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Questions and Answers
Which of the following medications would be used to lower blood pressure over 24-48 hours in a patient with hypertensive urgency?
Which of the following medications would be used to lower blood pressure over 24-48 hours in a patient with hypertensive urgency?
- Captopril (correct)
- Furosemide
- Nitroprusside
- Morphine
In hypertensive crisis, which of these is NOT a potential complication?
In hypertensive crisis, which of these is NOT a potential complication?
- Pulmonary embolism (correct)
- Hypertensive encephalopathy
- Stroke
- Myocardial infarction
Which of the following is a characteristic of hypertensive urgency?
Which of the following is a characteristic of hypertensive urgency?
- Rapid reduction of blood pressure required
- Typically treated with oral medications (correct)
- Intravenous medications are usually required
- Presence of target organ damage
Why is the rate of increase in blood pressure more important than the absolute value in hypertensive crisis?
Why is the rate of increase in blood pressure more important than the absolute value in hypertensive crisis?
Which of these situations could contribute to hypertensive crisis?
Which of these situations could contribute to hypertensive crisis?
Which of the following may be a sign of hypertensive encephalopathy?
Which of the following may be a sign of hypertensive encephalopathy?
What is the mechanism by which hypertensive crisis can lead to left ventricular hypertrophy?
What is the mechanism by which hypertensive crisis can lead to left ventricular hypertrophy?
What is the primary issue caused by ventricular dysrhythmias in emergency situations?
What is the primary issue caused by ventricular dysrhythmias in emergency situations?
Which of the following factors is NOT considered a risk factor for sudden cardiac death?
Which of the following factors is NOT considered a risk factor for sudden cardiac death?
What is a common cause of sudden cardiac death related to electrical disturbances in the heart?
What is a common cause of sudden cardiac death related to electrical disturbances in the heart?
Which symptom might go unrecognized prior to sudden cardiac death?
Which symptom might go unrecognized prior to sudden cardiac death?
What does the ECG typically show in cases of ventricular contraction that is independent of atrial contraction?
What does the ECG typically show in cases of ventricular contraction that is independent of atrial contraction?
What condition can lead to a pulse deficit?
What condition can lead to a pulse deficit?
Which arrhythmia is characterized by electrical signals being delayed or blocked?
Which arrhythmia is characterized by electrical signals being delayed or blocked?
Which of the following dysrhythmias is considered life-threatening?
Which of the following dysrhythmias is considered life-threatening?
What can atrial fibrillation lead to if it results in a rapid ventricular rate?
What can atrial fibrillation lead to if it results in a rapid ventricular rate?
Which condition involves the ventricles quivering instead of pumping blood?
Which condition involves the ventricles quivering instead of pumping blood?
What characterizes hypertensive retinopathy?
What characterizes hypertensive retinopathy?
What is Torsades de Pointes commonly associated with?
What is Torsades de Pointes commonly associated with?
What can occur when there is no transmission of impulses from the atria to the ventricles?
What can occur when there is no transmission of impulses from the atria to the ventricles?
What is a significant consequence of cardiac dysrhythmias on cardiac output?
What is a significant consequence of cardiac dysrhythmias on cardiac output?
Which of the following is NOT a systemic cause of cardiac dysrhythmias?
Which of the following is NOT a systemic cause of cardiac dysrhythmias?
Which type of arrhythmia is considered to be non-symptomatic unless it spreads to the ventricular pathways?
Which type of arrhythmia is considered to be non-symptomatic unless it spreads to the ventricular pathways?
What is the typical atrial rate for atrial flutter?
What is the typical atrial rate for atrial flutter?
What occurs in the heart's conduction system during a myocardial infarction?
What occurs in the heart's conduction system during a myocardial infarction?
Which dysrhythmia typically causes blood pooling that can lead to clot formation?
Which dysrhythmia typically causes blood pooling that can lead to clot formation?
What consequence may result from a rapid heart rate during diastole?
What consequence may result from a rapid heart rate during diastole?
Which of the following factors is NOT a risk factor for atrial dysrhythmias?
Which of the following factors is NOT a risk factor for atrial dysrhythmias?
Flashcards
Hypertensive Crisis
Hypertensive Crisis
A severe increase in blood pressure that can lead to a stroke.
Hypertensive Urgency
Hypertensive Urgency
Severe blood pressure elevation over 180/120 mmHg without organ damage; needs gradual treatment.
Hypertensive Emergency
Hypertensive Emergency
Severe blood pressure elevation with organ damage; requires immediate treatment.
Target Organ Damage
Target Organ Damage
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CNS Effects in Crisis
CNS Effects in Crisis
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Kidney Damage
Kidney Damage
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End-Organ Damage Testing
End-Organ Damage Testing
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Complications of Hypertension
Complications of Hypertension
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Hypertensive Retinopathy
Hypertensive Retinopathy
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Endothelial Damage
Endothelial Damage
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Cardiac Dysrhythmias
Cardiac Dysrhythmias
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Atrial Fibrillation
Atrial Fibrillation
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Atrial Flutter
Atrial Flutter
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Electrolyte Abnormalities
Electrolyte Abnormalities
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Conduction System Interference
Conduction System Interference
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Pulse Deficit
Pulse Deficit
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Ventricular Dysrhythmias
Ventricular Dysrhythmias
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Heart Block
Heart Block
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A-Fib with RVR
A-Fib with RVR
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Ventricular Fibrillation (V-Fib)
Ventricular Fibrillation (V-Fib)
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Ventricular Tachycardia (V-Tach)
Ventricular Tachycardia (V-Tach)
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Torsades de Pointes
Torsades de Pointes
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Cardiac Output (CO)
Cardiac Output (CO)
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Stokes-Adams Attack
Stokes-Adams Attack
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Sudden Cardiac Death (SCD)
Sudden Cardiac Death (SCD)
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Risk Factors for SCD
Risk Factors for SCD
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Study Notes
Hypertensive Crisis
- Hypertensive crisis: severe increase in blood pressure, potentially leading to stroke. Two categories: urgency and emergency.
- Hypertensive Urgency: systolic blood pressure over 180 mmHg or diastolic over 120 mmHg, no target organ damage. Reduce blood pressure over 24-48 hours, using oral medications (e.g., captopril, clonidine).
- Hypertensive Emergency: severe elevation in blood pressure with evidence of impending or progressive target organ damage. Requires immediate blood pressure reduction (usually within hours) using IV medications (e.g., nitroprusside). Key difference is presence/absence of end-organ damage (e.g., kidney damage, loss of consciousness).
- Rate of blood pressure increase is often more important than absolute value.
- Often occurs in people with a history of hypertension who haven't adhered to medication or are undermedicated. Rising BP triggers endothelial damage and a vicious cycle of elevation.
- Cocaine/crack use increasingly linked to hypertensive crises.
Clinical Manifestations/Complications
- Heart: increased workload, potential left ventricular hypertrophy, coronary artery disease, congestive heart failure, or myocardial infarction.
- Brain: hypertensive encephalopathy (headache, nausea, vomiting, seizures, confusion, coma). Stroke from hemorrhage or thrombosis.
- Kidneys: hypertensive nephropathy (proteinuria, kidney injury).
- Eyes: hypertensive retinopathy (retinal hemorrhage, vision loss).
- Blood Vessels: damage to endothelium, arteriosclerosis.
Cardiac Dysrhythmias
- Dysrhythmias reduce the heart's pumping efficiency.
- Cardiac output effects perfusion.
- Rapid heart rate reduces filling (diastole), decreasing cardiac output. Slow rate also impairs output.
- Atrial Dysrhythmias: originate in atria (e.g., atrial fibrillation, atrial flutter). SA node (sinus brady/tachycardia), AV node dysrhythmias.
- Risk factors include heart disease, surgery, older age, and diabetes.
- Atrial fibrillation (rate > 350 bpm) causes blood pooling and clotting.
- Atrial flutter (250-350 bpm) causes slower ventricular rate, potential pulse deficit.
- Ventricular Dysrhythmias: originate in ventricles (e.g., ventricular tachycardia, ventricular fibrillation).
- Understanding the specific dysrhythmia is crucial for treatment.
- Risk factors for dysrhythmias include heart disease, cardiac surgery, increasing age, and diabetes
- Heart block dysrhythmias: electrical signal delays/blocks (at the AV node or ventricular pathways).
Life Threatening Dysrhythmias
- Atrial fibrillation with rapid ventricular response (RVR): while atrial fibrillation itself isn't immediately life-threatening, a rapid ventricular rate can cause serious complications (stroke, heart failure).
- Ventricular fibrillation (VFib): chaotic rhythm, ventricles quiver instead of pumping blood (most serious cardiac rhythm disturbance).
Sudden Cardiac Death (SCD)
- Unexpected death from cardiac arrest or other causes. In many cases, not truly sudden.
- Causes typically include disrupted cardiac function causing immediate loss of cardiac output and cerebral blood flow.
- No history of CAD in some cases.
- Death often occurs within one hour of symptoms (e.g., angina, palpitations).
- Acute ventricular dysrhythmias (tachycardia, fibrillation) cause most cases of SCD.
- Less common causes: primary left ventricular outflow obstruction (e.g., aortic stenosis).
- Risk factors include male sex, family history of premature atherosclerosis, tobacco use, diabetes, hypercholesterolemia, hypertension, and cardiomyopathy.
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Description
This quiz covers the critical aspects of hypertensive crises, including definitions, categories, and management strategies for both urgency and emergency cases. Understand the differences in treatment protocols, particularly the importance of recognizing organ damage. It is vital for those in medical fields to grasp these concepts to provide appropriate care.
