Krisis Hipertensi pppt

7/26/2019 Krisis Hipertensi pppt

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Diana Ch. Lalenoh

Bagian Anestesi & Reanimmasi

FK UNSRAT / RSUP Prof R.D. Kandou

Manado

KRISIS HIPERTENSI


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TIU : Mahasiswa mampu mengenali,mendiagnosisdan mengelola keadaan krisis hipertensi

TIK : 1. Mahasiswa dapat menjelaskan definisikrisis hipertensi2. Mahasiswa dapat membuat klasifikasi jenis-

jenis krisis hipertensi

3. Mahasiswa dapat mengenali gejala dantanda krisis hipertensi emergensi

4. Mahasiswa dapat mengenali gejala & tandakrisis hipertensi urgent

5. Mahasiswa dpt menjelaskan pemeriksaanpenunjang yg diperlukan pd krisis hipertensi

6. Mahasiswa dpt menyebutkan penanganankrisis hipertensi


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About half of all cases of hypertensive crisis

occur in patients with chronic hypertension

who are either noncompliant with their

medication regimen or inadequately treated.

For hypertension management, many

clinicians rely on guidelines published by the

National Institutes of Health.

INTRODUCTION


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Krisis hipertensi (hypertension crisis) :Keadaan klinis yang yg merupakan suatukegawatan medik ditandai oleh tekanan darahyang sangat tinggi (> 180/120 mmHg), dandapat menimbulkan atau telah terjadi

kelainan organ target, sehingga membutuhkanpengelolaan yang tepat & cepat untukmenyelamatkan jiwa penderita

DEFINISI


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KLASIFIKASI HIPERTENSI


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Those at risk for hypertensive crisis include:

Patients with primary hypertension

A condition in which the cause of high blood

pressure is unknown

Patients with secondary hypertension, high blood

pressure that accompanies conditions such as renal

disease, cardiovascular disease, sleep apnea, orpheochromocytoma.

Discontinuation antihypertensive medication (table)

PREDISPOSITON/ETIOLOGY


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Can also be triggered by :

Surgery

Excess dietary salt intake

Worsening of existing hypertension that goesundetected.

In patients with or without existing hypertension, ahypertensive crisis can be triggered by:

neurological conditions

Alcohol withdrawal The use of illegal drugs like cocaine, or taking over-the-

counter preparations that contain pseudoephedrine.

INTRODUCTION


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Cessation of Medications Drug-Induced Secondary Causes

Blockers (e.g.,clonidine)

Blockers,Calcium-channel blockers

Minoxidil

Cocaine, phencyclidine

Monoamine Oxidaseinhibitors

Oral contraceptives

Renovascular disease

(renal failure, vasculitis, Ig

A, nephropathy)

Pheochromocytoma

Conn syndrome

CAUSES OF HYPERTENSIVE CRISIS(Jain,M.,1999,Principles of Critical Care 2nded)


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Berdasarkan prioritas penanganan (The 5thReport of The JoinNational Comitte on Detection,Evaluation,and Treatment of High Blood Pressure

/ JNCV):

1. Hipertensi emergensi (darurat):Situasi dimanadiperlukan penurunan tekanan darah yang

segera & terkendali dengan obat antihipertensiparenteral karena adanya kerusakan organtarget akut atau progresif

2. Hipertensi urgensi (mendesak) : situasi dimanaterdapat peningkatan tekanan darah yangbermakna tanpa adanya gejala yang berat ataukerusakan organ target progresif dan tekanandarah perlu diturunkan dalam beberapa jam.

KLASIFIKASI KRISIS HIPERTENSI


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HIPERTENSI REFRAKTER : Respons terapi tidak

memuaskan, BP>200/110 mmHg walau telah

diberi pengobatan efektif (triple drug)

HIPERTENSI AKSELERASI: BP (Diastolik>120mmHg)+ kelainan funduskopi KW III.Bl tidak

diterapi dpt berlanjut ke fase maligna

KLASIFIKASI LAIN


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HIPERTENSI MALIGNA: Hipertensi akselerasi dgn

TD diastolik>120-130 mmHg,kelainan funduskopi

KW IV disertai papil edema, TIK ,kerusakan

vaskular segera,GGA (+)kematian

HIPERTENSI ENSEFALOPATI: BPtiba2+sakit

kepala>>,perubahan kesadaran(+)irreversibelbila tidak segera ditangani

KLASIFIKASI LAIN


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Acute severe hypertensionde novo or

complicate underlying essential /secondaryhypertension.

Factors leadingsevere&rapid elevation BP in

hypertensive crises

poorly understood. Rapidity onsetsuggesttriggering factor

superimposed on preexisting hypertension

PATHOPHYSIOLOGY


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Hypertensive crisesinitiated by abruptincrease in SVR (systemic

vasc.resist)humoral vasoconstrictors

BPmechanical stress & endothelialinjurypermeability ,activation coagulationcascade&platelets,&deposition of fibrin

Severe BP

endothelial injury& fibrinoidnecrosis of arterioles.

PATHOPHYSIOLOGY


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EMERGENCY HYPERTENSION CRISIS

A marked elevation in BP that will result inacute organ damage if left unchecked isconsidered a hypertensive emergency.

Such emergencies develop over hours or daysand require immediate BP reduction toprevent or limit organ damage.

Examples include hypertension-inducedintracerebral and subarachnoid hemorrhage,encephalopathy, or cerebral infarction.


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BP harus segera diturunkan dlm hitunganmenit-jam

Disertai kerusakan berat organ target :

Acute pulmonary oedema (acute left ventricle impair) Brain Swelling or bleeding

Aortic dissection (dissecting aortic aneurysm)

Heart attack (unstable angina pectoris) Stroke, encephalopathy

Eclampsia (if pregnant)


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Diastolik > 120-130 mmHg

Most frequent signs&symptoms: chest pain,dyspneu, & neurologic deficits

Keterlambatan penanganan sequelae ataukematian

Memerlukan terapi parenteral

Penderita perlu dirawat di ruangan ICU (IntensiveCare Unit)

Jarang dijumpai


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Should proceed expeditiously to prevent ongoing end-organ damage

Histories:hypertensive history,previous control,currentantihypertensive medications with dosing,recreationaldrugs (amphetamines,cocaine,phencyclidine)/MAOinhibitor.

Physical examination:identify evidence of end-organdamagepulses in all extremities, auscultating

lung(if pulmonary edema+)& the heart(murmur/gallops),&bruits (renal arteries)

Neurologic & funduscopic examination


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URGENCY HYPERTENSION CRISIS

A hypertensive urgency, on the other hand, developsover days or weeks.

Characterized by a marked elevation in BP, but there isno indication of impending organ damage.

Can cause such symptoms as severe headache, anxiety,or shortness of breath.

Examples include hypertension associated withcoronary artery disease, preoperative or postoperativehypertension and uncontrolled hypertension in thepatient with increased intracranial pressure.


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BP harus segera diturunkan dlmBEBERAPA JAMBEBERAPA HARI

Tidak disertai kerusakan organ target

Severe headache

Severe anxiety

Shortness of breath


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BP harus diturunkan dalam waktu 24-48 jam

/sampai batas yang aman

Terapi bisa langsung terapi oral


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Anamnesis : Riwayat hipertensi dan terapinya, kepatuhan

minum OAH, tekanan darah ratarata,riwayat pemakaian obatobat

simpatomemik dan steroid, kelainanhormonal, riwayat penykit kronik lain, gejalagejala serebral, jantung, dan gangguanpenglihatan

DIAGNOSIS


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Pemeriksaan fisik : Tekanan darah pada kedua ekstermitas,

perabaan denyut nadi perifer, bunyi jantung,bruit pada abdomen, adanya edema atau

tanda penumpukkan cairan, dan statusneurologis.

Pem. Penunjang:

Laboratoriumsesuai dengan penyakitdasar, penyakit penyerta, dan kerusakanorgan target, funduskopi, X-Ray,CTSc

DIAGNOSIS


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RECOMMENDED ANTIHYPERTENSIVE AGENTS FOR

HYPERTENSIVE CRISES


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HYPERTENSIVE EMERGENCY Altered autoregulation occursif end-organ

damage (+)Rapid & Excessive correction BPcan propagate further injury

Best Managed: Continuous infusion

short-acting, titratable antihypertensive agent Avoided: SL & IM (unpredictable

pharmacodynamics) Should be managed in ICUclose monitoring,

invasive intra-arterial BP monitoring (mostlabile BP),use variety rapid-acting IVagentsdepend end-organ damage manifest.

PENANGANAN


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HYPERTENSIVE EMERGENCYUnless has neurological complications, thegoals are as follows: Reduce the mean arterialpressure by no more than 25% in the first hour.

Then, if the patient is stable, reduce diastolic BPto 100 - 110 mm Hg over the next two to sixhours.

If this level of BP is well tolerated, furthergradual reductions toward a normal BP can beimplemented in the next 24 - 48 hours.

PENANGANAN


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HYPERTENSIVE EMERGENCYFor patients with neurologicalcomplicationsPrimary goal is to maintainadequate cerebral perfusion, control

hypertension, minimize cerebral edema, andprevent further damage.BP reduced only 10% at a time, and no morethan 20% - 30% from the initial level, over aperiod of several minutes to hours. Once that's

achieved, lowering BP to the patient's pre-crisislevel should take another day or more.

PENANGANAN


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HYPERTENSIVE URGENCY No evidence end-organ damagepresent

for evaluation of another complaint Elevated BPrepresent an acute recognition

of chronic hypertension The best approach management: utilizing

oral medicationslower BP gradually over24-48 h.

Reduced BP must be lowered in a slow&controlled fashionto prevent organhypoperfusion

PENANGANAN


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PENANGANAN


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PENANGANAN


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HYPERTENSIVE CRISES


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HYPERTENSIVE CRISES

Krisis Hipertensi pppt

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