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"Hypertensive emergency"

Sarah Faloon, Hema Venkataraman, Kassiani Skordilis, Ewen A Griffiths, Neil Jl Gittoes, Zaki K Hassan-Smith, John Ayuk
A 26-year-old man presented following blunt abdominal trauma to a regional major trauma centre for emergency embolisation of a retroperitoneal bleed from a presumed renal laceration. Imaging had also revealed a large right suprarenal mass. Embolisation resulted in a hypertensive crisis raising the suspicion of a metabolically active adrenal tumour. The course was further complicated by the development of ischaemic bowel requiring emergency laparotomy. Intraoperatively he became haemodynamically unstable from an actively haemorrhaging lesion...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Giuliano Tocci, Ilaria Figliuzzi, Vivianne Presta, Francesca Miceli, Barbara Citoni, Roberta Coluccia, Maria Beatrice Musumeci, Andrea Ferrucci, Massimo Volpe
Uncontrolled hypertension is one of the most common determinant for the persistently high burden of cardiovascular (CV) disease, mostly including coronary artery disease (CAD) and hospital admissions due to acute coronary events. Markedly high blood pressure (BP) levels are also frequently observed during the acute phase of coronary syndromes (both ST-segment and non-ST-segment elevation myocardial infarction and unstable angina). In particular, a sustained raise of BP levels above 180/110 mmHg associated with acute cardiac organ damage, i...
July 31, 2018: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Sunkaru Touray, Baboucarr Sanyang, Gregory Zandrow, Fatoumatta Dibba, Kaddy Fadera, Ebrima Kanteh, Madikoi Danso, Landing N Sanyang, Masirending Njie, Grey Johnson, Awa Sanyang, Awa Touray
PURPOSE: Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking. MATERIALS AND METHODS: We surveyed eight of the eleven government-owned health facilities providing secondary and tertiary care in The Gambia's public health sector. At each hospital, a designated respondent completed a questionnaire reporting information on the presence of an intensive care unit, the number of critical care beds where available, monitoring equipment, and the ability to provide basic critical care services at their respective hospitals...
July 22, 2018: Journal of Critical Care
Keshav Menon, Patrick D Sutphin, Sonja Bartolome, Sanjeeva P Kalva, Takeshi Ogo
Chronic thromboembolic pulmonary hypertension (CTEPH) is a debilitating but potentially reversible complication of chronic pulmonary thromboembolic disease characterized by progressive right heart dysfunction secondary to pulmonary arterial stenosis or occlusion. Balloon pulmonary angioplasty (BPA) has recently emerged as an alternative intervention for non-surgical candidates with CTEPH. Modern reperfusion angioplasty techniques relieve sequela of chronic pulmonary hypertension, ameliorate right ventricular failure, and improve functional status...
June 2018: Cardiovascular Diagnosis and Therapy
Michael S Bleszynski, Alexsander K Bressan, Emilie Joos, S Morad Hameed, Chad G Ball
The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction, degree of portal hypertension, emergency of surgery, and severity of patients' comorbidities constitute predictors of postoperative mortality. Comprehensive history taking, physical examination, and thorough review of laboratory and imaging examinations typically elucidate clinical evidence of hepatic dysfunction, portal hypertension, and/or their complications...
2018: World Journal of Emergency Surgery: WJES
M José Forcadell, Angel Vila-Córcoles, Cinta de Diego, Olga Ochoa-Gondar, Eva Satué
Background Population-based data about the epidemiology of acute myocardial infarction is limited. This study investigated incidence and mortality of acute myocardial infarction in older adults with specific underlying chronic conditions and evaluated the influence of these conditions in developing acute myocardial infarction. Design and methods This was a population-based cohort study involving 27,204 individuals ≥ 60 years of age in Tarragona (Catalonia, Spain). Data on all cases of hospitalised acute myocardial infarction were collected from 1 December 2008-30 November 2011...
January 1, 2018: European Journal of Preventive Cardiology
Wesley Chan, Si Xi Zhao, Aaron Winter, Hesham Lakosha, R Rishi Gupta
Purpose: Hypertensive emergency usually presents to ophthalmologists in the form of hypertensive retinopathy. We present a case of hypertensive emergency that presented as bilateral transient myopic shift due to ciliary body detachment in the absence of any retinal pathology. The purpose of this paper is to showcase another ocular manifestation of hypertensive emergency. Observations: A 35 year-old female with a blood pressure of 192/114 mmHg presented to the emergency department with headache and acute onset blurry vision...
September 2018: American Journal of Ophthalmology Case Reports
Anna Paini, Carlo Aggiusti, Fabio Bertacchini, Claudia Agabiti Rosei, Giulia Maruelli, Chiara Arnoldi, Sara Cappellini, Maria Lorenza Muiesan, Massimo Salvetti
Acute blood pressure (BP) elevation represents a frequent reason of concern for clinicians in everyday clinical practice. The terms "hypertensive emergencies" and "hypertensive urgencies" may be used in order to better define the so called "hypertensive crises". A hypertensive emergency may be defined as a condition characterized by an acute and severe elevation of blood pressure (BP) associated to a new onset or worsening organ damage (OD). A hypertensive urgency may be defined as a condition characterized by an isolated elevation of BP values without evidence of acute hypertensive OD...
June 18, 2018: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Nadarajah Prasanna, Harsha A Dissanayake, Godwin R Constantine
OBJECTIVE: Hypertensive emergencies are potentially life threatening and require prompt blood pressure control with intravenous agents. Preparation of intravenous infusions is time consuming. Usefulness of sublingual nitroglycerin in this setting is not known. We aimed to assess the benefit of sublingual nitroglycerin as a bridge to IV therapy. In a clinical audit in an emergency department, patients presenting with hypertensive emergencies requiring intravenous nitroglycerin were administered single spray of sublingual nitroglycerin awaiting commencement of intravenous infusion...
June 5, 2018: BMC Research Notes
Massimo Salvetti, Anna Paini, Fabio Bertacchini, Carlo Aggiusti, Deborah Stassaldi, Laura Verzeri, Giovanni Saccà, Maria Lorenza Muiesan
Arterial hypertension represents the most important risk factor for ischemic and haemorrhagic stroke, and an acute hypertensive response is often observed in patients with intracranial haemorrhage (ICH). Available data indicate that the vast majority (> 70%) of patient with acute ICH have a systolic BP above 140 mmHg at the time of presentation in the ED; about 20% have SBP values above 180 mmHg. Severe BP elevation in the presence of ICH represents a hypertensive emergency, and worsening of clinical conditions is not infrequent in the first hours after admission; an aggressive early management is therefore required for these patients...
June 2018: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Anthony J Viera
Hypertensive emergency occurs when the blood pressure (BP) level is severely elevated (ie, higher than 180 mm Hg systolic or higher than 120 mm Hg diastolic) and acute organ damage is present. Patients with hypertensive emergencies are treated initially in the emergency department and then admitted to the intensive care unit. Management is directed at the specific situation, with the rate and extent of BP level lowering tailored to the type and extent of organ damage. Patients with severely elevated BP level but without symptoms have asymptomatic severe hypertension...
June 2018: FP Essentials
Kraftin E Schreyer, Jenna Otter, Zachary Johnston
Thoracic aorta thrombi are a rare condition typically presenting as a source for distal embolization in elderly patients with atherosclerotic risk factors. However, young patients with a variety of presentations resulting from such thrombi have rarely been reported. We describe a case of a young patient with refractory hypertensive emergency caused by a large thoracic aorta thrombus. Investigation was guided by abnormal physical exam findings.
November 2017: Clinical practice and cases in emergency medicine
Purva Sharma, Mohamad Kabach, Samineh Sehatbakhsh, Rashida Tharpe, Shaun Isaac, Robert Chait, Kleper De Almeida
Human immunodeficiency virus (HIV) infection confers an increased risk of cardiovascular disease, including acute coronary syndrome (ACS). Patients with perinatally acquired HIV may be at increased risk due to the viral infection itself and exposure to HAART in utero or as part of treatment. A 20-year-old female with transplacentally acquired HIV infection presented with symptoms of transient aphasia, headache, palpitations, and blurry vision. She was admitted for hypertensive emergency with blood pressure 203/100 mmHg...
2018: Case Reports in Infectious Diseases
Taseen Syed, Samid Farooqui, Rutaba Tajammal, Sultan Mahmood, Donald Kastens
Chilaiditi's sign is a rare radiological anomaly of hepato-diaphragmatic interposition of the bowel. We report a case of Chilaiditi's sign associated with acute colonic pseudo-obstruction. A 90-year-old male was admitted for hypertensive emergency. His physical examination showed a distended abdomen, decreased bowel sounds, and right upper quadrant tenderness. A chest radiograph demonstrated marked elevation of the right diaphragm and interposition of the hepatic flexure of the colon between the diaphragm and the liver, along with marked gaseous distension up to 9 cm in the ascending colon without any small bowel distension...
March 20, 2018: Curēus
Roberto Sansone, Maximilian Baaken, Patrick Horn, Dominik Schuler, Ralf Westenfeld, Nicolas Amabile, Malte Kelm, Christian Heiss
BACKGROUND AND AIMS: Circulating endothelial microparticles (EMPs) are increased in arterial hypertension. The role of physicomechanical factors that may induce EMP release in vivo is still unknown. We studied the relationship of EMPs and physicomechanical factors in stable arterial hypertension and hypertensive emergencies, and investigated the pattern of EMP release after mechanical endothelial injury. METHODS: In a pilot study, 41 subjects (50% hypertensives) were recruited...
June 2018: Atherosclerosis
Khalil El Karoui
IgA nephropathy can have various initial presentation and evolutive characteristics. In this article, specific forms of IgA nephropathy are described, such as hypertensive emergency, nephrotic syndrome, rapidly progressive glomerulonephritis, monotypic IgA deposits, or IgA nephropathy associated with inflammatory diseases. Identification of these specific forms is needed to better characterize and treat these rare pathologies.
April 2018: Néphrologie & Thérapeutique
R S Wightman, L S Nelson, J D Lee, L M Fox, S W Smith
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse...
June 2018: American Journal of Emergency Medicine
Stephen Boone, Dick Kuo
PURPOSE OF REVIEW: Early lowering of blood pressure is advised for patients with severe hypertension associated with signs of impending or progressive organ damage, whereas aggressive treatment is not recommended in patients with asymptomatic severe hypertension. As treatment goals for asymptomatic hypertension and true hypertensive emergency drastically differ, it is essential to identify patients with evidence of impending or progressive organ damage. Biomarkers may assist providers in identifying high-risk patients who would benefit from early blood pressure reduction...
March 19, 2018: Current Hypertension Reports
Ali Yousif, Rajesh Samannan, Mazen Abu-Fadel
Acute renal artery embolism (RAE) is a rare condition associated with significant morbidity and mortality. The treatment strategy for RAE includes anticoagulation with or without thrombolysis or surgical or endovascular embolectomy. We describe here a case presentation of acute RAE secondary to atrial fibrillation treated successfully with Penumbra Indigo Aspiration System, a novel device in peripheral endovascular interventions. Our patient had ongoing symptoms and acute renal failure on presentation with contraindication to thrombolysis given hypertensive emergency...
July 2018: Vascular and Endovascular Surgery
Bradford Bennett, Drew Johnson, Andrew Panakos, Aleksandr Rozenberg
A 51-year-old woman with history of migraine headaches and intermittent nausea, vomiting, palpitations, and diaphoresis presented to the emergency department with hypertensive emergency 1 month after starting a beta blocker for migraine prophylaxis. Contrast-enhanced computed tomography of the chest incidentally revealed a large abdominal mass in the area of the left adrenal gland. Iodine-123 metaiodobenzylguanidine scan imaging showed localized uptake into the left adrenal gland. Along with imaging results, laboratory testing confirmed the diagnosis of pheochromocytoma...
February 2018: Radiology Case Reports
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