Because blood pressure rises less rapidly with urgent hypertension than with emergency hypertension, the body adapts to the gradua
Emergency hypertension can result from several disorders, drugs, and procedures. Be alert for any of the following in your patient's history.Cardiovascular Disorders acute left ventricular failure acute myocardial infarction dissecting aortic aneurysm unstable angina pectoris worsening of chronic hypertension Neurologic Disorders cerebrovascular accident head trauma hypertensive encephalopathy intracranial hemorrhage spinal cord disease subarachnoid hemorrhage Renal Disorders acute glomerulonephritis renal parenchymatous disease renovascular hypertension Other Disorders eclampsia necrotizing vasculitis pheochromocytoma preeclampsia scleroderma crisis vasculitis Drugs amphetamines clonidine (withdrawal syndrome) cocaine lysergic acid diethylamide monoamine oxidase inhibitors taken with foods containing tyramine oral contraceptives phencyclidine sympathomimetic drugs Medical and Surgical Procedures carotid artery manipulation coronary artery bypass surgery Diagnostic Tests for CadA physician uses certain tests to assess the patient's risk of CAD, others to indicate whether he has CAD, and still others to determine if he has had an MI-a serious complication of CAD. Blood Tests A physician typically orders a serum lipid profile to assess the patient's risk of CAD. A total blood cholesterol level below 200 mg/dl indicates a relatively low risk of CAD. A level of 200 to 239 mg/dl indicates a moderate risk; one that exceeds 239 mg/dl indicates a serious risk of CAD. High-density lipoprotein (HDL) and LDL cholesterollevels may help predict the risk of CAD more accurately than total cholesterol levels. An elevated LDL cholesterol level indicates an increased risk of CAD, but a high HDL cholesterol level indicates a lower risk. A series of cardiac serum enzyme assays can confirm an MI. Total creatine kinase (CK) levels rise within 6 hours after the start of an Ml and peak in 12 to 24 hours after cardiac tissue death. When cardiac tissue dies, CK-MB isoenzymes, which are found only in myocardial cells, enter the bloodstream. Measuring their level can help determine the amount of myocardial damage. Cardiac troponin levels may be better indicators of myocardial damage than CK levels . The lactate dehydrogenase (LD) level also can indicate an MI. The blood's LD level rises 24 to 48 hours after an MI and peaks in 3 to 6 days. Two of the five isoenzymes that make up LD-LD1 and LD2-appear primarily in the heart. Normally, the LD2 level is higher than the LD1 level. But when a patient has had an MI, the LD1 level is higher. Other blood tests, such as aspartate aminotransferase and myoglobin protein levels, also may be used to detect an ML However, because these tests are not specific for MI, they aren't commonly used. With an MI, the level of serum aspartate aminotransferase, formerly called serum glutamic-oxaloacetic transaminase, rises. But because serum aspartate aminotransferase doesn't contain any heart-specific isoenzymes, the results aren't definitive. The myoglobin protein level is highly sensitive to myocardial injury, but an elevated level doesn't confirm an MI because trauma, inflammation, and ischemia also can increase the myoglobin protein level.
