Hypertensive crisis symptoms
The hypertensive crisis is often accompanied by a sense of fear, anxiety, tremor, chills, flushing, and sometimes facial swelling, visual impairment associated with hemorrhage in the structure of the eye or edema of the optic nerve, repeated attacks of vomiting, neurologic disorders with dissociation of reflexes on the upper and lower extremities andother disorders. Encephalopathy can manifest itself as irritability and depression, as well as euphoria.
In severe cases, hypertensive crisis may be accompanied by coma, pulmonary edema, thrombosis and embolism of various arteries, acute renal failure with decreased urinary output and azotemia.
In the hypertensive crisis, the course of IHD is often exacerbated with the development of tachycardia, extrasystolic and pain syndrome.
The above changes are observed with hypertensive crises at which both systolic and diastolic pressure significantly increase.
More favorable hypokinetic and eukinetic crises occur in which the neurovegetative syndrome is less pronounced. Hypokinetic crises prevail in elderly patients, who have a fairly pronounced cerebral symptomatology. Crises can last several days and are usually accompanied by a rise in predominantly diastolic pressure. Symptoms of hypokinetic crisis increase slowly( headache, nausea, urge for vomiting, dizziness).During a crisis, focal neurological symptoms sometimes occur.
Eukinetic crises develop more rapidly, usually proceed favorably with an increase in the total peripheral resistance and without a significant change in the shock volume. In the clinical picture of the disease, the cerebral and the cardiac symptoms and syndromes( bradycardia, extrasystole, signs of left ventricular, and sometimes coronary insufficiency) can predominate.
Hypertensive crises, although much less frequently than in hypertensive disease, develop with various diseases, the symptom-complex of which is, and sometimes does not, arterial hypertension. Such diseases include arteriosclerotic lesions of the aorta and its branches( especially the renal arteries), kidney diseases( acute and chronic glomerulonephritis, pyelonephritis, etc.), nodular polyarteritis, systemic lupus erythematosus, diabetes mellitus, nephropathy of pregnant women, nephroptosis( especially with elevation of gravity).
Of the diseases listed above, the most common cause of symptomatic hypertension is the damage to the kidneys and their vessels, but the flow of arterial hypertension is much less frequent than in hypertensive disease. It should be borne in mind that the crisis in kidney disease is often associated not so much with increasing blood pressure as with cerebral edema, which should be taken into account when appointing treatment.
Quite often, the hypertensive crisis develops with pheochromocytoma( a hormone-active tumor of adrenal medulla that sometimes is located outside the adrenal glands - in the lungs, bladder and other organs).Hypertension, which is a cardinal sign, depending on the secretory activity of the tumor can be in the form of a crisis or a constant. With the release of catecholamines, the tumor has a throbbing headache, sweating, pain in the chest or abdomen, a sense of fear of death. Paresthesia, convulsive shank muscles, nausea and vomiting are possible. During an attack or crisis, the patient experiences profuse sweating and pale skin. Pupils dilated, limbs cold, blood pressure increased( up to 240/140 mm Hg).Sometimes there is hyperthermia. After the attack, there comes a sharp weakness.
In patients with persistent hypertension, postural hypotension usually occurs, associated with coadolamines caused by hypovolemia.
The hypertensive crisis is observed with Cushing's disease, Conn's syndrome( adrenal cortex tumor or hyperplasia - primary hyperaldosteronism), organic lesion and brain dysfunction, particularly in brain tumors and visual crescendo( Penfield syndrome, manifested by seizures, lacrimation, nystagmus, tachycardia,hypothermia), familial autonomic dysfunction( Rayleigh-Deia syndrome, manifested by tearing, movement coordination disorder, mental lability, etc.), paroximal(peydz syndrome, mainly women suffer, tachycardia, hyperhidrosis, erythematous spots on the face and chest, frequent urination, etc.), acute alcohol-dependent arterial hypertension( sometimes with a stroke), which may not be associated with the essential and( even) symptomatic hypertension.
With many of the above diseases, the hypertensive crisis can occur not only against the background of increased but also normal blood pressure.
Distinguish uncomplicated and complicated hypertensive crisis. A complicated hypertensive crisis that threatens life is diagnosed under the following conditions: stroke( hemorrhagic or ischemic), subarachnoid hemorrhage, encephalopathy, cerebral edema, exfoliating aneurysm, left ventricular failure, pulmonary edema, acute myocardial infarction, eclampsia, hematuria, retinopathy.
Hypertensive crisis is a sudden increase in blood pressure( up to 220/120 mm Hg and higher), accompanied not only by transient neurovegetative disorders, but serious, sometimes organic changes in the body, and especially in the central nervous system, heart and largevessels.
The crisis develops in approximately 1% of patients with hypertension. The duration of the hypertensive crisis is from several hours to several days.
The diagnosis of the hypertensive( hypertensive) crisis is based on a significant disorder of the patient's well-being and his general condition, the BP figures are not determinative.
The average rate is considered to be AD 120-130 and 70-80 mm Hg. However, this can only be attributed to young healthy people. Each person has his own norm - "working blood pressure", under which he feels well and is relatively healthy.
Young women, often asthenic and normostenicheskogo physique( less often in men), the worker is sometimes 100-110 BP and 60-70 mmHg. They even tolerate a slight increase in their health.
In elderly chronic patients with hypertensive disease II-III st.and atherosclerosis of the aorta, coronary and cerebrovascular vessels, the worker can have a BP up to 150-170 and 80-90 mm Hg.and lowering it below these values, they suffer as badly as a significant increase. This is necessary to find out during the collection of anamnesis, as well as viewing the patient's medical records( outpatient card, hospital discharge, etc.).
Characteristic features of the hypertensive crisis are:
• redness of the face;
• severe headache, pain in the occiput;
• weakness, dizziness;
• hearing impairment and tinnitus;
• blurred vision and flashing of flies before the eyes;
• unpleasant sensations, sometimes pain in the heart;
• shortness of breath;
• nausea, vomiting;
• increased blood pressure to extremely high values,
• tachycardia;
• Sensitivity disorder in the extremities: tingling, numbness, etc.
The most common disease in which hypertensive crises develop is hypertensive disease, especially with malignant course. In approximately 1/3 of patients, hypertensive disease is complicated by hypertensive crises. They are most frequent in women in the climacteric period.
The cause of the development of hypertensive crisis are such factors as psychoemotional stress( anxiety), abrupt change in meteorological conditions, drinking alcohol and large quantities of salt and water, tea, coffee, abolition of antihypertensive drugs( especially ß-adrenoblockers, clonidine).
Bed rest, favorable psychological conditions. If the course of the crisis lasts a long time, a limited meal is recommended( diet No. 10, 10a).
Reducing blood pressure should be gradual, because an excessively rapid decrease can trigger kidney ischemia, the brain with the development of a stroke or myocardial infarction. Decrease in mean arterial pressure during the first hour by about 20-25% from the initial or diastolic to 110 mm Hg. Art.and then for 2-6 hours to 160/100 mm Hg. Art.
Clonidine( central antihypertensive drug) inside( initial dose is 0.2 mg, then 0.1 mg every hour until the blood pressure drops or to a total dose of 0.6 mg) or iv drip 1 ml 0.01%solution in 10 ml of a 0.9% solution of sodium chloride.
Nifedipine( calcium channel blocker, relaxes smooth muscles and dilates coronary and peripheral vessels) 5-10( less than 20) mg in tablets or capsules chew, and then under tongue or swallow;cautiously prescribed for hypertensive encephalopathy, edema of the optic nerve disk, heart failure with pulmonary edema.
Sodium nitroprusside( vasodilator, donator of nitric oxide) is dripped intravenously at a dose of 0.25-10 μg / min, then the dose is increased by 0.5 μg / min every 5 minutes, is shown with the simultaneous development of hypertensive encephalopathy, renal failure, withexfoliating aortic aneurysm. Administration is discontinued if there is no pronounced effect within 10 minutes after reaching the maximum dose.
Diazoxide( hyperstat, direct vasodilator) 50-150 mg IV bolus for 10-30 seconds( can be repeated after 5-10 minutes) or slow infusion of 15-30 mg / min for 20-30 minutes( no more than 600mg).Side effects: arterial hypertension, tachycardia, angina pectoris, nausea, vomiting, swelling.
Captopril( ACE inhibitor) 25-50 mg sublingually. Side effects: deterioration of renal circulation in stenosis of the renal arteries.
Labetalol( ß-adrenoblocker) 20-80 mg IV bolus every 10-15 minutes or IV droplet 50-300 mg at a rate of 0.5-2 mg / min. Side effects: bronchospasm, cardiac blockade, increased signs of heart failure, tachycardia. It is recommended for signs of encephalopathy, kidney failure.
Fentolamine( a-adrenoblocker) 5-15 mg once iv in hypertensive crisis associated with pheochromocytoma.
Enalapril( enap, ACE inhibitor) iv infusion for 5 minutes every 6 hours at a dose of 0.625-1.25 mg diluted in 50 ml of 5% glucose solution or saline solution;with hypertensive crisis in patients with exacerbation of IHD, chronic congestive heart failure, encephalopathy.
With the combination of hypertensive crisis with acute coronary syndrome( angina, infarction), but without the symptoms of left ventricular failure, nitroglycerin or isosorbide dinitrate is prescribed, in the absence of effect - in / in morphine;with persistent pain syndrome, especially in combination with tachycardia - ß-adrenoblockers( propranolol 10-20 mg under the tongue or intravenously every 3-5 minutes at 1 mg / min to the total dose of 10 mg), and in patients with bronchoobstructive syndrome -verapamil( 20-40 mg orally and 5-10 mg IV).
In hypertensive crisis with the development of acute left ventricular failure( pulmonary edema, cardiac asthma), diuretics are indicated( furosemide IV at an average dose of 60 mg( 40-180 mg), dexamethasone).
With a symptomatic hypertensive crisis, antihypertensives are prescribed taking into account the characteristics of the underlying disease.
In the treatment of hypertensive crisis, the above-mentioned preparations can be used both in combination with each other and with other antihypertensive agents, especially diuretics and ß-adrenoblockers.
Most often in the practice of first aid there are patients with hypertensive crises against the background of neurocirculatory dystopia, hypertension and widespread atherosclerosis of blood vessels. However, the cause of a sharp rise in blood pressure can also be diseases of the kidneys, the brain, various endocrine disorders, etc.
There are many different classifications of hypertensive crises. In the practice of symptomatic emergency care should be guided by clinical manifestations and take into account the mechanism of action of the drugs used.
I version of .Prevalence of complaints about palpitation, chills, "convulsions" in the hands and feet( objectively not noted), "lump in the throat", "hoop, squeezing the head, anxiety."Patients are nervous, fussy, excited, there may be a tremor of extremities, frequent urination. Crisis is often associated with stress.
Emergency care begins with giving the patient 1-2 tablets or 30-40 drops of tincture of valerian or the same amount of tincture of motherwort, corvalol or valocordin.
Intramuscularly administered magnesium sulfate 25% - 5-10 ml, you can enter Relanium( Seduxen).The patient should be reassured, from the room to remove superfluous people who support a nervous situation or overly actively sympathize with the patient. If blood pressure is increased significantly and badly decreases, you can also enter intramuscularly 3-5 ml of 1% dibazole or papaverine 2% - 2 ml.
II option. The patient complains of nausea( sometimes up to vomiting), "head is poured with lead," a spilled headache that increases with a change in body position, weakness, light irritates the eyes. These phenomena occur in those cases when the outflow of blood from the capillaries of the brain is violated due to spasm mainly veins and venules. Such a crisis is sometimes delayed for several hours and days.
Emergency care should be directed towards dehydration of the brain. Enter intramuscularly, less often intravenously, magnesium sulfate 25% - 10 ml;furosemide( lasix) - 2-4 ml;a good effect has dibazol( due to the expansion of predominantly venous bed).It is administered in an amount of 4-8 ml of a 1% solution( depending on the value of AD) intramuscularly or intravenously with 10 ml of isotonic sodium chloride solution or 40% glucose.
It should be noted that in some patients dibazol( more often with intravenous administration) in the first 10-15 minutes causes a slight increase in blood pressure, and then a gradual decrease in blood pressure.
The use of no-shpa, papaverine and preparations containing such substances( baralgin, spazgan) can cause a significant deterioration in the well-being of patients( nausea - vomiting will begin), although blood pressure, measured by a tonometer, may decrease. This is due to increased blood flow to the brain. It is acceptable to apply a combination of dibazolum and papaverine.
Clonidine frequently used by patients should not be reapplied if it does not have a positive effect, since this drug causes fluid retention in the body. In the case of protracted crises, the use of diuretic( furosemide, etc.) is especially indicated.
III version of .Pain predominates in the neck, half or in some specific area of the head. Sometimes patients can not localize the pain, but it is lomiting, it does not have the character of severity and raspiraniya, rarely accompanied by nausea. There may be chills. These sensations are due to the predominant spasm of arterioles and small arteries, which causes relative cerebral ischemia. Often, such patients during crises take pills containing caffeine, some drink coffee. At the same time, they feel better, headaches decrease, since caffeine dilates the vessels of the brain.
In these cases, the following are shown: no-spawn or papaverine 2% - 2 ml intramuscular;baralgin or spasgan 5 ml intramuscularly;10-20 ml of 40% glucose can also be administered intravenously.
In some cases, against the background of hypertensive crisis, patients develop disorders of sensitivity and mobility in individual limbs, disorders of consciousness and speech, visual impairment, severe dizziness. It is also caused by cerebral ischemia. In this case, intravenously injected eufillin 2,5% - 10 ml and 10-20 ml of 40% glucose and transmit an active challenge to the neurological team.
Assistance is considered effective if blood pressure has decreased by one-third of the baseline. Do not try to quickly and dramatically reduce blood pressure. After crisis relief, patients can be left at home with or without an active call to a district doctor. If the crisis can not be stopped, or it occurs again within 24 hours, and if the crisis occurred for the first time, or if the values of blood pressure are very high and the complications may develop, the patient should be hospitalized in the therapeutic department. From the street and from public places all patients are hospitalized.
The hypertensive crisis is observed in patients whose history indicates hypertensive disease.
Stomatological intervention, especially in people emotionally easily excitable, may be a provoking factor for the development of hypertensive crisis.
First aid:
• discontinuation of all dental procedures;
• giving a semi-sitting position, removing clothing pressure( collar, belt, etc.);
• administration of antihypertensive agents: magnesium sulfate 25% 10 ml intramuscularly, euphylline 2.4% 5 ml in physiological saline or glucose intravenously( euphyllin 1 ml 24% solution intramuscularly), 4 ml 1% solutiondibazolum intramuscularly or intravenously with dilution in physiological saline, 2 ml of 1% solution of papaverine subcutaneously, intramuscularly, intravenously. These drugs have a vasodilator effect, have a sedative effect, contribute to a reduction in cerebral edema;
• antihypertensive effect is also expressed in some diuretics: lasix, furosemide. These drugs supplement the action of the main antihypertensive drugs. Lasix should be administered intravenously in an amount of 2-4 ml. Furosemide is given internally at 40 mg;
• it is possible to conduct distractions: the application of mustard plasters on the waist, legs, head;
• call the ambulance team and hospitalization in a specialized hospital.