Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 7. Cardiovascular Disease >|
Chapter 61. Systemic and Pulmonary Hypertension
Sections: Systemic Hypertension, Pulmonary Hypertension, Acknowledgments, References.
Topics Discussed: hypertension.
Excerpt:"The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7)
redefined chronic hypertension into three classifications: prehypertension, stage
1 hypertension, and stage 2 hypertension1 (Table 61-1).The obvious differential decision point is distinguishing the
relatively uncommon patient with aortic dissection from patients
with the more common presentations of acute coronary syndrome. Although
recommendations for blood pressure control are different for the
two disorders, a precise early diagnosis is more crucial, because
anticoagulation may be indicated for the patient with acute coronary
syndrome, but is contraindicated in those with aortic dissection. Acute
aortic dissection presents with abrupt, severe onset of pain (90% of
cases), usually in the chest (78% of cases), typically
described as tearing or ripping, and radiating to the interscapular region19 (see Chapter 62, Aortic Dissection and Related Aortic Syndromes). Only 31% have pulse deficits (based on
blood pressure differentials), 28% have a diastolic murmur,
and 17% have neurologic deficits. Chest radiograph is abnormal
in 90%, but radiographic signs..."
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