krisis hipertensi pppt
TRANSCRIPT
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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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EMERGENCY HYPERTENSION CRISIS
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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EMERGENCY HYPERTENSION CRISIS
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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EMERGENCY HYPERTENSION CRISIS
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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URGENCY HYPERTENSION CRISIS
BP harus segera diturunkan dlmBEBERAPA JAMBEBERAPA HARI
Tidak disertai kerusakan organ target
Severe headache
Severe anxiety
Shortness of breath
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URGENCY HYPERTENSION CRISIS
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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RECOMMENDED ANTIHYPERTENSIVE AGENTS FOR
HYPERTENSIVE CRISES
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RECOMMENDED ANTIHYPERTENSIVE AGENTS FOR
HYPERTENSIVE CRISES