CASE REPORT

CRISIS HYPERTENSION

ARRANGED BY:

Salman Saisar Hidayat 2011730095

PRESEPTOR :

dr Ihsanil Husna, Sp.PD

STASE ILMU PENYAKIT DALAM RSIJ CEMPAKA PUTIH

PROGRAM STUDI KEDOKTERAN

FAKULTAS KEDOKTERAN DAN KESEHATAN

UNIVERSITAS MUHAMMADIYAH JAKARTA

2016

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 KATA PENGANTAR

AssalamualaikumWr. Wb.

Alhamdulillah, Puji syukur penyusun panjatkan kehadiran ALLAH SWT atas

terselesaikannya tugas Laporan Kasus Crisis Hypertension.

Makalah refreshing ini disusun dalam rangka untuk dapat lebih mendalami dan
memahami mengenai Crisis Hypertension . Tujuan khususnya adalah sebagai pemenuhan
tugas kepaniteraan Stase Ilmu Penyakit Dalam.

Semoga dengan adanya laporan kasus ini dapat menambah khasanah ilmu pengetahuan
dan berguna bagi penyusun maupun peserta didik lainnya.

Penyusun menyadari bahwa laporan kasus ini masih jauh dari kesempurnaan, oleh karena
itu penyusun sangat membutuhkan saran dan kritik untuk membangun laporan kasus yang lebih
baik di masa yang akan datang.

Terimakasih.

WassalamualaikumWr. Wb

Jakarta, April 2016

Penulis

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 BAB I

PATIENT STATUS

A. Patients identity

Name : Mrs. K

Age : 54th years old

Education : Senior High school

Marital status : Married

Occupation : Seller

Religion : Moslem

Date of admission : April 2016

MR number : 00937917

B. Anamnesis

1. Chief complaint :

Patient complained of headeche since 3 days ago.

Another complaint :

Patient felt weak.

2. History of present illness

Patient Patient came with complaint of her headeche since 3 days ago, and also felt

weak if she wanted to do the activity. She felt heavy in the back of neck. She denied any

heratbeat fast. She denied of decrease appetite. Patient admitted to have hypertension

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 disease but she never controlled about her disease. 2 weeks ago, patient has been

hospitalized because of hypertension and diabetes melitus. Her tension was 200 mmhg

at that time and didnt know about the sugar value. Sometimes she felt itchy and her

look was hazy. Before she hospitalized, she admitted lots of urine and many drink. She

denied eat a lot. She knew about her ddiabetes melitus disease but she never controlled

her disease

3. History of past illness

History of Hypertension

History of DM

No history of kidney disease

No history of asthma

No history of allergic

4. History of family

Her father has same problem in hypertension

No history of DM

No history of allergic

No history of kidney disease

5. History of allergy

Patient has no allergy to food, drugs and weather.

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6. History of treatment

Patient had drinked the hypertension drugs.

7. Habits

Smoking habits : Denied

Drinking alcohol : Denied

Doing exercise : Denied

C. Physical Examination

- Generalis status : Mild ill

- Conciusness: composmentis

Vital sign

- blood pressure: 110/70 mmHg

- Heart rate: 88x/minute

- Respiratory rate: 18x/minute

- Temperature : 36.9 C

D. General physical examination

Head : normocephal, deformity (-)

Eyes : anemic conjungtiva (-/-), icteric sclera (-/-), arcus senilis (+/+)

Mouth : the oral mucosa moist

Neck : not palpable mass, suprasternal retracion (-)

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Thorax

Inspection : the movement of the chest symmetrical, intercosta retraction (-)

Palpation : same vocal fremitus in dextra and sinistra

Percussion : sonor

Auscultacion : vesicular breath sounds + / +, ronkhi - / -, wheezing - / -

Heart

Inspection : ictus cordis not seen

Palpation : ictus cordis not palpable

Auscultation : Regular 1st & 2nd heart sounds, murmur (-), gallop (-)

Abdomen

Inspection: looked flat

Auscultation: bowel sounds (+)

Palpation: touching pain epigastrik (-) epigastrik retraction (-)

Percussion: timphani (+)

Extremities

Superior: Edema (- / -), warm akral(+ / +), RCT <2 seconds (+ / +)

Inferior: Edema (- / -), warm akral (+ / +), RCT <2 seconds (+ / +)

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 Resume :

Ms. K, 54th years old came to hospital with complained of her headeche since 3 days ago.

She also complained the body was felt weak. She felt heavy in the back of neck. She

admitted to have hypertension disease and diabetes melitus desease but she didnt

controll her desease. 2 weeks ago, her tension was 200 when she came to this hospital.

She felt itchy and her sight was blurry. History of past illness: hypertension and DM

History of treatment: she had consumed the hypertension drugs and DM drugs. She also

complains lots of urine and she drinks too much. Physical Examination: TD: 110/70 mmHg

Problem List:

Crisis hypertension

Diabetes mellitus

Assesment

1. Crisis hypertension

S: Ms. K, 54th years old came to hospital with complained of her headeche since 3

days ago. She also complained the body was felt weak. She felt heavy in the back

of neck. She admitted to have hypertension disease. She didnt controll her

desease. 2 weeks ago, her tension was 200. History of past illness hypertension.

History of treatment hypertension drugs.

O: TD: 110/70 mmHg

A: Crisis hypertension

P: Controlled blood pressure

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2. Diabetes mellitus

S: She felt itchy and her sight was blurry. History of past illness DM. She also

complains lots of urine and she drinks too much.

O: -

A: diabetes mellitus

P: controlled blood glucose

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 BAB II

LITERATURE REVIEW

A. Crisis hypertension

World Health Organization defines aortic hypertension as the level of systolic blood

pressure of 140 mmHg or higher and/or diastolic blood pressure of 90 mmHg or higher in

persons who do not take antihypertensive therapy. Hypertensive crises are defined as

levels of systolic blood pressure >180 mmHg and/ or levels of diastolic blood pressure

>120 mmHg and are mainly found in patients with essential artery hypertension. Crisis

hypertensive can be divided in two classification. Hypertensive urgency is a situation

with a severe increase in blood pressure without progressive dysfunction of target organs.

Hypertensive emergencies are life threatening states because their outcome is

complicated by acute damages of target organs. Primary aim of hypertensive crisis

management is to safely reduce blood pressure and stop damage of vital organs, and the

therapy can be parenteral, peroral and sublingual. Target blood pressure for 3-6 hours is

160/110 mmHg for hypertensive emergency, while diastolic pressure should be 100-105

mmHg for hypertensive urgency. Middle artery pressure should not be reduced by more

than 25% within the rst 24 hours.

B. Epidemiology

Hypertensive crises are present in less than 1% of adult population in the US. In an Italian

multicenter study of 1,546 patients with hypertensive crises, 13 % of men and 9 % of

women reported not taking antihypertensive drugs. Hypertensive emergencies

represented 25 % of crises. Approximately 25 % of adults with chronic hypertension were

unaware of their disease.

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 .

C. Etiology

Undiagnosed or untreated hypertension is the most important risk factor to be crises

hypertension. Genetic factor, lifestyle, diet, acute physical stress, chronic physiological

stress can be the causes of hypertension. So the primary treatment is to change the risk

factor that can make hypertension.

D. Patophysiology

Pathophysiology of hypertensive crises is still unclear. From the aspect of

pathophysiology, the disorder of systemic blood ow auto regulation on the level of

arterioles is considered to be a cause for both forms of hypertensive crisis. The sudden

increase in BP is mainly related to sympathetic activation and/or release of

vasoconstrictors occurring in various circumstances. The increase in intravascular

pressure triggers several vascular disturbances. Endothelial damage with activation of

adhesion molecules and the clotting cascade, fibrinoid necrosis of small vessels and

release of more vasoconstrictors form a vicious cycle leading to organ ischemia. These

changes are then responsible for hypertensive encephalopathy, acute kidney injury and

HELLP (hemo lysis, elevated liver enzymes, low platelet) syndrome. Markers of

thrombogenesis, fibrinolysis and inflammation are elevated during hypertensive

emergencies but not during urgencies.

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E. Supporting examinations

The supporting examinations in the hypertension patient is: the hematologic routine,

blood glucose, total cholesterol serum, uric acid serum, creatinin serum, kalium serum,

hemoglobin and hematocrit, urinalisis, electrocardiogram.

The other test is echocardiogram, USG carotis, C-reactive protein.

Examination in the damage organ target

1. Heart : physical examinations, chest radiography photo, electrocardiography,

echocardiography.

2. Vascular: pulse pressure, USG karotis, endotel function.

3. Brain: physical neurology examinations, CT scan, MRI.

4. Eyes: funduskopy.

5. Renal: examination of renal function, GFR,

F. Treatment

a. Nonpharmacologic

Lifestyle modification may have an impact on morbidity and mortality. A diet rich

in fruits, vegetables, and low-fat dairy foods and low in saturated and total fats

(DASH diet) has been shown to lower blood pressure. Additional measures, can

prevent or mitigate hyper- tension or its cardiovascular consequences. All patients

with high-normal or elevated blood pres- sures, those who have a family history

of cardiovascular complications of hypertension, and those who have multiple

coronary risk factors should be counseled about non- pharmacologic approaches

to lowering blood pressure. Approaches of proved but modest value include

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weight reduction, reduced alcohol consumption, and, in some patients, reduced

salt intake (less than 5 g salt or 2 g sodium). Gradually increasing activity levels

should be encouraged in previously sedentary patients, but strenuous exercise

training programs in already active individuals may have less benefit. Alternative

approaches that may be modestly effective include relaxation techniques and bio-

feedback. Calcium and potassium supplements have been advocated, but their

ability to lower blood pressure is lim- ited. Smoking cessation will reduce

cardiovascular risk. Overall, the effects of lifestyle modification on blood pres-

sure are modest.

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3. Pharmacology

In hypertensive urgencies, BP should be lowered gradually over 2448 h, usually

with oral medication such as an angiotensin-converting enzyme inhibitors or

calcium channel blockers. Hypertensive emergencies, BP reduction must be

achieved within 3060 min. This requires the administration of potent intravenous

antihypertensive drugs.

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G. Complication

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 REFERENCES

o Monnet, Xavier, Paul E. Marik. 2015. Whats new with hypertensive crises?.

Intensive Care Med. 41:127130

o Salkic, Sabina, Olivera Batic-Mujanovic, Farid Ljuca, Selmira Brkic. 2014.

Clinical Presentation of Hypertensive Crises in Emergency Medical Services.

Mater Sociomed. 26(1): 12-16

o Salkic, Sabina, Selmira Brkic, Olivera Batic-Mujanovic, Farid Ljuca, Almedina

Karabasic, Sehveta Mustafic. 2015. Emergency Room Treatment of Hypertensive

Crises. Med Arh, 69(5); 302-306

o Current Medical Diagnosis & Treatment. Systemic Hypertension. Sutters,

Michael.MD. 2016. 435-467

o American Journal of Emergency Medcine. The Relationship between vascular

inflammation and target organ damage in hypertensive crises. Karaback, Mustafa

MD. 2015; 497-500

o Jose Roesma. Krisis Hipertensi. Sudoyo, Idrus Alwi editor. Buku Ajar Ilmu

Penyakit Dalam Jilid II Edisi VI. Pusat penerbitan departemen penyakit dalam

FKUI.2014

o Leichter, Steven B, Eff Johnson, Michael Ammerman, and Susan Egbert. 2013.

The Associations of Arcus senilis with Age and Metabolic Abnormalities. J

Diabetes Metab. ISSN: 2155-6156

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