CASE REPORT

Crisis Hypertension

Preseptor : dr Ihsanil Husna, Sp.PD

Arranged by : Salman Saisar Hidayat (2011730095)

Patients identity

Name

Age
: 54th years old
Education
: Senior High school
Marital status: Married
Occupation
: Seller
Religion
: Moslem
Date of admission : April 2016
MR number
: 00937917

: Mrs. K

Anamnesis

Chief complaint :
Patient complained of headeche since 3
days ago.

Another complaint :
Patient felt weakness

History of present illness

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 heartbeat fast. She
denied of decrease appetite. Patient admitted to have
hypertension disease but she had never controlled her disease.

2 weeks ago, patient has been hospitalized because of

hypertension and diabetes melitus. Her tension was 200 at that
time and she didnt know about the blood sugar Sometimes she
felt itchy and her sight was blurry

Before she hospitalized, she also complains lots of urine and

she drinks too much. She denied eat a lot. She knew about her
diabetes melitus disease but she had never controlled her
disease

History of past illness

History of Hypertension
History of DM
No history of kidney disease
No history of asthma
No history of allergic

History of family

Her father has same problem in

hypertension
No history of DM
No history of allergic
No history of asthma
No history of kidney disease

History of allergy

Patient has no allergy to food, drugs and

weather.

History of treatment

Patient had drinked the hypertension

drugs

Habits

Smoking habits
Drinking alcohol
Doing exercise

: Denied
: Denied
: Denied

Physical examination

General
is
status
Vital
signs

General condition: mild

ill
Conciusness:
composmentis

Blood pressure: 110/70 mmHg

Heart rate: 88x/minute
Respiratory rate: 18x/minute
Temperature : 36.9 C

General
physical
examinati
on
Thorax

Heart

Head : normocephal, deformity (-)

Eyes : anemic conjungtiva (-/-), icteric sclera (-/-) arcus
senilis (+/+)
Mouth : the oral mucosa moist
Neck : not palpable mass, suprasternal retracion (-)

Inspection : the movement of the chest symmetrical,

intercosta retraction (-)
Palpation : same vocal fremitus in dextra and sinistra
Percussion : sonor
Auscultation : vesicular breath sounds + / +, ronkhi - /
-, wheezing - / -

Inspection : ictus cordis not seen

Palpation : : ictus cordis not palpable
Auscultation : Regular 1st & 2nd heart sounds, murmur
(-), gallop (-)

Abdome
n
Extremit
ies

Inspection: looked flat

Auscultation: bowel sounds (+)
Palpation: touching pain epigastrik (-) epigastrik
retraction (-)
Percussion: timphani

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

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

Resume
Mrs. 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 mellitus disease
but she didnt control her disease. 2 weeks ago, her
tension was 200 mmHg when she came to the
hospital. She felt itchy and her sight was blurry. she
also complains lots of urine and she drinks too
much. She denied eat a lot.
History of past illness: hypertension and DM
History of treatment: she had consumed the
hypertension drugs and DM drugs

Physical Examination:

TD: 110/70 mmHg

Problem list

Crisis hypertension
Diabetes Melitus

Assesment
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
1.

2.

A: Crisis hypertension
P: Controlled blood pressure
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: check blood glucose

Case analysis

Definition

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.

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.

Epidemiology

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.
In the US parallels the distribution of essential
hypertension with a twofold higher incidence in
AfricanAmericans than in whites.

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.

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.

Clinical manifestation

Hypertensive urgency is a situation with severe

increase in blood pressure without progressive
dysfunction of vital organs. The most common
symptoms are headache, dyspnea, nausea,
vomiting, epistaxis, and pronounced anxiety.
Hypertensive emergencies include hypertensive
encephalopathy, hypertensive acute left ventricular
relaxation associated with acute myocardial
infarction or unstable angina, aortic dissection,
subarhnoic hemorrhage, ischemic stroke, and
severe preeclampsia or eclampsia.

Clinical manifestation

Supporting examinations
Recommended testing includes the following:
Hematologic routine
Blood glucose
Total cholesterol serum
Serum uric acid
Creatinin serum
Kalium serum
Urinalisis
Electrocardiogram

Treatment

References

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

crises?. Intensive Care Med. 41:127130

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

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

Current Medical Diagnosis & Treatment. Systemic Hypertension.

Sutters, Michael.MD. 2016. 435-467

American Journal of Emergency Medcine. The Relationship between

vascular inflammation and target organ damage in hypertensive
crises. Karaback, Mustafa MD. 2015; 497-500

Jose Roesma. Krisis Hipertensi. Sudoyo, Idrus Alwi editor. Buku Ajar
Ilmu Penyakit Dalam Jilid II Edisi VI. Pusat penerbitan departemen
penyakit dalam FKUI.2014

Thank You