Luerding, MD Presentation R. Other medical problems include obesity and hypothyroidism. He has a history of heavy alcohol use but quit drinking alcohol 2 years ago.
Vascular changes in the fundus reflect hypertensive retinopathy and arteriosclerotic retinopathy Renal involvement: Stroke or transient ischemic attack TIA Complications of hypertension to vascular disease probably involve three interrelated processes: These three interrelated processes are probably responsible for the arteriolar and arterial sclerosis that is the usual consequence of longstanding hypertension.
Large vessels such as the aorta may be directly affected and be at risk for aneurysms and dissection. Braunwald E, Heart disease6th ed.
Are hypertensive patients at an increased risk for perioperative cardiac morbidity? Hypertensive patients are at increased risk for Hypertension clinical case studies artery disease, silent myocardial ischemia, CHF, and stroke.
However, whether preoperative hypertension is predictive of perioperative major cardiac morbidity remains controversial. Some investigators have shown that patients with untreated, poorly controlled, or labile preoperative hypertension are at increased risk for perioperative BP lability, dysrhythmias, myocardial ischemia, and transient neurologic complications.
Some suggested that preoperative hypertension predicted perioperative myocardial infarction. However, Goldman and Caldera demonstrated that mild-to-moderate hypertension did not increase the risk of major morbid events.
Instead, preoperative hypertension may predict several intermediates of outcome, such as BP lability and myocardial ischemia. The controversy may be due to the wide variability in the hypertensive population. Hypertension may affect perioperative morbidity through the extent of end-organ damage and not the manifestation of the disease itself.
LVH, which signifies longstanding poorly controlled hypertension, can increase the risk of myocardial ischemia from imbalances of myocardial oxygen supply and demand regardless of the presence or absence of coronary artery disease. Isolated systolic hypertension systolic BP greater than mm Hg and diastolic BP less than 90 mm Hg has been identified as a risk factor for cardiovascular complications in the general population and treatment reduces the future risk of stroke.
Howell SJ, et al. Resistant hypertension and preoperative silent myocardial ischaemia in surgical patients. Br J Anaesth Preoperative evaluation of the patient with hypertension. Anaesthesia and the hypertensive patient. Cardiac risk in noncardiac surgery: Risks of general anesthesia and elective operation in the hypertensive patient.
Browner WS, et al. Predictors of postoperative myocardial ischemia in patient undergoing noncardiac surgery. Are hypertensive patients at increased risk for perioperative cerebral and renal complications? Hypertensive patients are at increased risk for perioperative cerebrovascular accidents CVAs and acute renal failure.
Most anesthetic agents produce a dose-related depression of myocardial contractility with a fall in cardiac output and a decreased blood flow to brain and kidneys. Because autoregulation may be impaired in these patients, there is a greater susceptibility of the brain and kidney to sudden changes in pressure.Diabetic nephropathy is a clinical syndrome characterized by albuminuria, hypertension, and progressive renal insufficiency.
Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) in Western countries, accounting for ~35% of all new ESRD cases in the United States. The management of postoperative hypertension depends on the etiology of the hypertension, the clinical scenario, and the level of hypertension.
First, the cause of hypertension should be determined and treated accordingly. Randomized clinical trials are the backbone of evi-dence-based medicine. Large epidemiologic studies (Framingham, National Health and Nutrition Examina-tion Survey [NHANES]) and many clinical trials have Case Studies in .
Case Studies in Managgging Hypertension: Defining the Barriers to Control David Feldman, MD, PhD, FACC, FAHA *Hypothetical case based on a typical patient expected to present in clinical practice.
6 Three reviews of 50 observational studies found the risk of CV disease was lowered in those who were physically active.
is a year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia.
L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between and lb. Initial treatment . Clinical case scenarios: Hypertension () 4 Introduction Clinical case scenarios are an educational resource that can be used for individual or group learning.