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"Hypertensive emergency"

Nicholas Nacca, Rachel Schult, Robert Loflin, Adam Weltler, Rachel Gorodetsky, Sherri Kacinko, Jeffery Moran, Alex Krotulski, Timothy Wiegand
BACKGROUND: Synthetic cannabinoid intoxication has become difficult to diagnose and manage in the United States, in part due to varying clinical effects within this heterogeneous group of compounds. CASE REPORT: A 38-year-old man was admitted with altered mental status and bradycardia. He demonstrated progressive encephalopathy, seizure activity, second-degree atrioventricular block type I, respiratory failure, hypotension, hypothermia, and hypoglycemia. A computed tomography scan of the abdomen and pelvis revealed multiple packages in the patient's stomach and rectum...
October 5, 2018: Journal of Emergency Medicine
Sophie Kuntz, Romain Boulestreau, Sébastien Rubin, Antoine Cremer, Philippe Gosse
Hypertensive emergency. Stable incidence for several decades or even increasing (under diagnosed). Early and specific management improves prognosis. Absence of eye damage or lack of access to fundus should not delay or prevent the diagnosis. Multi Organ Damage Hypertension: new definition for an old entity: unusual, sudden and persistent blood pressure rise without threshold and ocular involvement or involvement of at least 3 target organs among brain, heart, kidney or endothelial disease.
October 4, 2018: La Presse Médicale
Irina Benenson, Frederick Andrew Waldron, Shelly A Jones Dillon, Shreni N Zinzuwadia, Nkehci Mbadugha, Natali Vicente, Ela Aris, Adedamola M Adeboye, Christine Makdisi
AIM: The aim of this study was to identify risk factors for hypertensive emergencies in diabetic patients presenting with severely elevated blood pressure. METHODS: Using electronic medical records, this study identified diabetic patients with hypertensive crisis who presented to the emergency department of Newark Beth Israel Medical Center, Newark, NJ from June 2013 to May 2016. Diabetic patients with hypertensive emergencies were compared with non-diabetic patients based on important demographic and clinical characteristics...
October 4, 2018: Clinical and Experimental Hypertension: CHE
Michael H Chiu, Nakul C Sharma
Thyroid hormones and the cardiovascular system are strongly intertwined with known risk of coronary disease, atrial fibrillation, and cardiomyopathy. Pericardial effusions are commonly seen in cases of severe hypothyroidism, however large to massive pericardial effusions with cardiac tamponade are exceptionally rare. We report a case of a patient presenting with hypertensive emergency and a concomitant diagnosis of primary hypothyroidism with a large pericardial effusion and early echocardiographic features of tamponade...
July 2018: Journal of Cardiology Cases
Tomáš Seeman, Gilad Hamdani, Mark Mitsnefes
Hypertensive crisis is a relatively rare condition in children. However, if not treated, it might be life-threatening and lead to irreversible damage of vital organs. Clinical presentation of patients with hypertensive crisis can vary from very mild (hypertensive urgency) to severe symptoms (hypertensive emergency) despite similarly high blood pressure (BP). Individualized assessment of patients presenting with high BP with emphasis on the evaluation of end-organ damage rather than on the specific BP number is a key in guiding physician's initial management of a hypertensive crisis...
October 1, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
D Sánchez-Fabra, R Marinas Sanz, E Tarí Ferrer, A Gracia Gutiérrez, S López Garrido, M Morando Pérez, B Amores Arriaga, J Cebollada Del Hoyo
OBJECTIVES: To describe the characteristics of hypertensive urgencies at the emergency department, as well as the variables associated with early re-admission (<7 days) and re-admission at one month (<30 days). METHODS: We conducted a descriptive, retrospective study of all patients who were admitted to the emergency department of a third level hospital during 2013. Subsequently, a case-control analysis was performed to analyze the group of patients with readmission...
September 20, 2018: Hipertensión y Riesgo Vascular
Danial Mir, Arash Ardabilygazir, Sonia Afshariyamchlou, Issac Sachmechi
Malignant hypertension (MH) has been described in association with high-dose (50 - 100 mcg) estrogen oral contraceptive pills (OCPs). Although the rise in blood pressure (BP) is usually mild, some women will have a more significant increase in BP, and hypertensive emergencies may very rarely occur. We present a 21-year-old Caucasian female with a past medical history of fibromyalgia and family history of hypertension (both grandparents) who was admitted with a three-day history of headache and blurring of vision in her left eye with a BP of 210/150...
July 13, 2018: Curēus
Jared W Davis, Muhannad Almubarak, Amrita Mukherjee, Samuel K McElwee, Massoud A Leesar, Arka Chatterjee
BACKGROUND: Patients presenting with hypertensive urgency / emergency (HUE) often have systolic heart failure(SHF). Coronary angiography is routinely done for these patients to rule out obstructive coronary artery disease (Obs-CAD). We performed a retrospective study to investigate predictors of ObsCAD in this population. METHODS: Patients who underwent angiography to investigate SHF and had hospital admission(s) for HUE in the preceding 6 months were included in the study...
August 16, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Joseph B Miller, Sean Calo, Brian Reed, Richard Thompson, Bashar Nahab, Evan Wu, Kaleem Chaudhry, Phillip Levy
STUDY OBJECTIVE: In the Emergency Department (ED) setting, clinicians commonly treat severely elevated blood pressure (BP) despite the absence of evidence supporting this practice. We sought to determine if this rapid reduction of severely elevated BP in the ED has negative cerebrovascular effects. METHODS: This was a prospective quasi-experimental study occurring in an academic emergency department. The study was inclusive of patients with a systolic BP (SBP) > 180 mm Hg for whom the treating clinicians ordered intensive BP lowering with intravenous or short-acting oral agents...
August 21, 2018: American Journal of Emergency Medicine
Fabian Rengier, Claudius Melzig, Thorsten Derlin, Alberto M Marra, Jens Vogel-Claussen
Pulmonary hypertension (PH) is a pathophysiological disorder defined by an increase in pulmonary arterial pressure which can occur in multiple clinical conditions. Irrespective of etiology, PH entails a negative impact on exercise capacity and quality of life, and is associated with high mortality particularly in pulmonary arterial hypertension. Noninvasive imaging techniques play an important role in suggesting the presence of PH, providing noninvasive pulmonary pressure measurements, classifying the group of PH, identifying a possibly underlying disease, providing prognostic information and assessing response to treatment...
August 30, 2018: International Journal of Cardiovascular Imaging
Bert-Jan H van den Born, Gregory Y H Lip, Jana Brguljan-Hitij, Antoine Cremer, Julian Segura, Enrique Morales, Felix Mahfoud, Fouad Amraoui, Alexandre Persu, Thomas Kahan, Enrico Agabiti Rosei, Giovanni de Simone, Philippe Gosse, Bryan Williams
Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation...
August 25, 2018: European Heart Journal. Cardiovascular Pharmacotherapy
Patrick Lavin, Morgan Patrylo, Matthew Hollar, Kiersten B Espaillat, Howard Kirshner, Matthew Schrag
PURPOSE: Central retinal artery occlusion (CRAO) is mechanistically similar to a stroke. Current guidelines recommend a standardized and systematic evaluation of risk factors for patients who have had a stroke. This study evaluates the yield of this evaluation in patients with CRAO and frequency of stroke in this population. DESIGN: Cohort study. METHODS: We evaluated the diagnostic yield of an expedited inpatient evaluation of cerebrovascular risk factors in a cohort of patients presenting with an acute CRAO within the period from 2009-2017 at an academic hospital...
August 25, 2018: American Journal of Ophthalmology
Rosemary J Froehlich, Lindsay Maggio, Phinnara Has, Roxanne Vrees, Brenna L Hughes
OBJECTIVE: To assess treatment outcomes associated with an obstetric hypertensive emergency quality improvement intervention instituted in a tertiary care women's emergency department. METHODS: We conducted a cohort study of pregnant (20 weeks of gestation or greater) and postpartum (6 weeks of gestation or less) women treated for hypertensive emergency (systolic blood pressure [BP] 160 mm Hg or greater, diastolic 110 mm Hg or greater, or both) before and after a quality improvement intervention...
October 2018: Obstetrics and Gynecology
Shenjing Li, Prince Sethi, Shawn C Kelly, Maryam Sheikh, Maria Stys, Adam Stys
An 83-year-old female presented to the emergency department with bilateral eye pain, dizziness, and acute shortness of breath. Her blood pressure (BP) at presentation was 184/93 mmHg. She was admitted for hypertensive emergency and her symptoms improved with BP control. However, during hospitalization, she developed left-sided paresthesia which on investigation was found to be secondary to ischemic stroke. She had two previous aortic mechanical valve replacements for aortic stenosis. Transthoracic echocardiogram revealed a large pseudoaneurysm of the non-coronary sinus of Valsalva that we believe was the cause of her recurrent stroke...
August 2018: South Dakota Medicine: the Journal of the South Dakota State Medical Association
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...
October 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
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