Extremely high blood pressure is defined as 180/120 mm Hg. Art. and higher. This condition can lead to damage to blood vessels. Also, with such high blood pressure, the heart cannot pump blood efficiently. For these reasons, it is important to seek immediate medical attention to reduce the risk of stroke and other cardiovascular complications.

A hypertensive crisis (HK) is a rapid and severe rise in blood pressure that can lead to a stroke or myocardial infarction. The pathological condition is most often the main complication of hypertension, although in some cases it develops suddenly without any previous signs.

The most common clinical manifestations of hypertension are: cerebral stroke (24.5%), pulmonary edema (22.5%), hypertensive encephalopathy (16.3%) and congestive heart failure (12%). Less commonly, intracranial bleeding, aortic rupture, and eclampsia develop.

A hypertensive crisis is most often determined by an ambulance, although with a long course of the disease, the patient could have experienced sharp rises in blood pressure earlier. In such cases, the clinic could be removed with drugs prescribed by the doctor in advance. In any case, special attention to the patient's condition and a thorough examination of all organs and body systems are required.

Video What is a hypertensive crisis?

Description

A hypertensive crisis encompasses a spectrum of clinical manifestations characterized by uncontrolled high blood pressure leading to progressive or impending organ dysfunction. Under these conditions, blood pressure should be lowered within the maximum allowable time.

Neurological damage to target organs associated with high blood pressure may include hypertensive encephalopathy, cerebral ischemia or stroke, subarachnoid hemorrhage, and/or intracranial hemorrhage.

Cardiovascular organ damage may include myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, and/or aortic rupture. Other organ systems can also be affected by GC, which can lead to acute renal failure, retinopathy, eclampsia, or microangiopathic hemolytic anemia.

The presence of a hypertensive crisis is assessed according to the following criteria:

sudden onset;
a strong increase in blood pressure;
the appearance or strengthening of signs from the target organs.

Additionally, disorders of the autonomic nervous system may appear or intensify. With proper treatment, it is possible to carry out successful prevention of GC, as well as improve the prognostic conclusion for the underlying disease.

There is such a designation of GC as “complicated hypertensive crisis”, which was previously called “malignant hypertension”. Its development is often associated with direct damage to one or more organs, and there must be evidence of such violations. Also in the US and Canada, the term “critical arterial hypertension” is more common.

Thus, only in the post-Soviet space, the following conditional classification for hypertensive crisis is considered:

Uncomplicated GC - not complicated by target organ damage
Complicated GC - symptoms of damage to target organs are determined.

Some statistics

The hypertensive crisis affects 500,000 Americans each year and is therefore the cause of serious morbidity in the US.
Approximately 50 million adults suffer from hypertension, of whom the hypertensive crisis accounts for less than 1% per year.
About 14% of adults who have been in US hospital emergency departments have systolic blood pressure ≥180 mmHg.
As a result of the use of antihypertensive drugs, the rate of hypertension has decreased from 7% to 1% of people with high blood pressure. There was also an increase in survival at 1 year. Until 1950, the rate was 20%, and now it is over 90% with proper treatment.
Statistics show that approximately 1% to 2% of people with hypertension experience a hypertensive crisis at some point in their lives.
Men are more likely to suffer from hypertensive crises than women.
Hospitalizations due to hypertensive crisis tripled from 1983 to 1990, from 23,000 to 73,000/year in the US.
The incidence of postoperative hypertensive crisis varies, yet most studies report an incidence of 4% to 35%.
Mortality from GC worldwide is 50-75%, while the percentage depends on the development of medical care in a particular country.

Causes

Common causes of hypertensive crisis:

irregular intake of drugs for high blood pressure;
stroke;
heart attack;
heart failure;
aortic rupture;
interaction with drugs;
kidney failure;
eclampsia.

In pregnant patients, a hypertensive crisis is usually due to hypertension or severe preeclampsia and can lead to maternal stroke, cardiopulmonary decompensation, fetal decompensation caused by reduced uterine perfusion, rupture, and stillbirth. Preeclampsia can also be complicated by pulmonary edema.

Clinic

Signs of a hypertensive crisis include:

severe headache;
shortness of breath
nosebleeds;
expressed anxiety.

Other symptoms of a hypertensive crisis may include blurred vision, nausea or vomiting, dizziness or weakness, and problems with thinking, sleeping, and behavior changes.

Statistics on the most common clinical manifestations of hypertensive crisis:

Cerebral infarction (24.5%) - fainting, after regaining consciousness, the patient may complain of retrosternal pain.
Pulmonary edema (22.5%) - hoarseness, choking, rapid breathing, severe sweating, fear of death.
Hypertensive encephalopathy (16.3%) - nausea and vomiting, anxiety, headache, dizziness and convulsions.
Congestive heart failure (12%) - weakness, shortness of breath and palpitations, cyanotic skin and mucous membranes, swelling in the legs.

Other clinical manifestations associated with hypertensive crises may include intracranial hemorrhage, aortic rupture and eclampsia, as well as acute myocardial infarction and damage to the retina and kidneys.

Patients may complain of specific symptoms that are associated with end-organ dysfunction. In particular:

chest pain often indicates myocardial ischemia or infarction;
back pain often means aortic dissection;
shortness of breath often
associated with pulmonary edema or congestive heart failure.

A neurological syndrome may present with seizures, visual disturbances, and an altered level of consciousness. The presence of such symptoms most often indicates hypertensive encephalopathy.

Clinical signs of malignant HC may include:

encephalopathy;
confusion of consciousness;
disruption of the left ventricle;
intravascular coagulation;
impaired renal function, with hematuria;
weight loss.

The pathological sign of malignant HC is fibrinoid necrosis of arterioles, which is characterized by systemic development, but most often affects the kidneys. These patients develop fatal complications and, if left untreated, more than 90% die within 1–2 years.

Video Hypertension crisis: symptoms and first aid

Diagnostics

The collection of a medical history and physical examination can determine the nature, severity and degree of controllability of a hypertensive crisis. The medical history may focus on the presence of end-organ dysfunction, circumstances associated with hypertension, and any identifiable etiology.

During the diagnosis of GC, the duration and severity of the patient's previous BP elevations (including the degree of BP control), as well as the history of treatment, are assessed. Details of antihypertensive drug therapy, drug use (sympathomimetic agents), and illicit drug use (cocaine) are important elements of the treatment history. In addition, information should be obtained on the presence of prior target organ dysfunction, especially renal and cerebrovascular disease, as well as any other medical problems (eg, thyroid disease, Cushing's disease, systemic lupus erythematosus). For women, the date of their last menstrual cycle is determined.

Physical examination

First of all, the presence of dysfunction in target organs is assessed. Blood pressure should be measured not only in the supine position, but also in a standing position. Measurements are also taken on both forearms. If there is a significant difference in measurements, aortic rupture may be suspected.

Hypertensive crises are diagnosed if systolic blood pressure is determined above 180 mm Hg. Art. or diastolic blood pressure greater than 120 mm Hg. Art.

When examining the retina, new hemorrhages, exudates or papillomas can be determined, then a hypertensive crisis is also confirmed. In the presence of heart failure, there is jugular venous distension, fissures on auscultation, and peripheral edema.

Central nervous system (CNS) findings may include changes in the patient's level of consciousness and visual fields and/or the presence of focal neurological signs.

The severity of a hypertensive crisis is assessed by the following indicators:

The level of electrolytes is determined.
The level of urea nitrogen in the blood and the level of creatinine are measured to assess kidney failure.
A urinalysis is done to check for hematuria or proteinuria and a microscopic urinalysis to look for red blood cells.
A complete blood count and a peripheral blood smear are done, which makes it possible to exclude microangiopathic anemia.

If necessary, the concentration of thyroid hormones is determined and other endocrine studies are done.

If pulmonary edema is suspected or the patient has chest pain, a chest X-ray and electrocardiography are done. Patients with neurological signs should be evaluated with computed tomography or magnetic resonance imaging.

In the malignant course of GC, ophthalmoscopy is mandatory, and in such cases, the patient has a retinal papilledema (as in the photo below). Additionally, optic disc edema is often noted.

Treatment

A hypertensive crisis can be treated through hospitalization followed by oral or intravenous medications.

The main goals of therapy for hypertensive crises:

Safely lower high blood pressure
Protect target organ function
Eliminate symptoms and manifestations
Reduce the likelihood of complications or their severity
Improve clinical outcomes.

In the absence of antihypertensive drug therapy, the average survival of patients is 10.4 months.

Key tactics for the treatment of patients with GC:

The drug of choice in the treatment of GC, together with acute aortic dissection, acute myocardial infarction or unstable angina, is esmolol, which is administered intravenously.
- Blood pressure should be reduced quickly and immediately, usually within 5-10 minutes, especially when determining aortic dissection.
- Lowering blood pressure is carried out with the help of beta-blockers. If the drugs were ineffective, then vasodilators are used, which are administered intravenously.
- Target blood pressure is less than 140/90 mmHg. in patients with acute myocardial infarction or unstable angina who do not have hemodynamic disturbances.
When combined with GC with pulmonary edema, nitroprusside, nitroglycerin are used, with the exception of beta-blockers.
The drugs of choice in the treatment of patients with GC and acute renal failure are clevidipine, fenoldopam, and nicardipine.
The drugs of choice in the treatment of patients with hypertensive crisis and eclampsia or preeclampsia are hydralazine, labetalol and nicardipine.

Blood pressure with GC decreases gradually. For the first hour - by about 25%, over the next 6 hours, blood pressure should be reduced to 160/100 mm. rt. Art. In the next 24-48 hours, blood pressure is brought to normal levels.

Hypertensive crisis in pregnant women should be treated immediately to prevent the development of severe complications. Women with hypertension who become pregnant or plan to become pregnant should take methyldopa, nifedipine, and/or labetalol during pregnancy. However, they should not be treated with ACE inhibitors, angiotensin receptor blockers, or direct renin inhibitors.

A gradual decrease in blood pressure is critical to prevent cerebral ischemia as a result of autoregulatory mechanisms.

Adults with a hypertensive crisis should be treated in an intensive care unit where blood pressure and target organ damage are continuously monitored. Parenteral administration of appropriate drugs is also carried out.
In adults with severe complications of GC (eg, aortic dissection, severe preeclampsia or eclampsia, exacerbation of pheochromocytoma), blood pressure falls below normal - less than 140 mm Hg. Art. during the first hour and less than 120 mm Hg. Art. with aortic dissection.
In adults without serious illness, but with GC, blood pressure decreases by up to 25% within the first hour. If the patient is clinically stable, blood pressure drops to 160/100 -110 mm Hg. over the next 2-6 hours, and then gently to normal levels over the next 24-48 hours.

Forecast

The long-term prognosis for patients with frequent hypertensive crises is defined as unfavorable. Basically, short-term death occurs from severe damage to the nervous system. Also, complications in the form of cardiovascular diseases are often determined, leading to death over the next 12 months.

Prevention

Prevention of a hypertensive crisis is possible by educating patients with hypertension. Information about this today is widespread and important. Some factors can lead to an uncontrolled rise in blood pressure, so you should, if possible, influence them:

Hyperlipidemia - lipid profile should be kept within the normal range.
Uncontrolled diabetes - it is important to follow medical advice to prevent the progression of the disease.
Missing doses of antihypertensive drugs - you need to adhere to the dosages and frequency of taking medications that help control blood pressure.

Old age is another factor that contributes to the development of HC, but it is almost impossible to influence it..

Important in the prevention of GC is the conduct of extensive education of patients with hypertension on the content within the allowable weight. For this, a special diet is most often used. Also, the doctor, if necessary, prescribes exercises to prevent diabetes, high blood pressure, cardiovascular disease and hyperlipidemia.

All these medical conditions are closely interrelated and need to be balanced. Special attention should be paid to compliance with medical procedures for the prevention of stroke and cardiovascular diseases.

Video Live Healthy! Hypertensive crisis

He does not particularly warn about his appearance and can catch the patient anywhere - in a minibus, at work, at a picnic, in a cafe. The prerequisites for GC are usually stresses, from which the nervous system of a particular person is not able to adequately exit. Her reaction explains the development of a vascular breakdown against the background of emotional overload.

Uncoordinated work of the departments of the autonomic nervous system (ANS) forms a specific type of GC. Their classification is based on these principles.

The treatment of GC determines its type, since it should directly influence the cause of the development of the crisis. Its appearance is facilitated by changes in the central humoral and local (kidney region) mechanisms, due to the loss of the ability to adapt to stress, in which the behavior of blood vessels plays a special role.

What is the difference between hypertension and hypertension.

Risk factors that provoke the development of GC can be:

Disorders in the work of the nervous system - situational neuroses and similar conditions;
Mental overload, regular stressful situations;
hereditary tendency;
endocrine problems;
Hormone imbalance (PMS (premenstrual syndrome), menopause);
Accumulation of water and salt in the organs due to the immoderate use of foodstuffs dangerous for hypertensive patients;
Smoking and drinking alcohol in any form and dose;
Excessive stress (emotional, physical, hearing or vision strain, strong vibration);
Geomagnetic storms and a sharp change in weather, which does not allow the body to quickly rebuild;
Exacerbation of concomitant chronic diseases;
kidney failure;
Unauthorized cancellation or periodic use of prescribed antihypertensive drugs;
Osteochondrosis of the cervical vertebrae.

Hypertensive crisis: emergency care (algorithm)

Emergency care for a hypertensive crisis is therefore called urgent first aid, because only immediate and clear actions of others can prevent serious complications.

Immediately call a doctor or an ambulance (it is better if someone else does this, and not the patient himself).
With the help of pillows, create a comfortable position for the victim - reclining.
Unfasten the collar and other clothing that makes it difficult to breathe, since during a crisis the patient does not have enough air.
Ventilate the room, after covering the patient with a blanket, so as not to overcool.
Apply a heating pad to your feet (a plastic bottle of hot water will do). You can put mustard plasters on your calves.
If the victim is hypertensive, give him the drug he usually takes.
Help relieve tension (20 drops). Usually the attack is accompanied by a panic fear of death.
You can put captopril under the tongue and ask to dissolve the tablet.
If the patient complains of pain bursting his head, a sign of high pressure, a furosemide tablet will help.
If you have nitroglycerin on hand, you can put the victim under the tongue. It is important to remember that the drug sharply lowers the pressure, this condition is accompanied by increasing headaches. To neutralize the negative side effect of nitroglycerin, it is sometimes taken in parallel with validol.

Emergency care for a hypertensive crisis, the algorithm of actions should be clear and consistent.
According to medical statistics, the mortality rate of patients with a hypertensive crisis who did not receive adequate treatment is 79% during the first year, with proper treatment and compliance with all prescriptions, more than 80% of patients who underwent GC overcome the five-year survival limit.
First aid for hypertensive crisis
The listed measures aimed at reducing blood pressure are first aid. It is necessary to help the patient at the first stage, before the arrival of the ambulance. But it is impossible to replace medical care with such methods. In case of a hypertensive crisis, first aid should be based on the main commandment of medicine “do no harm!”. First of all, this is related to the choice of drugs, since not all medicines that are used to stop a hypertensive crisis are completely safe.
For example, ACE inhibitors such as captopril or enalapril can cause angioedema. Outwardly, the reaction resembles an allergy, but its consequences are much more dangerous and insufficiently controlled.
You should not abuse the very popular nitroglycerin: if blood pressure is not critical, then with a sharp decrease, the drug can provoke collapse. The vasodilating effect of this drug is suitable for cardiovascular problems, and therefore it is necessary to use it in myocardial infarction. Before you offer a patient a medicine, you need to calmly assess the situation and make the right decision.
Of particular importance is adequate first aid for a hypertensive crisis, the algorithm of actions of which involves constant monitoring of pressure every 12 hours. For an accurate assessment of blood pressure, it is necessary to measure it on both arms, the cuff must be matched exactly to size. For comparative analysis, the pulse is checked both on the arms and on the legs.
With independent pressure control, the readings are 180/110 mm Hg. Art. talk about an impending hypertensive crisis if the parameters are repeated after a few minutes when re-measured.
First aid for hypertensive crisis at home
An ambulance team should deal with the relief of a hypertensive crisis with constant monitoring of blood pressure. But it is not always possible to quickly use its services. It’s good if a health worker lives next door (at least a nurse), and in the home medicine cabinet there are disposable syringes and injections that can be used to stop an attack at home.
Such a tactic is very helpful for hypertensive patients who are ill for a long time and always have medicines in stock that can stop an attack on their own, "so as not to disturb the doctors once again." Over time, they themselves acquire a certain competence, therefore, the provision of emergency care for a hypertensive crisis may be limited to the introduction of a complex of drugs intramuscularly:
Furosemide (do not forget that it is able to remove calcium, potassium and other trace elements, so its regular use involves the simultaneous use of Panangin);
Dibazol (at extremely high blood pressure, it is dangerous, as it tends to increase pressure before it starts to slowly lower it);
Magnesium sulphate - intravenous injection gives a positive effect, but it must be done with extreme caution or entrust this procedure to a doctor;
Antispasmodics such as no-shpy, papaverine;
Vitamin B6.

Hypertensive crisis treatment at home does not exclude if it did not cause complications.
In such a situation, the listed measures will be enough, it is only important to take into account that a sharp drop in blood pressure is dangerous not only for poor health - it worsens the blood flow of vital organs, so you can lower the pressure by a maximum of 25%!
Relief of a hypertensive crisis by a doctor
Emergency medical teams in their work are guided by the protocols approved by the Ministry of Health of the Russian Federation. For each disease, there has been developed its own algorithm for emergency medical care. According to this principle, a suitcase with tools and medicines, which doctors call "button accordion", is also completed.
For an emergency lowering of blood pressure, the stacks are equipped with means intended for slow and careful administration intravenously:
Clonidine (gemiton).
Ganglioblockers (benzogexonium)
Furosemide (Lasix) - the drug is indicated for hypertensive crisis with symptoms of brain disorders.
Dibazol (in adulthood it is able to sharply reduce the release of blood in the heart, before lowering blood pressure, it first increases it).
A solution of magnesium sulfate (treats encephalopathy).

Which of the drugs to use, and in accordance with which protocol, doctors determine on the basis of blood pressure indicators, the type of GC, taking into account the anamnesis, clinical signs, age and the patient's response to a set of first aid measures.
A hypertensive patient is subject to hospitalization in case of complications of GC in the form of:
brain stroke;
brain tumors;
Left ventricular failure;
coronary insufficiency.

If GC is stopped without complications, it is enough to observe your therapist.
Common Medications
Experienced hypertensive patients adapt to their condition in such a way that all emergency drugs are stored in a home medicine cabinet, relatives are instructed, they do not leave the house without medicines. But with brain disorders that occur during a hypertensive crisis, the patient does not always have the ability to adequately think and quickly make the right decisions, so a lot of medicines can only confuse him.
Many people dream of such a first-aid kit that could be put into the bag automatically, without thinking about the selection of medicines and doses. There are first-aid kits that are easy to understand for either the patient or those who are nearby. The set is patented and received permission for use in the Russian Federation. This is an algorithm for providing emergency care for a hypertensive crisis before the appearance of a doctor. In a compact waterproof case, which is convenient to take with you on the road, medicines are collected:
Nifedipine (blocks calcium channels) in a double dose;
Metoprolol (blocker) for single use.

With this arsenal, hypertensive patients can safely go to football and to a concert.
What to do after stopping a hypertensive crisis
When the most difficult period is over, it is important to understand that even with normal pressure, recovery from GC will take at least another week. If precautions are not taken, a new crisis with severe complications will not be long in coming. The rhythm of the patient's life should be calm and measured:
Without sudden movements and physical or psycho-emotional stress;
Without morning runs, nightly rest at the computer or TV with a horror movie;
With a salt-free diet, you can reassure yourself that the restrictions are temporary, and there you won’t get used to it for long;
With a gradual decrease in the volume of liquid;
Without household records - in the kitchen, in the garden, during repairs;
With an adequate response to any stress that affects the nervous system;
Do not create conflict situations, avoid those who provoke them;
Regularly take antihypertensive drugs prescribed by a doctor;
Forget about bad habits (smoking, overeating, alcohol).

During the rehabilitation period after GC, it is useful to think about sanatorium treatment without climate change.
If the resort is not affordable, you can limit yourself to a ticket to a specialized dispensary, where there are conditions for relaxation, physical procedures, exercise therapy, massage, evening walks in the park.

How to prevent relapse
Preventive measures are aimed at preventing a relapse, especially for those who have already acquired a diagnosis of arterial hypertension.
A healthy lifestyle: with a balanced diet, a sparing work regime and good rest.
Regular use of drugs that normalize blood pressure.
Constant monitoring of the salt content in foods for your diet.
Exclusion of drinks with caffeine (strong tea, coffee).
Liberation from bad habits.
Treatment of cervical osteochondrosis and other diseases that may be prerequisites for the development of hypertension.
Therapeutic exercise and massage (attention - the collar zone).
Systematic course of preventive therapy in a hospital.
Sanatorium-resort treatment in its climatic zone.
Regular intake of sedatives, including alternative medicine.

A hypertensive crisis usually comes unexpectedly, and the task of preventing his visit is not from simple attempts, but quite real. It must be solved, first of all, by the hypertensive person himself. If he can’t get away from his illness (about one billion people live on the planet with systemic hypertension), then its manifestations, including HA, can be predicted, which means that serious consequences can be prevented.

Arterial hypertension, even now, when the latest technologies are being introduced into modern medicine, is one of the most common. According to statistics, one third of the entire adult population suffers from this disease. This disease requires special treatment and constant monitoring. Otherwise, there is a risk of complications, one of which is a hypertensive crisis (HC).

Why is medical help needed?

Emergency care for a hypertensive crisis should be provided as soon as possible, because. there is a high probability of developing serious complications, such as myocardial infarction or stroke and other lesions of internal organs. In such situations, patients themselves or their relatives can provide first aid. Patients with hypertension should know as much as possible about their illness. To begin with, the patient and his relatives must understand what symptoms are characteristic of GC.

Hypertensive crisis. Urgent care. Symptoms. Treatment

A hypertensive crisis is a sudden rise in blood pressure. It can rise to very high values, for example, up to 240/120 mm Hg. Art. and even higher. In this case, the patient experiences a sudden deterioration in well-being. Appears:

Headache. Noise in the ears. Nausea and vomiting. Flushing (redness) of the face. Tremor of the extremities. Dry mouth. Palpitations (tachycardia). Visual disturbances (flies or veil before the eyes).

If such symptoms occur, emergency care is needed for a hypertensive crisis.

Causes

Often, a hypertensive crisis develops in patients suffering from diseases that are accompanied by an increase in blood pressure (BP). But they can also occur without its preliminary persistent increase.

The following diseases or conditions can contribute to the development of GC:

hypertension; menopause in women; atherosclerotic lesions of the aorta; kidney disease (pyelonephritis, glomerulonephritis, nephroptosis); systemic diseases, such as lupus erythematosus, etc.; nephropathy during pregnancy; pheochromocytoma; Itsenko-Cushing's disease.

In such conditions, any strong emotions or experiences, physical overstrain or meteorological factors, alcohol consumption or excessive consumption of salty foods can provoke the development of a crisis.

Despite such a variety of causes, the presence of dysregulation of vascular tone and arterial hypertension is common in this situation.

Hypertensive crisis. Clinic. Urgent care

The clinical picture in hypertensive crisis may differ somewhat depending on its form. There are three main forms:

Neurovegetative. Water-salt, or edematous. Convulsive.

Emergency care for a hypertensive crisis of any of these forms should be provided urgently.

Neurovegetative form

This form of GC is most often provoked by a sudden emotional overexcitation in which there is a sharp release of adrenaline. Patients are well expressed anxiety, arousal. There is hyperemia (redness) of the face and neck, tremor (trembling) of the hands, dry mouth. Cerebral symptoms join, such as severe headache, tinnitus, dizziness. There may be visual impairment and flies before the eyes or a veil. There is severe tachycardia. After removing the attack, the patient has increased urination with the separation of a large amount of clear light urine. The duration of this form of HA can be from one to five hours. As a rule, this form of HA does not pose a danger to life.

Water-salt form

This form of HA is most common in women who are overweight. The cause of the development of an attack is a violation of the renin-angiotensin-aldosterone system, which is responsible for renal blood flow, circulating blood volume and water-salt balance. Patients with the edematous form of HC are apathetic, lethargic, poorly oriented in space and time, the skin is pale, there is swelling of the face and fingers. Before the onset of an attack, there may be interruptions in the heart rate, muscle weakness and a decrease in diuresis. A hypertensive crisis of this form can last from several hours to a day. If emergency care is provided in a timely manner for a hypertensive crisis, then it has a favorable course.

Convulsive form

This is the most dangerous form of GC, it is also called acute arterial encephalopathy. It is dangerous for its complications: cerebral edema, development of intracerebral or subarachnoid hemorrhage, paresis. These patients have tonic or clonic convulsions followed by loss of consciousness. This state can last up to three days. If emergency care is not provided in time for a hypertensive crisis of this form, the patient may die. After the attack is removed, patients often experience amnesia.

Urgent care. Action algorithm

So, we found out that a serious complication of arterial hypertension and other pathological conditions is a hypertensive crisis. Emergency assistance - an algorithm of actions that must be clearly performed - must be provided quickly. First of all, relatives or friends should call for emergency help. The sequence of further actions is as follows:

If possible, you need to calm the person, especially if he is very excited. Emotional stress only contributes to an increase in blood pressure. Offer the patient to move to bed. The position of the body is semi-sitting. Open the window. An adequate supply of fresh air must be provided. Unfasten the collar of the garment. The patient's breathing should be even. It is necessary to remind him to breathe deeply and evenly. Give an antihypertensive drug that he constantly takes. Under the patient's tongue, put one of the emergency aids to reduce blood pressure: Copoten, Captopril, Corinfar, Nifedipine, Cordaflex. If the medical team has not yet arrived in half an hour, and the patient does not feel better, you can repeat the medication. In total, such means of emergency lowering blood pressure can be given no more than two times. You can offer the patient a tincture of valerian, motherwort, or Corvalol. If he is worried about chest pain, give a Nitroglycerin tablet under the tongue. heating pads or plastic bottles of warm water and cover with a blanket.

The doctors will follow. Sometimes, with a diagnosis of a "hypertensive crisis", emergency care - an algorithm of actions taken by relatives and medical workers who came to the call - turns out to be sufficient, and hospitalization is not required.

The patient is alone at home. What to do?

If the patient is at home alone, he should first of all take an antihypertensive drug, and then open the door. This is done so that the team that came to the call could get into the house if the patient gets worse, and only then help him. After the lock of the front door is open, the patient needs to independently dial the number "03" and call the doctors.

Health care

If the patient has a hypertensive crisis, the emergency care of the nurse consists in the intravenous administration of Dibazol and diuretics. With uncomplicated GC, this is sometimes sufficient.

In the case of tachycardia, beta-blockers give positive dynamics, these are the drugs Obzidan, Inderal, Rausedil. These drugs can be administered both intravenously and intramuscularly.

In addition, under the tongue, the patient needs to put the antihypertensive drug Corinfar or Nifedipine.

If the hypertensive crisis is complicated, emergency care is provided by the doctors of the intensive care unit. Sometimes GC is complicated by signs of acute left ventricular failure. In this case, ganglion blockers in combination with diuretics have a good effect.

With the development of acute coronary insufficiency, the patient is also placed in the intensive care unit and the drugs Sustak, Nitrosorbitol, Nitrong and analgesics are administered. If the pain is not relieved, then narcotic drugs may be prescribed.

The most formidable complications of GC are the development of myocardial infarction, angina pectoris, and stroke. In these cases, the patient is treated in the intensive care unit and resuscitation.

Drugs for GC

When diagnosed with a hypertensive crisis, emergency care (standard), as a rule, is provided with the help of certain groups of medicines. The goal of treatment is to lower blood pressure to the patient's usual numbers. It should be borne in mind that this decrease should occur slowly, because. with its rapid fall, it is possible to provoke a collapse in the patient.

Beta-blockers dilate the lumen of arterial vessels and relieve tachycardia. Drugs: Anaprilin, Inderal, Metoprolol, Obzidan, Labetolol, Atenolol. ACE inhibitors have an effect on the renin-angiotensin-aldosterone system (used to reduce pressure). Preparations: "Enam", "Enap". The drug "Clonidine" is used with caution. When taking it, a sharp drop in blood pressure is possible. Muscle relaxants - relax the walls of the arteries, thereby reducing blood pressure. Preparations: "Dibazol" and others. Calcium channel blockers are prescribed for arrhythmias. Preparations: "Kordipin", "Normodipin". Diuretics remove excess fluid. Preparations: Furosemide, Lasix. Nitrates expand the arterial lumen. Drugs: "Nitroprusside", etc.

With timely medical care, the prognosis for GC is favorable. Fatal cases usually occur with severe complications, such as pulmonary edema, stroke, heart failure, myocardial infarction.

To prevent GC, you need to regularly monitor blood pressure, systematically take prescribed antihypertensive drugs and follow the recommendations of a cardiologist, as well as not overload yourself with physical activity, if possible, eliminate smoking and alcohol, and limit salt intake.

Hypertensive crisis is a dangerous condition, manifested by a sharp and rapid rise in pressure. If the condition arose against the background of a person having secondary diseases (heart attack, tachycardia, cerebral encephalopathy), then a complicated course of the disease is formed. A different tactic for the treatment of pathology in the uncomplicated development of the disease.

Hypertensive crisis with tachycardia: emergency care

Treatment of a hypertensive crisis with tachycardia (increased heart rate) requires the appointment of the following drugs:

Non-selective beta-blockers - propranolol at a dose of 20-40 mg. After taking the medicine, the therapeutic effect occurs within 30 minutes. Duration of action - 6 hours. It should be borne in mind that non-selective beta-blockers have a side effect in the form of bronchial constriction. Contraindications to the use of drugs are blockades and weakness of the sinus node. The drug should be used carefully in chronic and allergic diseases of the lungs, liver failure, vascular diseases; A means of central hypotensive action - clonidine during a crisis is taken orally at a dose of up to 150 mg. The duration of action is up to 12 hours, and the first effects are achieved after half an hour. The use of clonidine provokes side effects: drowsiness, dry mouth, dizziness, bradycardia, decreased gastric secretion. Contraindications to the use of clonidine are various types of heart blockade and atherosclerosis of blood vessels.

If the hypertensive type occurs, treatment should not be started until the heart rate has changed.

Emergency care for hypertensive type without tachycardia

Drugs prescribed for the treatment of hypertensive crisis without tachycardia:

Short-acting antagonist (nifedipine) - taken under the tongue at a dose of 10 mg. After starting the medication, the first hypotensive effect is observed after 10-15 minutes, and the duration of action is up to 6 hours. The side effect of the drug is manifested in nausea, weakness, and a decrease in the frequency of myocardial contractions. Do not use nifedipine for heart attack, heart failure, mitral stenosis; Before using captopril (under the tongue at a dose of 25 mg), the first effects are observed after 20-40 minutes. The duration of action of the drug is up to a day. After taking a dose of the drug, people may experience side effects: narrowing of the renal arteries, diarrhea, skin rash, cough, protein in the urine. Contraindications to taking captopril are pregnancy, high sensitivity to ACE inhibitors, autoimmune diseases, chronic kidney failure, weakness of bone marrow suppression. For patients under the age of 18, the drug is not recommended, as well as for people with diabetes and cardiosclerosis.

Tactics of treatment of hypertensive crisis of uncomplicated type

Treatment of the uncomplicated type of condition is carried out by taking drugs orally or through intramuscular injections. To reduce high blood pressure during a crisis, nifedipine, clonidine, captopril should be taken.

If pressure reduction is carried out at home, it must be remembered that optimal treatment requires a gradual decrease in vascular tone. It will be enough to “knock down” the level by 10 mmHg per hour.

In uncomplicated hypertension with systolic blood pressure greater than 220 mm. rt. st and diastolic more than 120 mm. rt. Art. doctors expect levels to decrease by 15% within 12 to 20 hours. The effectiveness of the drug should be observed after 15-30 minutes. If this does not happen, you need to add another antihypertensive agent.

Uncomplicated hypertensive crisis should be treated with a single drug. During the first day, the effectiveness of treatment is evaluated. If it was possible to achieve the target values of hypertension (160 to 110 mmHg) throughout the day, the drug can be considered successful in preventing a crisis in a particular person.

Treatment for myocardial infarction

Hypertensive crisis in myocardial infarction is dangerous by the rapid development of coronary syndrome. Emergency care for this pathology should be provided to a person within the first 20 minutes. In the acute course of the disease, myocardial ischemia is formed.

Obviously, a sharp and increased increase in heart disease without adequate help will be fatal. Therefore, when hypertension appears, doctors not only determine the heart rate, but also prescribe electrocardiography, which can detect angina pectoris and myocardial infarction.

Hypertensive crisis in myocardial infarction: treatment with pills

Treatment of a condition with myocardial infarction is carried out with the following tablets:

Sublingual nitroglycerin (under the tongue) at a dose of 0.5 mg; Propranolol - intravenously, 1 ml of a 1% solution; Enalaprinate - 1.250 mg intravenously; Morphine - 1 ml of a 1% solution in a 0.9% sodium chloride solution; Ascorbic acid 250 mg.

First aid for hypertension in a crisis

First aid for 3 types of hypertensive crisis is different, so the treatment should be selected correctly.

In the first type of crisis, the symptoms of the disease develop rapidly within 3-4 hours, which is accompanied by increased sweating, tachycardia, pain in the back of the head, flickering flies, redness of the skin, and pain in the temples.

The second type of crisis is formed slowly. It is typical for hypertensive patients with experience.

Emergency care for hypertensive crisis at home:

Take a horizontal position; Physical and emotional peace; Cold to the back of the head in the form of a compress; Put mustard plasters on the calves and lower back; Take your blood pressure medication immediately.

No need to take "improvised" drugs. When the ambulance arrives, a doctor or paramedic will administer an antihypertensive drug, but it is not known how long it will take for a qualified team to reach the patient.

Emergency care in a severe crisis also requires the elimination of dangerous symptoms of concomitant diseases:

stroke; heart attack; kidney failure; Left ventricular failure; Pulmonary edema.

As a rule, people with serious illnesses have in their arsenal a list of pills for effective treatment of the disease. If you provide first aid to a person with a complicated hypertensive crisis, look in his first aid kit. There you will find not only suitable drugs, but also according to their list you can guess what diseases a person has.

Medical procedures for complicated hypertensive crisis

Sanitation of the respiratory tract; Oxygen supply (artificial ventilation); Elimination of venous thrombi; Treatment of complications; antihypertensive therapy.

To reduce pressure in a complicated hypertensive crisis, the following tablets are used:

Nifedipine - under the tongue (for heart failure and pulmonary edema); Clonidine - intravenously or orally; Sodium nitroprusside - drip; Captopril - under the tongue (with renal failure); Phentolamine - intravenously (with pheochromocytoma); Enalapril - intravenously (with chronic heart failure and encephalopathy).

Therapeutic measures are carried out under the supervision of a doctor, when the patient is shown bed rest.

Emergency care for a complicated crisis

Emergency care can be started with nifedipine 15-20 mg sublingually. The choice of this drug by specialists is due to the fact that its therapeutic effects are quite predictable. After 5-30 minutes of taking the drug, a gradual decrease in pressure is observed. The maximum effect appears after 4-6 hours. If within 30 minutes there is no decrease in hypertension by 15%, the effectiveness of the drug should be doubted. In such a situation, the addition of another drug can be recommended, but the choice of dosage should be made by the doctor, taking into account previous therapy.

There is also an opposite opinion of physicians with the low effectiveness of nifedipine against the background of the first dose. You need to repeat taking the pills after 30 minutes. This approach is rational at pressures above 180 mmHg. Studies by pharmacologists have shown that the use of the drug is more rational at high pressure figures.

Contraindications to nifedipine:

Headache; Drowsiness; Tachycardia or bradycardia; Hypersensitivity to the drug.

Kapoten at a dose of 25-50 mg also helps to get rid of a hypertensive crisis. Its lesser popularity is due to the less predictable side effects of the drug. If you take captopril under the tongue, the antihypertensive effect is observed after 10 minutes. Its duration is about an hour. If there is no effect during this period, you can take another pill. This significantly increases the likelihood of side effects:

Dry cough; Increase in urea; Spasm of the bronchi; Headache; Fainting; Protein in the urine; Renal failure.

Attention! ACE inhibitors are contraindicated in pregnancy. They provoke toxicosis.

The hyperkinetic variant of the crisis is treated with clonidine orally under the tongue at a dose of 0.075 mg. The hypotensive effect can be traced after 20-30 minutes, but may appear earlier.

Side effects of clonidine (clonidine):

Drowsiness; dry mouth; Difficulties in muscle activity.

Clonidine should not be used in the following conditions:

heart block; Sick sinus syndrome; myocardial infarction; encephalopathy; Obliterating vascular diseases; Depression.

If a sharp increase in pressure is associated with an increase in heart rate, you need to take the drug sublingually at a dosage of 20 to 40 mg.

If there are contraindications to taking beta-blockers, you can use magnesium sulfate at a dose of 1500 to 2500 mg (intravenous administration). The drug has the following mechanisms of action:

Vasodilator; Anticonvulsant; Soothing.

The use of magnesium sulfate is indicated for hypertensive crisis with convulsive syndrome.

Side effects of taking the remedy:

bradycardia; Atrioventricular block.

Contraindications to the use of magnesium:

kidney failure; bradycardia; atrioventricular block; myasthenia; bradycardia; Blockade 2 degrees.

Hypertensive crisis: first aid at home

The algorithm for emergency care in a crisis at home consists of the following items:

Call an ambulance; Before the arrival of the brigade, take a supine position and calm down; Measure your blood pressure every 15 minutes; Take an antihypertensive medication. It is better to use the standard tablets that the person took to treat hypertension; With retrosternal pain, you need to put a nitroglycerin tablet under the tongue; Take corvalol and valerian; Ask loved ones to ventilate the room; Create silence; Turn down the brightness in the room.

Elderly people need to be taken care of. They have secondary diseases, therefore, when using antihypertensive drugs, secondary pathology can worsen.

Before the arrival of an ambulance, it is advisable to coordinate all therapeutic measures with a doctor. Before this, measure the level of blood pressure and report any complications in order to optimally select an antihypertensive drug.

You should not rely on the fact that emergency care will be provided by a team of doctors. Against the background of a crisis, there is a danger of rupture of cerebral vessels (stroke), which can form in a few minutes.

Hypertensive crisis (HC) is such a widespread phenomenon that, perhaps, you will not meet people in the metropolis after forty who have not experienced all the delights of this unexpected and sad surprise.

Uncoordinated work of the departments of the autonomic nervous system (ANS) forms a specific type of GC. Their classification is based on these principles.

Risk factors provoking GC

Risk factors that provoke the development of GC can be:

Disorders in the work of the nervous system - situational neuroses and similar conditions; Mental overload, regular stressful situations; hereditary tendency; endocrine problems; Hormone imbalance (PMS (premenstrual syndrome), menopause); Accumulation of water and salt in the organs due to the immoderate use of foodstuffs dangerous for hypertensive patients; Smoking and drinking alcohol in any form and dose; Excessive stress (emotional, physical, hearing or vision strain, strong vibration); Geomagnetic storms and a sharp change in weather, which does not allow the body to quickly rebuild; Exacerbation of concomitant chronic diseases; kidney failure; Unauthorized cancellation or periodic use of prescribed antihypertensive drugs; Osteochondrosis of the cervical vertebrae.

Any of the indicated reasons is enough to provoke GC. Depending on which part of the ANS will be involved in the first place, there are 2 types of the disease. Hypertensive crisis will have symptoms depending on its variety.

The main signs of the disease

The hyperkinetic type occurs with a high tone of the sympathetic division of the ANS. It most often occurs at a young age, preferably in men. It develops instantly and is characterized by the following features:

Serious increase in blood pressure; General overexcitation; Increased sweat secretion; Tachycardia; Pain in the head of a throbbing character; Painful symptoms in the heart, with a feeling that it stops periodically; Hand tremor; Dryness in the mouth, flushing of the face; After stopping GC - frequent urge to the toilet with a large volume of excreted fluid.

Type 1 HC (also called cardiac, systolic) occurs when the output of blood in the heart increases and its contractions become more frequent, while vascular resistance and blood volume remain the same. This manifests itself in the form of an increase in pressure (pulse, heart). The consequences of cardiac type GC can end in:

Hemorrhage or swelling of the brain; myocardial infarction; Impaired kidney function; Eye damage.

So is it any wonder if at a young age a strong strong man dies of a stroke or heart attack?

The hypokinetic type develops imperceptibly, gradually, but surely. It overtakes women who have gained excess weight during menopause due to hormonal disruptions. The GC of the second type sends hints about its appearance several days in advance. Symptoms of a hypertensive crisis of the second type:

Sleepiness, apathy. Decreased performance and mood. Dizziness and weakness. Pain in the head of a bursting nature, when there is a desire to pull the head with a towel. Nausea and vomiting do not relieve all signs of illness. Reduction of excreted urine, manifested by swelling of the face, arms, legs. Decreased visual acuity, darkening of the eyes. The skin is dry and pale.

The second type (its other name is edematous) controls the parasympathetic part of the ANS. It is characterized by a decrease in the frequency of heart contractions and blood ejection with a simultaneous increase in its volume and peripheral resistance. Symptoms of GC according to the edematous type indicate its diastolic origin. With the formation of acute insufficiency of the left ventricle, one can speak of complications of GC.

Complications with GC

Complicated (convulsive, cerebral) crises are treated in neurology. GC in the form of a disorder of the coronary and cerebral blood flow, accompanied by convulsions, can develop with equal probability from GC of any type. In this case, an individual approach is necessary not only in primary care, but also in subsequent GC therapy, since a convulsive crisis can be aggravated by such serious diseases as:

Stroke; myocardial infarction; Arrhythmia; swelling of the lungs or brain; Renal pathologies.

Diagnose the condition on the basis of history, age characteristics, clinical parameters and compare with hypertension symptoms, characterized by:

Glomerulonephritis (kidney disease). Neoplasms of the adrenal glands that produce hormones. Manifestations of traumatic brain injury. Edema of the brain against the background of high blood pressure. Vegetovascular dystonia with its various manifestations. Consequences from the use of drugs such as LSD, amphetamine or cocaine.

An uncontrolled increase in blood pressure is extremely dangerous for the body, as it threatens it with a vascular catastrophe.

Complications of GC in the form of impaired cerebral blood flow and its consequences quickly lead to death. According to medical statistics, about half of patients with this diagnosis die within 3 years due to kidney problems or stroke. In 83% of patients, damage to the 1st target organ was recorded, in 14% - 2, approximately 3% have multiple organ failure.

Symptoms of GC

After identifying the nature of GC, the patient will be prescribed treatment in accordance with his type of disease. But most often, vascular problems of this kind happen unexpectedly, when a person has no idea about the problem. To quickly navigate, it is important to distinguish between the symptoms of GC:

Sudden changes in blood pressure; Acute pain in the back of the head and parietal zone; Impaired coordination, dizziness, flashing "flies" in the eyes; Heart pain, tachycardia; Fainting and loss of strength; Oxygen deficiency, shortness of breath; Bleeding from the nose; Nausea and vomiting that does not relieve all other symptoms; Drowsiness and disorders of consciousness; Psychomotor overexcitation.

Rarer manifestations of impending disease include paresthesia and arrhythmia.

Hypertensive crisis symptoms and first aid is standard, not related to its type.

Hypertensive crisis: emergency care (algorithm)

Emergency care for a hypertensive crisis is therefore called urgent first aid, because only immediate and clear actions of others can prevent serious complications.

Immediately call a doctor or an ambulance (it is better if someone else does this, and not the patient himself). With the help of pillows, create a comfortable position for the victim - reclining. Unfasten the collar and other clothing that makes it difficult to breathe, since during a crisis the patient does not have enough air. Ventilate the room, after covering the patient with a blanket, so as not to overcool. Apply a heating pad to your feet (a plastic bottle of hot water will do). You can put mustard plasters on your calves. If the victim is hypertensive, give him the drug he usually takes. Corvalol (20 drops) will help relieve stress. Usually the attack is accompanied by a panic fear of death. You can put captopril under the tongue and ask to dissolve the tablet. If the patient complains of pain bursting his head, a sign of high pressure, a furosemide tablet will help. If you have nitroglycerin on hand, you can put the victim under the tongue. It is important to remember that the drug sharply lowers the pressure, this condition is accompanied by increasing headaches. To neutralize the negative side effect of nitroglycerin, it is sometimes taken in parallel with validol.

Emergency care for a hypertensive crisis, the algorithm of actions should be clear and consistent.

According to medical statistics, the mortality rate of patients with a hypertensive crisis who did not receive adequate treatment is 79% during the first year, with proper treatment and compliance with all prescriptions, more than 80% of patients who underwent GC overcome the five-year survival limit.

First aid for hypertensive crisis

The listed measures aimed at reducing blood pressure are first aid. It is necessary to help the patient at the first stage, before the arrival of the ambulance. But it is impossible to replace medical care with such methods. In case of a hypertensive crisis, first aid should be based on the main commandment of medicine “do no harm!”. First of all, this is related to the choice of drugs, since not all medicines that are used to stop a hypertensive crisis are completely safe.

For example, ACE inhibitors such as captopril or enalapril can cause angioedema. Outwardly, the reaction resembles an allergy, but its consequences are much more dangerous and insufficiently controlled.

You should not abuse the very popular nitroglycerin: if blood pressure is not critical, then with a sharp decrease, the drug can provoke collapse. The vasodilating effect of this drug is suitable for cardiovascular problems, and therefore it is necessary to use it in myocardial infarction. Before you offer a patient a medicine, you need to calmly assess the situation and make the right decision.

Of particular importance is adequate first aid for a hypertensive crisis, the algorithm of actions of which involves constant monitoring of pressure every 12 hours. For an accurate assessment of blood pressure, it is necessary to measure it on both arms, the cuff must be matched exactly to size. For comparative analysis, the pulse is checked both on the arms and on the legs.

With independent pressure control, the readings are 180/110 mm Hg. Art. talk about an impending hypertensive crisis if the parameters are repeated after a few minutes when re-measured.

First aid for hypertensive crisis at home

An ambulance team should deal with the relief of a hypertensive crisis with constant monitoring of blood pressure. But it is not always possible to quickly use its services. It’s good if a health worker lives next door (at least a nurse), and in the home medicine cabinet there are disposable syringes and injections that can be used to stop an attack at home.

Such a tactic is very helpful for hypertensive patients who are ill for a long time and always have medicines in stock that can stop an attack on their own, "so as not to disturb the doctors once again." Over time, they themselves acquire a certain competence, therefore, the provision of emergency care for a hypertensive crisis may be limited to the introduction of a complex of drugs intramuscularly:

Furosemide (do not forget that it is able to remove calcium, potassium and other trace elements, so its regular use involves the simultaneous use of Panangin); Dibazol (at extremely high blood pressure, it is dangerous, as it tends to increase pressure before it starts to slowly lower it); Magnesium sulphate - intravenous injection gives a positive effect, but it must be done with extreme caution or entrust this procedure to a doctor; Antispasmodics such as no-shpy, papaverine; Vitamin B6.

Hypertensive crisis treatment at home does not exclude if it did not cause complications.

In such a situation, the listed measures will be enough, it is only important to take into account that a sharp drop in blood pressure is dangerous not only for poor health - it worsens the blood flow of vital organs, so you can lower the pressure by a maximum of 25%!

Relief of a hypertensive crisis by a doctor

Emergency medical teams in their work are guided by the protocols approved by the Ministry of Health of the Russian Federation. For each disease, there has been developed its own algorithm for emergency medical care. According to this principle, a suitcase with tools and medicines, which doctors call "button accordion", is also completed.

For an emergency lowering of blood pressure, the stacks are equipped with means intended for slow and careful administration intravenously:

Clonidine (gemiton). Ganglioblockers (benzogexonium) Furosemide (Lasix) - the drug is indicated for hypertensive crisis with symptoms of brain disorders. Dibazol (in adulthood it is able to sharply reduce the release of blood in the heart, before lowering blood pressure, it first increases it). A solution of magnesium sulfate (treats encephalopathy). Dibazol Furosemide Ganglion blockers Clonidine

Which of the drugs to use, and in accordance with which protocol, doctors determine on the basis of blood pressure indicators, the type of GC, taking into account the anamnesis, clinical signs, age and the patient's response to a set of first aid measures.

A hypertensive patient is subject to hospitalization in case of complications of GC in the form of:

brain stroke; brain tumors; Left ventricular failure; coronary insufficiency.

If GC is stopped without complications, it is enough to observe your therapist.

Common Medications

Experienced hypertensive patients adapt to their condition in such a way that all emergency drugs are stored in a home medicine cabinet, relatives are instructed, they do not leave the house without medicines. But with brain disorders that occur during a hypertensive crisis, the patient does not always have the ability to adequately think and quickly make the right decisions, so a lot of medicines can only confuse him.

Many people dream of such a first-aid kit that could be put into the bag automatically, without thinking about the selection of medicines and doses. There are first-aid kits that are easy to understand for either the patient or those who are nearby. The set is patented and received permission for use in the Russian Federation. This is an algorithm for providing emergency care for a hypertensive crisis before the appearance of a doctor. In a compact waterproof case, which is convenient to take with you on the road, medicines are collected:

Nifedipine (blocks calcium channels) in a double dose; Metoprolol (blocker) for single use. Nifedipine Metoprolol

With this arsenal, hypertensive patients can safely go to football and to a concert.

What to do after stopping a hypertensive crisis

When the most difficult period is over, it is important to understand that even with normal pressure, recovery from GC will take at least another week. If precautions are not taken, a new crisis with severe complications will not be long in coming. The rhythm of the patient's life should be calm and measured:

Without sudden movements and physical or psycho-emotional stress; Without morning runs, nightly rest at the computer or TV with a horror movie; With a salt-free diet, you can reassure yourself that the restrictions are temporary, and there you won’t get used to it for long; With a gradual decrease in the volume of liquid; Without household records - in the kitchen, in the garden, during repairs; With an adequate response to any stress that affects the nervous system; Do not create conflict situations, avoid those who provoke them; Regularly take antihypertensive drugs prescribed by a doctor; Forget about bad habits (smoking, overeating, alcohol).

During the rehabilitation period after GC, it is useful to think about sanatorium treatment without climate change.

If the resort is not affordable, you can limit yourself to a ticket to a specialized dispensary, where there are conditions for relaxation, physical procedures, exercise therapy, massage, evening walks in the park.

How to prevent relapse

Preventive measures are aimed at preventing a relapse, especially for those who have already acquired a diagnosis of arterial hypertension.

A healthy lifestyle: with a balanced diet, a sparing work regime and good rest. Regular use of drugs that normalize blood pressure. Constant monitoring of the salt content in foods for your diet. Exclusion of drinks with caffeine (strong tea, coffee). Liberation from bad habits. Treatment of cervical osteochondrosis and other diseases that may be prerequisites for the development of hypertension. Therapeutic exercise and massage (attention - the collar zone). Systematic course of preventive therapy in a hospital. Sanatorium-resort treatment in its climatic zone. Regular intake of sedatives, including alternative medicine.

A hypertensive crisis usually comes unexpectedly, and the task of preventing his visit is not from simple attempts, but quite real. It must be solved, first of all, by the hypertensive person himself. If he can’t get away from his illness (about one billion people live on the planet with systemic hypertension), then its manifestations, including HA, can be predicted, which means that serious consequences can be prevented.

A hypertensive crisis is a condition in which there is a sharp increase in blood pressure, accompanied by a deterioration in well-being. Hypertension is very common, so almost everyone has experienced manifestations of a crisis in relatives, friends or colleagues. This means that any person must be able to recognize this condition and provide competent emergency care.

As a rule, a hypertensive crisis occurs in people who have long suffered from arterial hypertension, who are aware of their illness; and therefore they themselves are able to determine the nature of the bad state of health that occurs in such a state. However, sometimes a hypertensive crisis occurs in a person who usually has a normal arterial. This is possible, for example, with excessive consumption of energy drinks containing caffeine, or when taking certain narcotic drugs - cocaine and substances similar to it.

Sometimes in a healthy person, severe nervous stress can lead to a sharp increase in blood pressure, requiring emergency care. Usually, a hypertensive crisis develops in those who are already familiar with arterial hypertension. An increase in blood pressure can develop even in patients who regularly take the appropriate medications. The following provoking factors lead to hypertensive crises.

Change of weather.

Weather dependence is a fairly common cause. People who are prone to high blood pressure under the influence of meteorological factors usually have headaches when weather conditions change, while hypertension is often accompanied by numerous vegetative manifestations (trembling, discomfort in the chest, cold extremities).

Psycho-emotional load.

This factor is also not uncommon. An unpleasant conversation, bad memories, a difficult situation in the family or at work - all this contributes to the development of a hypertensive crisis.

Pauses in taking drugs that reduce blood pressure, or their cancellation.

If a person has arterial hypertension at the stage when he needs to take medications, then most likely it will be impossible to refuse them for good. Arterial hypertension is a disease in which a normal level of blood pressure is maintained only through regular, i.e. daily, medication.

Therefore, an accidental or intentional skipping of a pill (this is especially true for adrenergic blockers, among their representatives - metoprolol, bisoprolol, carvedilol, etc.) can cause a hypertensive crisis. Some patients, not having received proper explanations from the doctor and focusing on good health and normal blood pressure, refuse to take medication. This can cause a sudden deterioration in the condition.

Alcohol consumption.

As you know, ethyl alcohol has a dual effect on blood vessels: first, it expands them, which leads to a decrease in pressure in the arterial system, and then narrows. The latter contributes to an increase in blood pressure. Typically, a hypertensive crisis occurs with a single use of a large dose of alcohol (as part of a hangover syndrome) or with regular alcohol abuse.

Excess salt in food.

Table salt has the ability to retain fluid in the body and, in addition, causes thirst. Most of this fluid passes into the bloodstream, and the total volume of blood becomes larger. As a result, with the frequent use of salty foods, a person becomes prone to increased blood pressure.

There are more rare causes of hypertensive crisis. For example, a sharp increase in blood pressure can occur while taking certain antidepressants and eating foods containing the organic substance tyramine. It is found in fermentation products - wine, vinegar, cheeses. That is why such states are called "cheese" crises.

Symptoms of a hypertensive crisis.

The reaction to a sudden increase in pressure can be different. Someone does not feel its rise at all, and someone even suffers a slight excess of the usual norm very painfully. Symptoms of a hypertensive crisis occur in different people in different combinations. Their common feature is that they appear suddenly. In most cases, a person is able to say with an accuracy of an hour when he had a hypertensive crisis.

The most common symptom is a headache. It arises from the fact that an increase in blood pressure in the vascular bed leads to an increase in intracranial pressure. As a rule, the back of the head hurts; this sensation may be constant pressing or pulsating. Also, redness of the face and neck is often noted when the patient complains of a feeling of heat. Visual disturbances can occur - its weakening, flashing of small black dots or a veil before the eyes.

Due to the spasm of the blood vessels, the heart muscle has to apply more force to pump blood. There is a feeling of increased, rapid heartbeat. Sometimes there are a variety of unpleasant sensations in the region of the heart - from discomfort to pain attacks, if the patient suffers from angina pectoris. Dizziness, nausea, vomiting are possible.

In some patients, the so-called vegetative symptoms come first - signs associated with disorders of the autonomic nervous system. If they prevail over other symptoms, it is sometimes difficult to assume a hypertensive crisis at first glance. Vegetative manifestations include trembling in the body, excessive sweating, cold hands and feet, a feeling of lack of air.

A hypertensive crisis can proceed in different ways. The most common option is with a sharp onset, when a headache suddenly occurs, the patient becomes restless, agitated, complains of nausea, feeling hot, and seeks help. As a rule, such crises are rather short-lived, lasting up to 5-7 hours. After normalization of pressure, the patient may experience frequent urination. In the future, well-being is getting better.

A rarer, but more dangerous variant of a hypertensive crisis is called edematous. The symptoms are dominated by signs of cerebral edema. It starts more gradually. Such patients, in contrast to patients of the first group, usually become silent, withdrawn, they answer questions with a delay. Complain of severe headache, visual disturbances. Sometimes consciousness becomes oppressed. If help is not provided in time, this condition in the patient sometimes lasts up to several days.

The third, rarest, but most dangerous variant of a hypertensive crisis is convulsive. What causes convulsions, disorders of consciousness and speech. This type of hypertensive crisis requires prompt medical attention.

A sharp increase in blood pressure, especially if it happened in a person with existing diseases of the circulatory organs (angina pectoris, myocardial infarctions and strokes), leads to pathological changes in the myocardium, kidneys and other organs, i.e., it can aggravate the course of the disease. Therefore, in any hypertensive crisis, you should seek qualified medical help.

First emergency aid for hypertensive crisis, pressure measurement.

The first skill that a person assisting a patient with a hypertensive crisis should possess is the measurement of blood pressure. It is this manipulation that is primarily necessary if a hypertensive crisis is suspected. Otherwise, focusing only on the symptoms, you can misinterpret them, which will lead to errors in the provision of emergency care.

After all, if, for example, reddening of the face or visual disturbances are caused by a stroke, and not by a hypertensive crisis, then the use of drugs that reduce blood pressure can lead to arterial hypotension, which will reduce blood flow to the brain and make the situation even more serious for the patient.

Blood pressure can be measured by any available serviceable device - mechanical, semi-automatic or automatic. However, in each case, the measurement must be repeated three times in order for the blood pressure value to be determined more accurately. It is very important. With a single measurement, the result may turn out to be incorrect, firstly, due to some external factors (noise), and secondly, due to the so-called "white coat" syndrome (increased reaction to the medical staff or anyone providing assistance).

A person, when he feels unwell and is afraid for his health, is especially anxious and receptive. All this is accompanied by stress and anxiety, in which blood pressure rises even more. Therefore, the first measurement of blood pressure, especially if this procedure is little known to the patient, often gives inflated numbers. This creates the need to repeat the measurement three times. The patient gradually calms down, and on the third time the results are most accurate. The technique of tonometry is described in detail in the chapter on medical manipulations.

In crises, blood pressure rarely returns to normal on its own. Special medications are required, but along with their intake, it is necessary to provide the patient with non-drug assistance. It is necessary to provide physical and emotional rest, to sit down, or rather to lay down and try to calm the person, since an increase in blood pressure is sometimes accompanied by a feeling of anxiety, irritability or tearfulness.

It is advisable to provide assistance in a well-ventilated, quiet area, since lack of oxygen, strong odors and noise can only help maintain high blood pressure numbers. Bright lighting should also be avoided, especially if it is created by fluorescent lamps - they blink, which creates an extra load on the eyes and makes you feel worse.

In a hypertensive crisis, due to the acceleration of blood flow, patients often complain of a feeling of heat. The person should be advised to unbutton the top buttons of his shirt and offer him a cold compress. It is placed on the forehead and changed as the tissue warms up, that is, every 2-3 minutes. You can also simply wipe the face and neck of the patient with a damp cloth. If a person feels so unwell that he is unable to unbutton his shirt or apply a compress, this should be done for him.

With hypertensive crises, some are worried about nausea, less often - vomiting. If the patient makes such complaints, one must be ready to help with vomiting - lay him on his side, prepare a basin, water for rinsing his mouth and a clean towel. As already mentioned, a hypertensive crisis usually occurs in people who have been ill for a long time and are likely to receive treatment, which means that they can be helped by having access to their personal first-aid kit.

Fortunately, there are quite a lot of drugs that lower blood pressure, they are easily accessible and are available in almost every apartment, even if there are no hypertensive patients among its inhabitants. If a person has a hypertensive crisis on the street, any pharmacy also has a large number of such drugs. When helping a person with a hypertensive crisis, you need to remember two basic rules.

First, whatever medicine is used, it must be borne in mind that they do not all act instantly. The effect occurs 15-40 minutes after taking the pill, and in the future, as the drug is absorbed, its effect increases. As a rule, the maximum effect can be observed 2-3 hours after administration. With this in mind, you should not measure blood pressure almost immediately after the patient has drunk the pill.

After such a short period of time, there will be no effect, and excessive haste can lead to errors in actions. An early measurement of blood pressure gives the impression that the drug is not working; as a result, the patient receives another dose or more, or a different drug altogether. As a result, all these funds, starting to act in due time, not only cause a sharp drop in blood pressure, but can also lead the patient to the other extreme - hypotension.

Sudden changes in blood pressure, the transition from hypertonic to hypotonic state create an enormous load on the heart, brain, blood vessels and kidneys. As a result, you can expect a deterioration in well-being and the manifestation of complications. To avoid such consequences, it is necessary to evaluate blood pressure no more than every 15 minutes.

The second rule is to correctly calculate the rate of fall in blood pressure. Seeing how the arrow of the tonometer begins to fluctuate on the numbers 160, 180 or 200 mm Hg. Art., (as you know, these are very high numbers), the person who provides assistance, if he is not a doctor, involuntarily panics. Naturally, there is a desire to bring the patient to blood pressure figures of 120–130 mm Hg as soon as possible. Art. This is not worth doing.

In uncomplicated hypertensive crises (if there is no pain in the heart, movement disorders of the limbs, signs of pulmonary edema), the rate of decrease in blood pressure should be 15–20 mm Hg. Art. at one o'clock. International guidelines for the treatment of hypertensive crises even offer schemes by which the patient is returned to normal blood pressure figures within 2-3 days. Therefore, one should not overload a person with drugs. If during the provision of emergency care there has been at least a tendency to lower blood pressure, this is already good.

Before you give a person some kind of drug, you need to find out what values of blood pressure the patient has at normal times. It is not necessary to strive to reduce blood pressure indicators to numbers less than usual. For most older people with angina and hypertension, "comfortable" blood pressure is 140 and 90 mm Hg. Art. It can be regarded as high for a young healthy person, but for such a patient, these figures will be the norm.

To combat hypertensive crises, there are special treatment regimens. Employees of the ambulance team and doctors in hospitals usually use several drugs at once, which are administered in a certain sequence. When providing first aid, it is not necessary to adhere to these schemes, especially since most of them require intravenous administration of drugs. You just need to be able to find the right drugs, know how to use them, and have an idea about the contraindications to them.

Nifedipine.

Previously used in hypertensive crises almost always. It is recommended to chew it or take it orally with water at an initial dose of 10 mg (1 tablet). With a weak effect after 20-30 minutes, repeated use of the drug is allowed. Despite the fact that nifedipine quickly and effectively lowers blood pressure, it is worth remembering about contraindications. It should not be taken by people with serious heart disease (recent myocardial infarction, severe angina pectoris). In addition, if the patient has signs of angina pectoris, myocardial infarction or pulmonary edema at the time of the crisis (chest pain, shortness of breath), nifedipine is also strictly contraindicated.

Captopril.

The same applies to fast-acting drugs. It is taken at a dosage of 25-50 mg under the tongue. The drug has a minimum of contraindications, is well tolerated and effectively reduces blood pressure. When taking captopril, you need to carefully monitor the dynamics of changes in blood pressure, since it may fall too sharply.

Anaprilin (20-40 mg), metoprolol (25-50 mg) and carvedilol (12.5-25 mg).

They belong to the same group of drugs and have a similar effect. They lower blood pressure and slow down the heart rate. In this connection, drugs are contraindicated in patients whose initial pulse rate is less than 60-65 beats per minute. Before offering any of these drugs to the patient, it is also necessary to clarify whether he has heart conduction disorders (blockade) and lung diseases (for example, bronchial asthma). Under these conditions, they cannot be used.

Nitroglycerine.

Known as a medicine intended for the treatment of angina attacks. But, in addition to acting on the vessels of the heart, this drug also affects other parts of the vascular bed. The expansion of arteries and veins leads to a decrease in blood pressure, which can also be used in a hypertensive crisis. Especially nitroglycerin is indicated for those who, against the background of increased blood pressure, have chest pains. When using nitroglycerin (it can be not only in tablets that are taken under the tongue, but also in the form of a spray), you should be aware of possible side effects, the most common of which is headache.

other medicines.

Many elderly people suffering from arterial hypertension are well aware of the old remedy - intramuscular injection of solutions of papaverine hydrochloride and dibazol. Now this combination of drugs is considered not quite effective, but in the absence of funds, it can also be used. The rest of the drugs that can be used to combat a hypertensive crisis are intended for intravenous administration, which creates inconvenience in their use (enalaprilat, magnesium sulfate, etc.). They are mainly practiced by paramedics and in hospitals.

Sometimes, to normalize blood pressure in the conditions of first aid, furosemide is used in tablets or solutions for intramuscular injection (20–40 mg). It quickly removes fluid from the body, which leads to a decrease in blood pressure. However, this drug can have many side effects, so it is better to prefer other drugs from the ones described above.

A hypertensive crisis can happen not only at home or at work, where medicines are always available, but also outside the city or in the country. In this case, it is necessary to take measures to transport the patient to the clinic, where he can be provided with qualified medical care. Within the framework of pre-medical measures, the greatest attention should be paid to non-drug methods, which have already been described above.

Question 2 Cardiogenic shock. Emergency care, symptoms, pathogenesis

Definition, pathogenesis of cardiogenic shock

Cardiogenic shock- this is a state of severe hypoxia of organs and tissues, due to a sharp decrease in cardiac output of blood

Symptoms of cardiogenic shock

1. Falling GARDEN< 90/80.
2. Decrease in pulse pressure< 25 - 20 мм. рт. ст. (пульсовое = САД - ДАД)
3. Peripheral symptoms of shock: the skin is pale, cold, moist, cyanotic. Marble skin pattern, acrocyanosis. Collapsed peripheral veins.
4. Oliguria, anuria.

Emergency care for cardiogenic shock

1. Adequate pain relief
2. Restoration of a normal rhythm (decrease in heart rate to 80 - 100 per minute with tachycardia, increased frequency with bradycardia< 40 в мин.
3. Plasma substitutes: rheopoliglyukin, poliglukin, rheomokradex 400.0 intravenously under the control of respiratory rate and auscultatory picture of the lungs, blood pressure and heart rate.
4. With efficiency:
GARDEN< 70 мм. рт. ст. норадреналин 2,0 на 200,0 физ. р-ра или адреналин 1,0 - 2,0 на 200,0 физ. р-ра в/в капельно.
GARDEN 70 - 90 mm. rt. Art. dopamine 5.0 per 200.0 physical. solution in / in drip.
5. Calling a special team, hospitalization in the intensive care unit, intensive care unit

Hypertensive crisis: causes, clinic, emergency care

Hypertensive (hypertensive) crisis is a sudden and significant increase in blood pressure.

Usually, in a hypertensive crisis, a sudden increase in pressure is accompanied by a significant deterioration in blood circulation and the occurrence of neurovascular and hormonal disorders. This can cause serious damage to organs that are most vulnerable to hypertension. These organs include the heart, blood vessels, kidneys, brain and retina. Most often, a hypertensive crisis is provoked by a patient's neuropsychic overstrain, as well as violations of the lifestyle prescribed by a cardiologist for hypertension.

A hypertensive crisis can develop with any degree of arterial hypertension or with symptomatic arterial hypertension. Sometimes a hypertensive crisis can occur in a healthy person.

^ Signs of a hypertensive crisis:

·
sudden onset

·
the level of blood pressure is individually high, which depends on the initial level of blood pressure. If the patient has a constantly low level of pressure, even a slight increase can cause a hypertensive crisis.

·
the presence of complaints from the heart (pain in the heart, palpitations)

·
the presence of complaints from the brain (headaches, dizziness, various visual impairments)

·
the presence of complaints from the autonomic nervous system (chills, trembling, sweating, a feeling of a rush of blood to the head, a feeling of lack of air, etc.)
There are five variants of hypertensive crises, of which three are the most common:
hypertensive cardiac crisis
cerebral angiohypotensive crisis
cerebral ischemic crisis
Hypertensive cardiac crisis is characterized by acute left ventricular heart failure with a sharp increase in blood pressure - usually above 220/120 mm Hg. Art.

Cerebral angiohypotensive crisis corresponds to the so-called hypertensive encephalopathy, caused by overstretching of the intracranial veins and venous sinuses by blood with an increase in pressure in the capillaries of the brain, which leads to an increase in intracranial pressure.

Cerebral ischemic crisis is caused by an excessive tonic response of the cerebral arteries in response to an extreme increase in blood pressure.

To prevent crises, it is necessary to constantly treat arterial hypertension, find out the conditions and causes of crises and avoid them.

^ Urgent measures carried out when the risk of complications due to a sharp decrease in blood pressure, as a rule, exceeds the risk of damage to target organs (brain, heart, kidneys). In such situations, it is necessary to achieve a decrease in blood pressure within 24 hours. This group can include patients with type I hypertensive crisis (neurovegetative, hyperkinetic). To stop the crisis, both tablet forms of drugs (clofelin, nifedipine, captopril), and intravenous or intramuscular injections of rausedil (1 ml of a 0.1-0.25% solution) or dibazol (4-5 ml of a 1% solution) can be used. ). Effective is the use of droperidol (2-4 ml of a 0.25% solution intramuscularly) or aminazine (1 ml of a 2.5% solution intramuscularly).

In some cases, with a neurovegetative crisis with a pronounced hyperkinetic syndrome, a good effect is given by the introduction of obzidan 3-5 mg in 20 ml of isotonic sodium chloride solution intravenously slowly. Perhaps intravenous administration of veraiamil. The initial dose is 5 mg, the maximum total dose is 20 mg. Hospitalization of this category of patients is not required.

Conditions requiring emergency medical attention are characterized by a significant risk of target organ damage. Blood pressure must be reduced within 1 hour.

This applies to patients with hypertensive crisis Type II (cerebral, hypo- and eukinetic). In such a situation, the drug of choice is sodium nitroprusside, which has a powerful antihypertensive effect, which manifests itself in the first 2-5 minutes. The drug is quickly excreted from the body, which facilitates its titration.

Sodium nitroprusside is administered intravenously in 500 ml of 5% glucose solution under the control of blood pressure. A good effect in crises is given by diazoxide, which is administered intravenously at a dose of 150-300 ml.

For relief of hypertensive crisis Type II at the prehospital stage, ganglion-blocking drugs are widely used: pentamine (1 ml of a 5% solution) or benzohexonium (1 ml of a 2.5% solution), which are injected into 20 ml of isotonic sodium chloride solution intravenously slowly under the control of blood pressure. If the crisis was complicated by acute coronary insufficiency, then along with antihypertensive therapy, it is necessary to stop the pain attack, which is achieved by prescribing nitroglycerin - 2 ml of a 1% alcohol solution intravenously capillo or droperiadol (0.1 mg / kg of body weight) in combination with fentanyl (1- 2 ml of 0.005% solution intravenously).

At the same time, diuretic drugs are prescribed, of which furosemide is the most effective (60-80 mg intravenously in a stream). The latter is especially indicated for sodium and fluid retention in the body, as well as for hypertensive crisis, complicated by left ventricular failure (pulmonary edema) or hypertensive encephalopathy with signs of hypervolemia and cerebral edema. In the latter case, magnesium sulfate is indicated (10 ml of 25% solution) intramuscularly or intravenously slowly.

^ At the prehospital stage of treatment of hypertensive crisis currently widely used calcium antagonists of the nifedipine group, which reduce diastolic blood pressure more effectively than drugs of the verapamil group. Both the tablet form of nifedipine (10-20 mg, or 1-2 tablets under the tongue 2-3 times with an interval of 10-15 minutes) and its liquid form (nifedipine in drops, 5-10 drops per dose) are used. ). For the treatment of a hypertensive crisis, capoten is prescribed (25-50 mg sublingually).

4 Emergency help. An attack of angina pectoris should be stopped as early as possible from the onset of its occurrence. It is unacceptable to leave the patient at the site of the disease with incompletely relieved pain. Treatment should begin with the intake of nitroglycerin (tablets of 0.0005 g or 2 drops of a 1% alcohol solution). The effect of the drug occurs in 1-3 minutes. Side effects in the form of headache, noise, slight dizziness are not contraindications to the further appointment of nitroglycerin. It is necessary to patiently explain to the patient the mechanism of these transient phenomena (dilatation of cerebral vessels). More serious complications in the treatment of nitroglycerin can be hypotension and even collapse. These phenomena are the result of a decrease in blood flow to the heart as a result of its redistribution in delated peripheral vessels and are often observed in patients with severe coronary atherosclerosis and reduced compensatory capabilities of the cardiovascular system. In each case of such a complication, one should think about the possible development of myocardial infarction. The decrease in blood pressure caused by nitroglycerin in most cases is short-lived (10-20 minutes) and is easily overcome when the patient is transferred to a horizontal position or to a position with the head end of the bed lowered. If after 5-10 minutes there is no rise in blood pressure, one should proceed to a rapid intravenous drip of polyglucin (50-60 drops per minute), as well as a fractional injection of the sympathomimetic drug mezaton (0.2-0.3 ml of 1% solution).

If nitroglycerin does not cause complications, then with the resumption of pain, it is possible to re-use the drug as many times as necessary, since nitroglycerin does not accumulate in the body. In the absence of an effect (or its incomplete manifestation), they proceed to intravenous jet administration of painkillers. With intense pain, the introduction of a 50% solution of analgin (2 ml) is indicated in combination with 1 ml of a 1% solution of diphenhydramine and 2 ml of a 2% solution of papaverine or baralgin (5 ml of the solution contains 2.5 g of analgin, 0.01 g of a drug that acts like papaverine, and 0.0001 g of a ganglioblocking drug; injected slowly into 10 ml of 0.9% sodium chloride solution). With an intense pain syndrome, it is preferable to administer narcotic painkillers (1 ml of a 2% solution of promedol or a 2% solution of omnopon, or a 1% solution of morphine) in combination with antihistamines (preferably 1% diphenhydramine solution), which have antiemetic and sedative effects. For more effective pain relief in severe cases, neuroleptanalgesia is used with the introduction of a synthetic narcotic analgesic fentanyl (1-2 ml of a 0.005% solution) in combination with the neuroleptic droperidol (1-4 ml of a 0.25% solution). All drugs cause respiratory depression, especially in elderly and senile patients against the background of chronic cerebrovascular and chronic heart failure.

Effective relief of an angina attack in patients with hypertension or angina on the background of a hypertensive crisis, it is possible with a combination of antihypertensive, vasodilating and analgesic therapy. Sometimes only a decrease in pressure leads to the elimination of pain. When stopping angina pectoris, one should not forget about such aids as mustard plasters on the region of the heart or sternum.

Patients with a primary developed attack should be transferred to a specialized team for further examination, treatment and hospitalization in a cardiological hospital. With a completely stopped angina attack against the background of chronic coronary insufficiency, patients can be hospitalized in a hospital or transferred for further treatment to a local doctor (active call). All patients who have had an attack of angina pectoris are shown a dynamic electrocardiographic examination.

5 Relief of an attack of paroxysmal supraventricular tachycardia (PNT)

PNT is characterized by the stopping effect of vagal tests. The most effective is usually the Valsalva test (straining with holding the breath for 20-30 seconds), but deep breathing, the Dagnini-Ashner test (pressure on the eyeballs for 5 seconds), squatting, lowering the face into cold water for 10 seconds can also be useful. -30 sec, massage of one of the carotid sinuses, etc. The use of vagal tests is contraindicated in patients with conduction disorders, SSS, severe heart failure, glaucoma, as well as with severe dyscirculatory encephalopathy and a history of stroke. Massage of the carotid sinus is also contraindicated in case of a sharp decrease in pulsation and the presence of noise over the carotid artery.

In the absence of the effect of vagal tests and the presence of severe hemodynamic disorders, emergency relief of the paroxysm is indicated using transesophageal cardiac stimulation (CHPSS) or electrical impulse therapy (EIT). CPSS is also used in case of intolerance to antiarrhythmics, anamnestic data on the development of serious conduction disturbances during the exit from an attack (with SSSU and AV blockades). With multifocal atrial tachycardia, EIT and HRPS are not used; they are ineffective in ectopic atrial and ectopic AV nodal forms of PNT.

Although it is desirable to determine its specific form for the most effective relief of PNT, in real clinical practice, due to the need for urgent therapeutic measures and possible diagnostic difficulties, it is advisable to focus primarily on algorithms for the relief of tachycardia with narrow and wide QRS complexes - to provide emergency care to a patient with paroxysm of supraventricular tachycardia, in most cases it is not required to accurately determine its mechanism.

Suspicion of paroxysmal supraventricular tachycardia (PVT) should arise if the patient suddenly ("as if on a switch") has attacks of palpitations. To confirm the diagnosis, a physical examination and instrumental diagnostics are performed, the main method of which is electrocardiography (ECG).

Diagnostic methods

Collection of anamnesis

For a preliminary diagnosis of paroxysmal supraventricular tachycardia, in most cases, it is enough to take an anamnesis: the presence of a completely sudden (“as if by pressing a switch”) onset of an attack of a sharp heartbeat is an extremely characteristic sign. It is very important to find out from the patient whether the change in rhythm really occurs instantly. Many patients believe that their palpitations occur suddenly, but a more detailed questioning allows us to establish that in fact the increase in heart rate occurs gradually, over several minutes. This picture is typical for episodes of sinus tachycardia.

In differential diagnosis, if a patient has tachycardia with wide QRS complexes, it should be remembered that, other things being equal, patients tolerate supraventricular (atrial and atrioventricular) paroxysmal supraventricular tachycardia (PNT) more easily than ventricular tachycardia. In addition, the incidence of ventricular tachycardia increases significantly with age; in relation to supraventricular PNT, this pattern is absent. PNT is much more likely than ventricular tachycardia to have a pronounced vegetative color (sweating, feeling of internal trembling, nausea, frequent urination). The stopping effect of vagal tests is extremely characteristic.

Physical examination

Auscultation during an attack revealed frequent rhythmic heart sounds; A heart rate of 150 beats/min and above excludes the diagnosis of sinus tachycardia, a heart rate of more than 200 makes ventricular tachycardia unlikely. One should be aware of the possibility of atrial flutter with a conduction ratio of 2:1, in which vagal tests can lead to a short-term deterioration in conduction (up to 3:1, 4:1) with a corresponding abrupt decrease in heart rate. If the duration of systole and diastole become approximately equal, the second tone becomes indistinguishable from the first in volume and timbre (the so-called pendulum rhythm, or embryocardia). Most paroxysmal supraventricular tachycardias (PNT) are characterized by rhythm rigidity (its frequency is not affected by intensive breathing, physical activity, etc.).

However, auscultation does not allow to find out the source of tachycardia, and sometimes to distinguish sinus tachycardia from paroxysmal.

Occasionally, for example, with a combination of paroxysmal supraventricular tachycardia (PNT) and atrioventricular blockade of the II degree with Samoilov-Wenckebach periods or with chaotic (multifocal) atrial tachycardia, the regularity of the rhythm is disturbed; at the same time, a differential diagnosis with atrial fibrillation is possible only by ECG.

Blood pressure usually goes down. Sometimes an attack is accompanied by acute left ventricular failure (cardiac asthma, pulmonary edema).

Instrumental diagnostics

Holter monitoring

Stress ECG tests

Transesophageal cardiac pacing (TEPS)

Intracardiac electrophysiological study (EPS)

10 Sometimes the differential diagnosis of NCD with thyrotoxicosis causes difficulties. Common signs are: palpitations, subfebrile temperature, pain in the region of the heart, increased blood pressure. In patients with thyrotoxicosis, there is a constant tachycardia, even during sleep, in contrast to NDC, in which it is unstable. Thyrotoxicosis is also characterized by weight loss against the background of preserved and increased appetite and an increase in pulse pressure due to an increase in systolic and a decrease in diastolic pressure. With NCD, these symptoms are not expressed. Patients with thyrotoxicosis may periodically experience attacks of atrial fibrillation, which does not happen with NCD. In the advanced stage of the disease, eye symptoms are often detected: exophthalmos, symptoms of Graefe, Mobius. Of decisive importance are the determination of the content of thyroxine, 3-iodine-thyronine and thyroid-stimulating hormones in the blood and a radionuclide study of the thyroid gland (in thyrotoxicosis, the increase in the accumulation of radioactive iodine in it exceeds 25% in 2 hours, and 50% in 24 hours).

Subfebrile temperature, tachycardia, rhythm disturbances, pain in the heart area and systolic murmur, characteristic of patients with NCD, often cause an erroneous diagnosis of primary or recurrent rheumatic heart disease. The latter, however, is distinguished by the onset of the disease 2 weeks after a streptococcal infection, joint damage in the form of polyarthralgia or polyarthritis, and signs of endomyocarditis in clinical, radiological and echocardiographic studies. Of great importance are the data of a laboratory study, in which leukocytosis is determined with a shift of the leukocyte formula to the left, an increase in ESR, the content of C-reactive protein, seromucoid, fibrinogen, and dysproteinemia.

29 In the differential diagnosis of NCD and IHD as the cause of changes in repolarization on the ECG, S. A. Abbakumov et al. accuracy up to 100%. Highly informative methods for diagnosing myocardial ischemia are ECG Holter monitoring and myocardial scintigraphy, especially when conducting a dipyridamole test. In diagnostically difficult cases, coronary angiography is necessary.

For myocarditis, unlike NCD, signs of myocardial damage are characteristic - an increase in the size of the heart, a violation of the systolic and diastolic functions of the left ventricle, which are often accompanied by clinical signs of heart failure. ECG changes in myocarditis are more diverse. These include a decrease in voltage, various arrhythmias and conduction disturbances, and persistent changes in the phase of repolarization. The negative result of pharmacological, orthostatic and hyperventilation tests is typical.

With NCD of the hypertensive type, when the leading symptom in the clinic is an increase in blood pressure, there is a need for differential diagnosis with stage I hypertension. At the same time, aggravated heredity in hypertension and a more persistent nature of the increase in blood pressure, as evidenced by the results of its systematic measurement every 2-3 hours for 3-4 days, testify in favor of hypertension. Segmental narrowing of the arterioles of the fundus can be determined. The response of blood pressure to exercise is important. In hypertension, a reaction of the hypertonic type is noted, i.e., systolic and diastolic pressure increases simultaneously (normally, diastolic pressure decreases). 5 minutes after exercise, blood pressure does not normalize and does not return to the initial level (Fig. 48). With NCD of the hypertensive type, along with an increase in systolic blood pressure, there is a more pronounced decrease in diastolic pressure than in healthy individuals (Fig. 49).

41 Neurocirculatory dystonia in the literature it is sometimes referred to by the terms "cardiac neurosis", "neurocirculatory asthenia", "excitable heart". It is customary to distinguish between two types of functional disorders of the cardiovascular system: vegetative-vascular and neurocirculatory dystonia. Vegetative-vascular dystonia combines various manifestations of autonomic dysfunction that accompany organic lesions of the nervous, endocrine and other systems. Neurocirculatory dystonia is an independent nosological form with its own etiology, pathogenesis, symptoms and prognosis and differs in a number of features from autonomic dysfunction. Distinctive features of neurocirculatory dystonia are the predominance of cardiovascular symptoms among the clinical manifestations, the primary functional nature of autonomic regulation disorders and the lack of connection with organic pathology, including neurosis.

Neurologists, cardiologists, general practitioners quite often have to deal with neurocirculatory dystonia. Among patients with a cardiological and therapeutic profile, NCD occurs in 30-50% of individuals. Neurocirculatory dysfunction can develop at different ages, but is more common in young people, mostly women, who suffer from it 2-3 times more often than men. The disease rarely develops in people younger than 15 and older than 40-45 years.