HTN Urgency/Emergency Flashcards
HTN Urgency
Systolic BP >180 and/or diastolic BP > 120 with NO evidence of acute end-organ damage
HTN Emergency
Systolic BP >180 and/or diastolic BP >120 WITH evidence of acute end-organ damage
How can HTN emergency manifest w/i CV system?
-acute MI
-acute HF
-aortic dissection d/t high pressure > causes tear
-intrinsic AKI (from fibrinoid necrosis of arterioles and small aa)
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How can HTN emergency manifest w/i renal system?
-intrinsic AKI (from fibrinoid necrosis of arterioles and small aa)
How can HTN emergency manifest w/i heme system?
Shearing of RBCs (MAHA) d/t fibrin deposition in vessels
How can HTN emergency manifest w/i neuro system?
Intracranial hemorrhage, stroke or encephalopathy d/t increased intracranial BP (exceeds ability for autoregulation to control)
What is the expected parasympathetic response to increased BP?
Increased vagal nerve output to SA node with resultant increased Ach, decrease in HR
Sympathetic response to increased BP in alpha-1
-Decreased sympathetic output > less NE released > less alpha-1 receptor stimulation > vaso/venodilation > decreased TPR (vaso) and decreased venous return/preload (veno)
Sympathetic response to increased BP in beta-1
Decreased sympathetic output > less NE released > decreased beta-1 activity > decreased force of contraction in ventricular myocardium and decreased HR in SA node > decreased CO
Potential causes of HTN development
- Resetting of baroreceptors to higher threshold
- Untreated or undertreated primary or secondary HTN
- medication noncompliance
- rebound phenomenon from abrupt cessation of anti-HTN
- illicit drug use
- hormones - thyroid, pheo, pregnancy
- idiopathic
S/S of acute MI
chest pain, diaphoresis, SOB, EKG changes, elevated troponin
S/S of aortic dissection
chest pain radiating to shoulder blades, markedly elevated BP, aortic regurg murmur
S/S of acute HF
SOB, peripheral edema, crackles or decreased breath sounds, elevated BNP, abnormal CXR
S/S of AKI
decreased urine output, muscle cramps, increased serum creatinine
How can AKI manifest?
Prerenal - absolute or effective hypovolemia
Intrinsic - ATI (ischemic or toxic), rhabdo, AIN, cholesterol atheroembolic disease, RAS
Postrenal - obstruction of urinary collecting system causing back pressure on tubules d/t BPH, kidney stones or clots, pelvic malignancy, lymphoma (retroperitoneal fibrosis d/t radiation), neurogenic bladder, etc.
