ILLNESS of HUMAN
That we know about illnesses
Saturday, 25 Oct 2014
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HYPERTONIC CRISIS

Hypertonic crisis - the clinical syndrome, described sharp rising of arterial pressure (in relation to habitual for the patient to digits; diastolic pressure, as a rule, exceeds 120 mm hg) And an exacerbation of the signs inherent in an arterial hypertensia. Numerous clinical observations speak that quite often crisises develop immediately after a mental trauma. Besides the essential role is played with a condition of endocrine system. So, at women crisises meet much more often, than at men. Especially often they arise during the premenstrual period, and also during a climacterium. At men the hypertonic crisis is quite often provoked by reception of alcohol. The excessive use of table salt also can lead to occurrence of a hypertonic crisis. The big influence of factors of weather on state of health sick of an essential arterial hypertensia is known - crisises arise in the spring and in the autumn in days with sharp fluctuations of atmospheric pressure is more often. Quite often hypertonic crisis is provoked by a sharp cancelling of antihypertensives (especially Clophelinum).

Signs, current. In a clinical picture of a crisis on the foreground the signs bound to rising of arterial pressure act. It is necessary to consider, that absolute sizes both maximal, and the minimal pressure do not play a main role. Sick of an arterial hypertensia can "get used" to very high level of the pressure (200/110-120 mm hg and more), to feel at it well (feeling, for example, only constant gravity in head) and to keep working capacity. Certainly, in such cases about a condition of a crisis to speak it is not necessary. Speed of increase of pressure (minute or hours, but not day) is important first of all. The hypertonic crisis usually arises more or less suddenly (in some cases harbingers in the form of depression, sleeplessnesses are observed, intensifyings of headaches). Raises, as a rule, both the maximal and minimal pressure, but in a different degree, therefore pressure of pulse can be enlarged and decrease. The most constant sign of an arterial hypertensia - a strong headache. It can be paroxysmal and constant, blunt and pulsing, can be localized in the field of a nape, a forehead and is caused more often by frustration of blood supply of a brain. At hypertonic crisises the headache sharply amplifies or appears, if it before was not. Its intensity is those, that for the patient any hum is excruciating, it is difficult to it to talk, turn a head. The last can be caused and a giddiness. The giddiness, loss of equilibrium, sensation, that « all floats around », - frequent complaints of patients during a crisis. Quite often headache and a giddiness are combined with a sonitus. The nausea and a vomiting concern to cerebral signs of a crisis. Their combination to a headache at a serious general condition of the patient can testify to rising intracranial pressure and an edematization of a brain. Deterioration of vision quite often accompanies with development of a crisis and is consequence of changes of an eyeground (a vasospasm of a retina, an edema of disks of optic nerves). The degree of visual disturbances can be various: from a grid of dark or light moving points before eyes up to a short-term loss of sight. Unpleasant sensations concern to frequent complaints of patients during a hypertonic crisis in the field of heart: a pain, palpitation, faults, a dyspnea. The pain can be strong, pricking (as a cardialgia), but quite often has character of a typical intensive compressing retrosternal pain, gives to the left arm, a scapula, decreases after reception of Nitroglycerinum and testify to occurrence of an attack of a stenocardia. There are displays of vascular disturbances in other organs - abdominal pains (« an abdominal toad »), an alternating lameness less often. Immediate research of the patient allows to tap series of characteristic signs for a crisis. On the foreground attributes of the broken activity of the central and vegetative nervous system act. Patients are raised, irritable, a skin wet. Quite often on the face, a neck, breasts appear red maculae; arise a cold fit, a muscular shiver, the temperature raises up to subfebrile digits. In other cases, on the contrary, obviously sharp oppression of nervous system: a flaccidity, a sleepiness. Muscular twitchings and even cramps between which attacks of the patient is in a coma can be observed. Alalias, (in easier cases sensation of crawling of small insects, a pricking in arms and legs) in extremities speak unilateral delicacy and abaissement of painful sensitivity about transient focal disturbances in the central nervous system. Obligatory display of hemodynamic disturbances at a crisis is only rising of arterial pressure. In the rest the picture of a cardiovascular pathology is diverse. Pulse is quite often accelerated, however the heart consciousness can and not be accompanied by a tachycardia. The bradycardia is sometimes observed.

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