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Cardiology

Question
36 out of 36
 

Rapid Reduction of blood pressure is indicated in: (AIIMS May 2010)



A Acute Aortic Dissection

B Hypertensive Encephalopathy

C Intracerebral hemorrhage

D All of the above

Ans. D

All of the above

A hypertensive emergency (formerly called "malignant hypertension") is severe hypertension with acute impairment of one or more organ systems (especially the central nervous system, cardiovascular system and/or the renal system) that can result in irreversible organ damage.

(So in Malignant hypertension. Abrupt increasing in BP, clinically has very high BP associated with papilledema, proteinuria, microangiopathic hemolytic anemia and encephalopathy.)

In a hypertensive emergency, the blood pressure should be substantially lowered over a period of minutes to hours with an antihypertensive agent.

Complications of malignant hypertension Q:

1. acute renal failure,

2. heart failure,

3. encephalopathy,

4. CAD

Pathologicalhallmark is fibrinoid necrosis Q.

Treatment: Avoid sudden drops in BP as cerebral autoregulation is poor

1. Drugs used are: Nitroprusside, nicardipine, labetalol, Nitroglycerin, enalaprilat

Note:loop diuretics is to be used only if there is LVF also.

Table 247–10. Antihypertensive Agents Used in Hypertensive Emergencies. (Ref. Hari-18th ed., Pg- 2058)

1. Nitroprusside

2. Nicardipine

3. Labetalol

4. Esmolol

5. Phentolamine

6. Nitroglycerin

7. Hydralazine

Recent Advances:

1. Previously sublingual nifedipineand injection frusemide were used in severe hypertension. But now both these drugs are contraindicated in severe hypertension.

2. Never use sublingual nifedipine Q to reduce BP (big drop in BP and increase CAD risk) (PNQ)

3. Injection frusemide should not be used in severe HT But can be used in severe HT with LVF. (PNQ)

Diet in Hypertensive patient:

The DASH Diet Eating Plan

The DASH (Dietary Approaches to Stop Hypertension) diet is recommended to many people with hypertension.

The DASH diet provides more than the traditional low salt or low sodium diet to reduce blood pressure. It is based on an eating plan rich in fruits and vegetables, and low-fat or non-fat diet.

Cardiology Flashcard List

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