Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. Systolic and diastolic blood pressures are usually greater than 200 and 140, respectively. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... This article does not cite any references or sources. ... A sphygmomanometer, a device used for measuring blood pressure. ... A human eye Eyes are organs of vision that detect light. ... In animals, the brain or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for behaviour. ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Papilledema is optic disc swelling that is caused by increased intracranial pressure. ... Systolic is the adjective form of systole, typically referring to the contraction activity of the heart. ... Diastolic is the adjective form of diastole referring to relaxation of the heart, between muscle contractions. ... A sphygmomanometer, a device used for measuring blood pressure. ...

History

The most common presentations of hypertensive emergencies at an emergency department are chest pain (27%), dyspnea (22%), and neurologic deficit (21%). The primary cardiac symptoms are angina, myocardial infarction, and pulmonary edema. Orthostatic symptoms may be prominent. Neurologic presentations are occipital headache, cerebral infarction or hemorrhage, visual disturbance, or hypertensive encephalopathy (a symptom complex of severe hypertension, headache, vomiting, visual disturbance, mental status changes, seizure, and retinopathy with papilledema). Medications or drugs that may cause a hypertensive emergency include cocaine, monoamine oxidase inhibitors (MAOIs), and oral contraceptives; the withdrawal of beta-blockers, alpha-stimulants (such as clonidine), or alcohol, steroids also may cause hypertensive emergency. Renal disease may present as oliguria (renal failure) or any of the typical features of renal failure. Gastrointestinal symptoms are nausea and vomiting. Dyspnea (R06. ... angina tonsillaris see tonsillitis. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Pulmonary edema is swelling and/or fluid accumulation in the lungs. ... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Encephalopathy literally means disease of the brain. ... Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... Clonidine is a direct-acting adrenergic agonist prescribed historically as an anti-hypertensive agent. ... This article does not cite any references or sources. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Renal failure is the condition in which the kidneys fail to function properly. ...

Physical

Cardiovascular system

Blood pressure must be checked in both arms to screen for aortic dissection or coarctation. If coarctation is suspected, blood pressure also should be measured in the legs. Screen for carotid or renal bruits. Listen for a third or fourth heart sound or murmurs. Volume status should be assessed, with orthostatic vital signs, examination of jugular veins, assessment of liver size, and investigation for peripheral edema and pulmonary rales. Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. ...

Central nervous system

A complete neurologic examination is needed to screen for localizing signs. Focal neurologic signs might not be attributable to encephalopathy. Focal signs mandate screening for subarachnoid hemorrhage, infarct, or the presence of a mass. A funduscopic examination may reveal silver wiring (Grade I retinopathy), AV nipping (Grade II) flame-shaped retinal hemorrhages, soft exudates (Grade III), or papilledema (Grade IV).

Lab studies

Lab studies include a complete blood count and electrolytes, coagulation profile, and urinalysis, cardiac enzymes, urinary catecholamines, thyroid-stimulating hormone (TSH), and 24-hour urine collection for vanillylmandelic acid (VMA) and catecholamines. Schematics of shorthand for complete blood count commonly used by physicians. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ... Coagulation is a complex process by which blood forms solid clots. ... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ... Medical tests that are often referred to as cardiac enzymes include: GOT (Glutamic Oxaloacetic Transaminase, also called Serum Glutamic Oxaloacetic Transaminase (SGOT), Aspartate transaminase (AST), or aspartate aminotransferase (ASAT) LDH (Lactate dehydrogenase) troponin CK (creatine kinase, also known as phosphocreatine kinase or creatine phosphokinase), CK-MB Cardiac enzymes are released... Catecholamines are chemical compounds derived from the amino acid tyrosine that act as hormones or neurotransmitters. ... Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland. ... Vanillyl mandelic acid (VMA) is a chemical end product of catecholamine metabolism. ...

Renal function should be evaluated through a urinalysis, complete chemistry profile, and complete blood count. Expected findings include elevated BUN and creatinine, hyperphosphatemia, hyperkalemia or hypokalemia, glucose abnormalities, acidosis, hypernatremia, and evidence of microangiopathic hemolytic anemia. Urinalysis may reveal proteinuria, microscopic hematuria, and RBC or hyaline casts. In patients with hyperaldosteronism (a secondary cause of hypertension), aldosterone promotes renal potassium wasting, resulting in low serum potassium. A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ... Schematics of shorthand for complete blood count commonly used by physicians. ... A Swedish-style saffron bun traditionally consumed en masse with Christmas at hand. ... This article needs additional references or sources for verification. ... Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. ... Hyperkalemia is an elevated blood level (above 5. ... Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. ... Acidosis is an increased acidity (i. ... Hypernatremia is an electrolyte disturbance consisting of an elevated sodium level in the blood (compare to hyponatremia, meaning a low sodium level). ... In medicine (hematology) microangiopathic hemolytic anemia (MAHA) is a subgroup of hemolytic anemia (anemia, loss of red blood cells through destruction) caused by factors in the small blood vessels. ... Proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine. ... In medicine, hematuria (or haematuria) is the presence of blood in the urine. ... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ...

The chest radiograph is useful for assessment of cardiac enlargement, pulmonary edema, or involvement of other thoracic structures, such as rib notching with aortic coarctation or a widened mediastinum with aortic dissection. Other tests, such as head CT scan, transesophageal echocardiogram, and renal angiography, are indicated only as directed by the initial workup. The ECG is necessary to screen for ischemia, infarct, or evidence of electrolyte abnormalities or drug overdose. Pulmonary edema is swelling and/or fluid accumulation in the lungs. ... FIG. 967– Transverse section through the upper margin of the second thoracic vertebra The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ...

Treatment

A commonly used drug is IV fenoldopam. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Hydralazine is reserved for use in pregnant patients, while phentolamine is the drug of choice for a pheochromocytoma crisis. iv sodium nitroprusside should never be used as it can cause a rapid uncontrollable drop in blood pressure. Fenoldopam is a synthetic compound that acts as a dopamine D1 receptor agonist. ... The examples and perspective in this article do not represent a worldwide view. ... Esmolol (tradename Brevibloc®) is a cardioselective beta-blocker given by slow injection into the veins. ... “Minax” redirects here. ... Hydralazine hydrochloride (1 -hydrazinophthalazine monohydrochloride; Apresoline®) is a medication used to treat high blood pressure. ... Phentolamine is a competitive nonselective alpha adrenergic receptor antagonist. ... A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). ...

Prognosis

Prior to effective therapy, life expectancy was less than 2 years, with most deaths resulting from stroke, renal failure, or heart failure. The survival rate at 1 year was less than 25% and at 5 years was less than 1%. With current therapy, including dialysis, the survival rate at 1 year is greater than 90% and at 5 years is 80%. The most common cause of death is cardiac, with stroke and renal failure also common. The single greatest prognostic factor in malignant hypertension is renal function, with renal insufficiency secondary to malignant nephrosclerosis being strongly associated with poorer outcomes. Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ... The heart and lungs, from an older edition of Grays Anatomy. ...

References

1. ^ http://medaphase.net/Newsletter/ViewArticle.asp?ArticleID=20

See also

• Hypertensive emergency
• Hypertension
• Hypertensive retinopathy