It is believed that the arterial hypertension is characteristic only for adults. However, children and even infants can also suffer from it.
Vascular changes in the fundus reflect hypertensive retinopathy and arteriosclerotic retinopathy Renal involvement: Stroke or transient ischemic attack TIA Complications of hypertension to vascular disease probably involve three interrelated processes: These three interrelated processes are probably responsible for the arteriolar and arterial sclerosis that is the usual consequence of longstanding hypertension.
Large vessels such as the aorta may be directly affected and be at risk for aneurysms and dissection. Braunwald E, Heart disease6th ed. Are hypertensive patients at an increased risk for perioperative cardiac morbidity? Hypertensive patients are at increased risk for coronary artery disease, silent myocardial ischemia, CHF, and stroke.
However, whether preoperative hypertension is predictive of perioperative major cardiac morbidity remains controversial. Some investigators have shown that patients with untreated, poorly controlled, or labile preoperative hypertension are at increased risk for perioperative BP lability, dysrhythmias, myocardial ischemia, and transient neurologic complications.
Some suggested that preoperative hypertension predicted perioperative myocardial infarction. However, Goldman and Caldera demonstrated that mild-to-moderate hypertension did not increase the risk of major morbid events.
Instead, preoperative hypertension may predict several intermediates of outcome, such as BP lability and myocardial ischemia. The Hypertension case study may be due to the wide variability in the hypertensive population.
Hypertension may affect perioperative morbidity through the extent of end-organ damage and not the manifestation of the disease itself. LVH, which signifies longstanding poorly controlled hypertension, can increase the risk of myocardial ischemia from imbalances of myocardial oxygen supply and demand regardless of the presence or absence of coronary artery disease.
Isolated systolic hypertension systolic BP greater than mm Hg and diastolic BP less than 90 mm Hg has been identified as a risk factor for cardiovascular complications in the general population and treatment reduces the future risk of stroke.
Howell SJ, et al. Resistant hypertension and preoperative silent myocardial ischaemia in surgical patients. Br J Anaesth Preoperative evaluation of the patient with hypertension.
Anaesthesia and the hypertensive patient. Cardiac risk in noncardiac surgery: Risks of general anesthesia and elective operation in the hypertensive patient. Browner WS, et al.
Predictors of postoperative myocardial ischemia in patient undergoing noncardiac surgery. Are hypertensive patients at increased risk for perioperative cerebral and renal complications? Hypertensive patients are at increased risk for perioperative cerebrovascular accidents CVAs and acute renal failure.
Most anesthetic agents produce a dose-related depression of myocardial contractility with a fall in cardiac output and a decreased blood flow to brain and kidneys.
Because autoregulation may be impaired in these patients, there is a greater susceptibility of the brain and kidney to sudden changes in pressure.
In hypertensive patients, autoregulation of cerebral blood flow is reset to a higher range than normal, and although it protects the brain against sudden increases in pressure, it makes it more vulnerable to hypotension. Thus, when BP is lowered acutely, hypertensive patients will show signs of cerebral ischemia at a higher level of BP than normotensive patients.
Hypertension may accelerate cognitive decline with age. Hypertension, particularly systolic, is a major risk factor for initial and recurrent stroke and for transient ischemia attacks caused by extracranial atherosclerosis. Chronic renal insufficiency is a common sequela of hypertension.
Patients with hypertension should have a measurement of baseline serum creatinine. In the original Cardiac Risk Index, an elevated serum creatinine level [greater than 3.
This has been confirmed in the revised Cardiac Risk Index, in which a preoperative serum creatinine level greater than 2. Frost PH, et al.Learn hypertension case study with free interactive flashcards.
Choose from different sets of hypertension case study flashcards on Quizlet.
CASE STUDIES. Case Study: A Year-Old Man With Type 2 Diabetes, Hypertension, and Microalbuminuria. Jeffrey A. Luerding, MD. Presentation Diabetic nephropathy is a clinical syndrome characterized by albuminuria, hypertension, and progressive renal insufficiency.
Diabetic nephropathy is the most common cause of end-stage renal disease. Presentation. L.N. is a year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia.
INTRODUCTION — Early identification and treatment of pulmonary hypertension (PH) is generally suggested because advanced disease may be less responsive to therapy .Treatment begins with a baseline assessment of disease severity, followed by primary therapy.
Primary therapy is directed at the underlying cause of the PH. Critically Ill Obese Patient presented by Scott Shikora, MD, FACS A 55 year old female is transferred to your ICU from an outside hospital with septic shock after undergoing an exploratory laparotomy and colon resection for a perforated diverticulitis.
Clinical case scenarios: Hypertension () 4 Introduction Clinical case scenarios are an educational resource that can be used for individual or group learning.