Complicated hypertensive crisis: causes, symptoms, treatment, prognosis

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Complicated hypertensive crisis is acute, but the main danger lies in the defeat of target organs. This condition, in contrast to the uncomplicated form of the crisis, requires immediate medical intervention, as it is very dangerous for the patient's life. Reduction of blood pressure( BP) is important to spend the first hour after the onset of symptoms of crisis.

So, let's talk about a complicated hypertensive crisis, its causes, symptoms, consequences, tactics of first aid at home.

Features of the disease

Acute hypertensive crisis appears usually in severe forms of hypertension. The internal organs are also likely to suffer from it, which means that the consequences for the patient can be fatal.

The attack begins as a result of chronic shortage of blood circulation and pathologies in the work of the cardiovascular system. Under the influence of a number of factors, deterioration of the condition begins, which gradually leads to an acute phase. To lead to an increase in pressure, a stressful situation may occur, in the future there is a decrease in vasodilators, the heartbeat is upset, which aggravates the state of health and leads to significant BP figures.

More details about the hypertensive crisis will be described in the video below:

Species

The types of this hypertensive crisis are subdivided according to the complications that pathology entails. The disease most often occurs against the background of the following complications:

1. Ischemic attack( transient).All the symptoms are similar to the manifestations of a stroke, but they disappear after a day.
2. Myocardial infarction.
3. Arrhythmias of different types and severity.
4. Insufficiency of the( acute) left ventricle. It develops as a result of constant overload and often entails swelling of the lungs. Prolonged oxygen starvation threatens and other dangerous consequences, especially for the cerebral cortex.
5. Aneurysm stratification occurs when there is atherosclerotic plaque in large arteries. Under the influence of high blood pressure it can even lead to a rupture of the aorta, which even with timely surgery often ends fatal. The pain that occurs with this complication, often exceed several times the pain in the infarction.
6. Stroke. The death of certain areas of the brain often leads to other dangerous disorders, including cardiac, visual, speech, etc.
7. Lung edema develops, like many of the complications, against a background of lack of blood circulation and high blood pressure. The flow of this form of crisis is as unfavorable as the previous one.
8. Encephalopathy is often accompanied by brain edema, which can trigger a stroke. This variant of the disease can also be called spasmodic, since it is characterized by loss of consciousness and convulsions.

Forms

The same disease can be divided into the form of the flow.

• In the cerebral form of the pathology, the brain becomes the object of the crisis,
• asthmatically affects the left ventricle of the heart,
• and in the coronary type of the disease the target will be large and important cardiac vessels.

About the causes of hypertensive crisis, complicated by pulmonary edema, encephalopathy, acute left ventricular failure and other ailments, read below.

Reasons for the

To reasons provoking the development of an attack, it is customary to include a number of external factors. This includes excessive abuse of salt and bad habits, non-observance of the work and rest regime, weather conditions and their sudden change, psycho-emotional factors. Often the crisis happens and against the background of the cancellation of certain medicines. In particular, this can cause clonidine and beta-adrenoblockers.

To the factors of the emergence of the crisis can be attributed to internal cardiac diseases, as well as a number of other pathologies:

• diabetes mellitus,
• lupus,
• hormonal background change,
• arterial hypertension,
• kidney disease,
• nephroptosis,
• atherosclerosis.

Sometimes, surgical interventions performed on the heart are brought to this pathology.

Symptoms of

The complicated hypertensive crisis develops gradually, its symptoms last for several days, starting as an easy malaise. Initially, there is weakness, noise in the ears, vomiting and nausea, then a strong headache joins these symptoms. Sometimes a person is inhibited, his reaction is poor, his hearing and eyesight worsen.

Shortness of breath is one of the frequent symptoms of a crisis. Rattles are audible, the patient does not have enough air, he suffers suffocation. Weaker this symptom becomes when taking a semi-sitting position, but in a recumbent it only worsens. From the side it is noticeable that the person is unusually pale, the surface of the skin is cool and dry, his face turns red. What is typical, the pulse is kept at the usual level, the limbs tremble in the patient. Women can note a common puffiness.

The disease is characterized by the fact that for some time after the end of the attack symptoms persist. The manifestations of a crisis depend a lot on its type and form, therefore the symptoms described above can be supplemented by various symptoms from the cerebral, cardiac and other body systems. The main symptoms, of course, is just the increased pressure.

The following video will also tell you about the symptoms of the hypertensive crisis in detail:

Diagnosis

Because the clinical picture of the pathology is not always stable and many symptoms may not be present at all, the main criterion of diagnosis is precisely high blood pressure. They conduct an examination, during which pressure is measured, laboratory tests, and ECG is often prescribed from the list of instrumental examinations.

In the presence of complications affecting brain activity, a rheoencephalography is performed.

Treatment of a complicated hypertensive crisis

It is imperative to observe rest and stop any negative factors, be it physical stress or stress. It is also important to know what is the standard algorithm for providing first aid for a complicated and uncomplicated hypertensive crisis, as detailed in the special material.

Therapeutic

Methods of therapeutic therapy can include any means of achieving a relaxed and restful state, whether it be any spiritual practice and meditation or massage. It is necessary to avoid any shocks and experiences, so as not to provoke a recovery of blood pressure.

It is equally important to maintain a special diet. Since the risk of complications is very high, all products that have an additional burden on the heart should be discarded. It is necessary to switch to lean, but rich in the necessary micronutrient food, in addition trying to eat food in small portions, give up salt. Particular attention should be paid to recommending changes in nutrition to those who are overweight.

The following section will tell you about what preparations are administered for a hypertensive crisis complicated by pulmonary edema and other ailments.

Medicated

Medications are the most preferred therapy for a crisis in this species. The most effective intravenous administration, but also from the tablet form of drugs, too, do not refuse. With the introduction of drugs through a dropper, it is very important to observe a certain rate of administration, so that the lowering of blood pressure is gradual and does not cause negative consequences.

Any medicine can be precisely selected and prescribed only by a doctor, and in case of a complicated course of the disease, their reception requires observation from his side. In the treatment, different groups of agents are used, the action of which will be directed not only to lowering the pressure, but also to eliminate the likelihood of complications from different body systems. Their probability, according to statistics, reaches 30 percent in each of the cases.

Essential medicines that are effective in case of an attack are listed in the table.

Drug	Action	Contraindications
Sodium nitroprusside	This medication takes the main place in the whole therapy and is widely used for the relief of complex hypertensive crises. Also, the drug is necessary in the presence of a high risk of aortic dissection, encephalopathy, left ventricular insufficiency of acute form, as well as other serious complications. The effect of the application of the remedy becomes noticeable in the nearest seconds, and after a short time( no more than 5 minutes) a normal blood pressure level is reached.	Lactation, atrophy of the optic nerve, hypothyroidism, renal and hepatic failure, deficiency B12, coarctation of the aorta, arteriovenous shunt, circulatory disorders of acute forms. Special instructions: in difficult and emergency cases, these contraindications are relative.
Beta-blockers	A number of tools are used to reduce the heart rate and blood pressure, which allows you to remove and increased stress on the myocardium. Particularly shown to patients who have a severe acute crisis accompanied by serious cardiac complications.	Bradycardia, asthma, weakness of the sinus node, atrio-ventricular blockades of 3-4 degrees, heart failure( severe), hypersensitivity, angina of princemetal.
Nitroglycerin	Has a predominant effect on venous vessels, and also lowers the oxygen demand of the myocardium. In comparison with nitroprusside has the best vasodilating effect. This makes it a more preferred drug in cases where hypertensive crises are combined with coronary insufficiency.	Head injuries, breastfeeding and gestation period, sensitivity to nitrates, hemorrhage subarachnoid, hypothyroidism, stroke.
Alpha blockers	The purpose of these drugs is to increase the catecholamines.	Orthostatic hypotension, pericarditis, hypersensitivity, pregnancy.
Magnesium sulfate	Reduces the incidence of eclampsia, lowers blood pressure, and also eliminates the danger of brain edema.	There may be an oppression of the respiratory center, but only with rapid administration.
Hydralazine	Does not affect the venous vessels, but the arterial vessels expand. Assign it is necessary in cases when there is eclampsia. High duration of action, the effect is first noticeable after 10 minutes.	It is not recommended to use the drug for the development of cerebrovascular complications, since it is capable of creating low and high pressure zones.
Methyldopa	Stimulates alpha2-adrenergic receptors, significantly lowering blood pressure, affecting the central mechanism of its regulation. This remedy is especially indicated for relief of seizures in pregnant women.	Cerebrovascular diseases, pheochromocytoma, infarction, hypersensitivity.
Enalaprilat	Refers to the group of ACE inhibitors. It is suitable not only for the elimination of symptoms of the attack, but also for its consequences, therefore it is prescribed for coronary syndromes, encephalopathy, cerebral blood flow and heart failure. The action begins almost instantaneously, therefore it is important to administer the drug slowly.	Breastfeeding, hypersensitivity.

Together with the preparations of the directed spectrum of action, it is also worth taking vitamin remedies in order to provide proper nutrition to the heart muscle and support the body in this way. Do not forget that some medicines are selected by the doctor strictly individually, based on the form of the attack.

The following video will tell you about first aid in hypertensive crisis:

Prevention

To prevent the emergence of a complicated crisis is possible if you follow your own condition and especially sensitive to the level of pressure. It is necessary to avoid all factors that can lead to the development of hypertension: overeating, conflicts and stresses, physical overload, violations of the regime. It is worthwhile to maintain proper nutrition and not ignore employment even if the morning gymnastics.

If the drugs are already prescribed for hypertension and the illness( or inclination for its appearance) is already there, it is important to follow all the doctor's advice and try not to skip the medications. Prevent an attack easier than to survive it and fight its consequences.

Complications of

The absence of therapy aimed at lowering blood pressure and arresting an attack, entails many life-threatening complications. Their list has already been given above in the list of forms and types of crisis. Often violated mental abilities.

Bleeding is sometimes the result of a surgical operation done with any cardiac pathology. The stitches have vascular insufficiency and diverge. The condition worsens with elevated blood pressure. Sometimes bleeding due to pressure can also be from the nose, and very significant and abundant.

Forecast

If you turn to medical practice, then the lethal outcome in the next 3 years after the seizure occurs in almost a third of cases. This happens more often if the patient has a stroke or kidney failure of severe form.