associated with hemorrhage in the eye structures or swelling of the optic nerve, recurrent bouts of vomiting, neurological disorders with the dissociation of reflections on the top and bottomlimbs and other disorders.Encephalopathy may manifest as irritability and oppression, and euphoria.
In severe cases, a hypertensive crisis may be followed by coma, pulmonary edema, thrombosis and embolism of various arteries, acute renal failure with a decrease in urine output and azotemia.
PNDS crises often exacerbated during the development of coronary heart disease with tachycardia, extrasystolic and pain.
The above changes are observed in hypertensive crises in which significantly increases both systolic and diastolic blood pressure.
more favorable flow hypokinetic and eukinetic crises in which the neurovegetative syndrome are less bright.Hypokinetic crises prevalent in elderly patients who have enough pronounced cerebral symptoms.Crises can last several days and are usually accompanied by the rise of predominantly diastolic pressure.Hypokinetic symptoms of crisis are growing slowly (headache, nausea, retching, dizziness).During the crisis is sometimes focal neurological symptoms.
eukinetic crises develop more quickly, usually proceed favorably with an increase in total peripheral resistance and without significant changes in stroke volume.The clinical picture may be dominated by the cerebral, the cardiac symptoms and syndromes (bradycardia, arrythmia, signs of left ventricular, and sometimes coronary insufficiency).
Hypertensive crises, although much less frequently than in hypertension, developed for different diseases, in symptom which comes and sometimes not included hypertension.Such diseases include arteriosclerotic lesion of the aorta and its branches (especially renal artery), kidney disease (acute and chronic glomerulonephritis, pyelonephritis, etc..), Polyarteritis nodosa, systemic lupus erythematosus, diabetes, nephropathy pregnant, nephroptosis (especially when heavy lifting).
the conditions listed above the most common cause of symptomatic hypertension is kidney damage and blood vessels, but krizovoe for hypertension at the same time is much rarer than in hypertension.It should be borne in mind that the crisis in renal disease is often associated not only with an increase in blood pressure as a brain edema, which should be considered when assigning remedial measures.
Quite often develops hypertensive crisis in pheochromocytoma (hormone-active tumors of the adrenal medulla, which is sometimes localized to the adrenal glands - in the lungs, bladder and other organs).Hypertension, which feature dramatically, depending on the secretory activity of the tumor can be a constant or crisis.When krizovoe release catecholamines tumors arise throbbing headache, sweating, pain in the chest or abdomen, a feeling of fear of death.There may be paresthesia, twitching leg muscles, nausea and vomiting.During an attack or crisis in a patient observed profuse sweating and pale skin.Pupils dilated, cold limbs, blood pressure increased (up to 240/140 mm Hg. Art.).Sometimes there is hyperthermia.After an attack occurs severe weakness.
Patients with hypertension typically occurs constant postural hypotension associated with hypovolemia called catecholamines.
Hypertensive crisis is marked with Cushing's disease, Conn's syndrome (a tumor or adrenal hyperplasia - primary hyperaldosteronism), organic lesions, and brain dysfunction, in particular brain tumors and thalamus (Penfield syndrome, manifested convulsions, lacrimation, nystagmus, tachycardia,hypothermia), familial autonomic dysfunction (Reilly-Day syndrome, manifest violation lacrimation, ataxia, mental lability, etc.), paroxysmal diencephalic hypertension (Page's syndrome predominantly affects women, is characterized by tachycardia, rash, erythematous spots on the face and chest, frequent urination, etc..), alcohol-dependent acute hypertension (stroke times), which may be associated with and essential (even) symptomatic hypertension.In many
hypertensive crisis of diseases mentioned above may occur not only in high background, but also the normal blood pressure.
There are uncomplicated and complicated hypertensive crisis.Complicated hypertensive crisis that threatens life, is diagnosed for the following conditions: stroke (hemorrhagic or ischemic), subarachnoid hemorrhage, encephalopathy, cerebral edema, aneurysm, left ventricular failure, pulmonary edema, acute myocardial infarction, eclampsia, hematuria, retinopathy.
Bed rest, a favorable psychological climate.If krizovoe continues for a long time, we recommend a limited intake of food (diet number 10, 10a).
Lowering blood pressure must be gradual, since excessively rapid decrease can cause renal ischemia, cerebral stroke, a myocardial infarction or development.Reduction in mean arterial pressure in the first hour at approximately 20-25% of baseline diastolic or 110 mm Hg.Art.and then for 6.2 h to 160/100 mm Hg.Art.
Clonidine (an antihypertensive drug central action) inside (initial dose - 0.2 mg, then 0.1 mg every hour to reduce blood pressure or up to a total dose of 0.6 mg) or / drip 1 ml 0.01% solution in 10 ml of 0.9% sodium chloride solution.
Nifedipine (a calcium channel blocker, relaxes smooth muscle and dilates coronary and peripheral vessels) 5-10 (rarely 20) mg in tablets or capsules chew and then swallow or under the tongue;caution is prescribed for hypertensive encephalopathy, papilledema, heart failure with pulmonary edema.
sodium nitroprusside (vasodilator nitric oxide donator) / drip in a dose of 0.25-10 mg / min, then to increase the dose of 0.5 mg / min every 5 min is shown while developing hypertensive encephalopathy, kidney failure, withdissecting aortic aneurysm.Introduction of discontinued if no pronounced effect within 10 minutes after reaching a maximum dose.
Diazoxide (giperstat, a direct vasodilator) 50-150 mg / per bolus over 10-30 seconds (may be repeated after 5-10 min) or slow infusion of 15-30 mg / min for 20-30 min (no more than 600mg).Side effects: hypertension, tachycardia, angina pectoris, nausea, vomiting, edema.
captopril (an ACE inhibitor) 25-50 mg sublingually.Side effects: deterioration of renal circulation in renal artery stenosis.
Labetalol (ß-blocker) 20-80 mg / bolus every 10-15 min or in / in the drip 50-300 mg at a rate of 0.5-2 mg / min.Side effects: bronchospasm, heart block, increased symptoms of heart failure, tachycardia.It is recommended for symptoms of encephalopathy, renal failure.
Phentolamine (a-blocker) 5-15 mg once / in for hypertensive crisis associated with pheochromocytoma.
enalapril (enap ACE inhibitor) on / in a bolus over 5 minutes every 6 hours at a dose of 0,625-1,25 mg diluted in 50 ml of 5% glucose solution or physiological saline;for hypertensive crisis in patients with acute exacerbation of coronary artery disease, chronic congestive heart failure, encephalopathy.
When combined hypertensive crisis with acute coronary syndrome (angina, heart attack), but without signs of left ventricular failure prescribed nitroglycerin or isosorbide dinitrate, with no effect - in / morphine;when persistent pain syndrome, especially in conjunction with tachycardia - ß-blockers (propranolol 10-20 mg sublingually or / every 3-5 min to 1 mg / min to sheathe 10 mg), and in patients with BOS syndrome -verapamil (20-40 mg orally and 5-10 mg / w).
When hypertensive crisis with the development of acute left ventricular failure (pulmonary edema, cardiac asthma) shows diuretic (furosemide / in at a mean dose of 60 mg (40-180 mg), dexamethasone).
When symptomatic hypertensive crisis antihypertensives prescribed taking into account features of the underlying disease.
In the treatment of hypertensive crisis drugs mentioned above can be used in combination with each other or with other agents, particularly diuretics, ß-blockers.
most often in practice, the ambulance found patients with hypertensive crises in the background neurocirculatory dystopia, hypertension and widespread atherosclerosis.However, the cause of a sharp rise in blood pressure may also be kidney, brain, multiple endocrine disorders, etc.
There are many different classifications of hypertensive crises.The practice of providing symptomatic emergency should focus on the clinical manifestations and to consider the mechanism of action of the drugs.
I variant .Predominant complaints of palpitations, chills, "seizures" in the hands and feet (not objectively observed), "a lump in the throat", "hoop clutching his head," anxiety.Patients are nervous, hectic, nervous, can be limb tremor, frequent urination.The crisis is often associated with stress.
Emergency care begins with patient cottages 1-2 tablets or 30-40 drops of tincture of valerian, or the same amount of tincture of Leonurus, korvalola or valokordin.
magnesium sulfate administered intramuscularly 25% - 5.10 ml, you can enter relanium (seduksen).The patient should be reassured of the room to remove the extra people that support the nervous atmosphere or too actively sympathize with the patient.If blood pressure increased significantly decreased and bad, it can be entered as intramuscularly 3-5 ml of 1% or papaverine dibazola 2% - 2 ml.
II variant. patient complains of nausea (sometimes vomiting), "head poured lead" diffuse headache, aggravated by changing the position of the body, weakness, light is irritating to the eyes.These phenomena occur in cases where the impaired blood outflow from the capillaries of the brain due to spasm mostly veins and venules.This crisis is sometimes delayed for a few hours and days.
Emergency assistance should be directed to the dehydration of the brain.Enter intramuscularly, rarely intravenous magnesium sulfate 25% - 10 ml;furosemide (lasix) - 2.4 ml;good effect has Dibazolum (mainly due to expansion of the venous bed).It is administered in an amount of 4.8 ml of a 1% solution (depending on the value of BP) intramuscularly or intravenously with 10 ml isotonic sodium chloride solution or 40% glucose.
Please note that some patients Dibazolum (usually by intravenous administration) in the first 10-15 minutes of calls a certain rise in blood pressure, and then smooth it drop.
Application of No-Spa, papaverine and preparations containing these substances (baralgin, spazgan) can cause significant deterioration of health of patients (had nausea - vomiting starts), although blood pressure measured by a tonometer, may decline.This is due to increased blood flow to the brain.Acceptable use dibazola combination with papaverine.
often used by patients clonidine should not be used again, if he did not give a positive effect, because this drug causes fluid retention in the body.In the event of protracted crises in particular shows the use of diuretics (furosemide, etc.).
III variant .Mostly the pain in the neck, half or in a particular area of the head.Sometimes the patient can not localize the pain, but it is bursting is not of the nature and severity of fullness, rarely accompanied by nausea.Maybe chills.These sensations are caused by a primary spasm of arterioles and small arteries, causing the relative brain ischemia.Often these patients during crises take pills containing caffeine, some drink coffee.At the same time improving their well-being, decrease headaches as caffeine enhances brain vessels.
In these cases shows: No-Spa, papaverine, or 2% - 2 ml intramuscular;baralgin or spazgan 5 mL intramuscularly;You can also enter intravenously 10-20 ml of 40% glucose.
In some cases, against the background of hypertensive crisis patients develop sensory disturbances and mobility in certain limbs, disorders of consciousness and speech, impaired vision, severe dizziness.This is also called cerebral ischemia.In this case, the injected aminophylline 2.5% - 10 ml and 10-20 ml of 40% glucose and transmitting the active call neurological brigade.
Assistance is considered effective if the blood pressure decreased to 1/3 of the original.No need to strive for a rapid and sharp decrease in blood pressure.After arresting crisis patients can be left at home to transfer an active call your GP or without it.If the crisis can not be cut short, or it occurs repeatedly throughout the day, and if a crisis arose for the first time, or very high values of blood pressure and may develop complications, the patient should be hospitalized in the therapeutic department.On the streets and public places of all hospitalized patients.
Hypertensive crisis observed in patients with a history of hypertension is indicated on.
dental procedures, especially in people who are emotionally easily excitable, can be a precipitating factor for the development of hypertensive crisis.