Page 34/59 · Cardiovascular Critical Care II

Data Tables

Cardiovascular Critical Care II

Patrick M. Wieruszewski ~3 min read Module 12 of 20

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Cardiovascular Critical Care II

Patient Case

K.G., a 71-year-old woman with a history of atrial fibrillation, coronary artery disease status post three-vessel

coronary bypass artery grafting 6 years ago, diabetes, and osteoarthritis, is being admitted to your MICU for

temperature control after PEA arrest and subsequent ROSC. K.G., who remained comatose after the ROSC,

was intubated and is now hemodynamically stable (BP 94/72 mm Hg and HR 86 beats/minute). Which is the

most accurate statement regarding temperature control?

A.Hypoglycemia is a common complication of hypothermia and may require continuous dextrose infusions.

B.Dose modifications or avoidance of cytochrome P450 (CYP)–metabolized medications should occur

during hypothermia.

C.The optimal duration of temperature control should be at least 72 hours to affect survival.

D.Temperature targets should be 28°C–30°C to improve the neurologic recovery.

II.HYPERTENSIVE CRISIS

A.Definitions have been recently revised to capture the importance of blood pressure-related organ damage

(Bress 2024; Johnson 2012; Marik 2007; Aggarwal 2006):

Asymptomatic, markedly elevated blood pressure: A systolic blood pressure (SBP) greater than 180 mm

Hg and/or a diastolic blood pressure (DBP) greater than 110–120 mm Hg without evidence of new or

worsening target organ damage

2Hypertensive emergency: An SBP greater than 180 mm Hg and/or DBP greater than 110–120 mm Hg

with new or worsening target organ dysfunction (e.g., acute kidney injury, heart failure exacerbation,

obtundation). Table 7 lists example conditions that, when accompanied by high BP, define hypertensive

emergency

Importantly, target organ damage may still occur below SBP and DBP thresholds used in definitions.

MAP: Average pressure in the arteries (mm Hg) experienced during one cardiac cycle. Calculated by

MAP = 1/3 SBP + 2/3 DBP.

Table 7. Examples of Acute Target Organ Damage and Clinical Presentations

Eclampsia, preeclampsia

Hypertensive encephalopathy

Acute kidney injury

Acute shortness of breath, flash pulmonary edema, or acute left

ventricular dysfunction

Acute aortic dissection (type A or B)

Acute intracranial bleeding (nontraumatic)

Seizures

Acute myocardial ischemia/infarction

Retinopathy

Cerebral infarction

B.Estimated that 1-3% of patients with hypertension will experience a hypertensive crisis (Acta Med Scand

Suppl 1981;650:1-62; Am J Cardiol 2011;108:1277-82),

C.10-year survival approaches 70% (Q J Med 1993;96:485-93), with 1-year survival greater than 90%.

D.Common Causes (Cardiol Clin 2012;30:533-43; Cardiol Clin 2006;24:135-46):

Intoxications – Cocaine, amphetamines, phencyclidine hydrochloride, stimulant diet pills

2Nonadherence to antihypertensive regimen

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