Malignant Hypertension

Definition: Malignant Hypertension

Malignant Hypertension

Noun

1. Severe hypertension that runs a rapid course and damages the inner linings of the blood vessels and the heart and spleen and kidneys and brain; "malignant hypertension is the most lethal form of hypertension".

Crosswords: Malignant Hypertension

English words defined with "malignant hypertension": adenomyosarcoma ♦ embryoma of the kidney ♦ nephroblastoma ♦ Wilms' tumor, Wilms tumour. (references)

Specialty definitions using "malignant hypertension": Hypertensive Encephalopathy ♦ papilloedema. (references)

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Specialty Definition: Malignant hypertension

(From Wikipedia, the free Encyclopedia)

Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. Systolic and diastolic blood pressures are usually greater than 240 and 120, respectively.

History

The most common presentations of hypertensive emergencies at an emergency department are chest pain (27%), dyspnea (22%), and neurologic deficit (21%). The primary cardiac symptoms are angina, myocardial infarction, and pulmonary edema. Orthostatic symptoms may be prominent. Neurologic presentations are occipital headache, cerebral infarction or hemorrhage, visual disturbance, or hypertensive encephalopathy (a symptom complex of severe hypertension, headache, vomiting, visual disturbance, mental status changes, seizure, and retinopathy with papilledema). Medications or drugs that may cause a hypertensive emergency include cocaine, monoamine oxidase inhibitors (MAOIs), and oral contraceptives; the withdrawal of beta-blockers, alpha-stimulants (such as clonidine), or alcohol also may cause hypertensive emergency. Renal disease may present as oliguria or any of the typical features of renal failure. Gastrointestinal symptoms are nausea and vomiting.

Physical

Cardiovascular system

Blood pressure must be checked in both arms to screen for aortic dissection or coarctation. If coarctation is suspected, blood pressure also should be measured in the legs. Screen for carotid or renal bruits. Listen for a third or fourth heart sound or murmurs. Volume status should be assessed, with orthostatic vital signs, examination of jugular veins, assessment of liver size, and investigation for peripheral edema and pulmonary rales.

Central nervous system

A complete neurologic examination is needed to screen for localizing signs. Focal neurologic signs might not be attributable to encephalopathy. Focal signs mandate screening for cerebral hemorrhage, infarct, or the presence of a mass. A funduscopic examination may reveal flame-shaped retinal hemorrhages, soft exudates, or papilledema.

Lab Studies

Include a complete blood count and electrolytes, coagulation profile, and urinalysis, cardiac enzymes, urinary catecholamines, thyroid-stimulating hormone (TSH), and 24-hour urine collection for vanillylmandelic acid (VMA) and catecholamines. Renal function should be evaluated through a urinalysis, complete chemistry profile, and complete blood count. Expected findings include elevated BUN and creatinine, hyperphosphatemia, hyperkalemia or hypokalemia, glucose abnormalities, acidosis, hypernatremia, and evidence of microangiopathic hemolytic anemia. Urinalysis may reveal proteinuria, microscopic hematuria, and RBC or hyaline casts. In patients with hyperaldosteronism (a secondary cause of hypertension), aldosterone promotes renal potassium wasting, resulting in low serum potassium. The chest radiograph is useful for assessment of cardiac enlargement, pulmonary edema, or involvement of other thoracic structures, such as rib notching with aortic coarctation or a widened mediastinum with aortic dissection. Other tests, such as head CT scan, transesophageal echocardiogram, and renal angiography, are indicated only as directed by the initial workup. The ECG is necessary to screen for ischemia, infarct, or evidence of electrolyte abnormalities or drug overdose.

Treatment

Once the diagnosis of hypertensive emergency is made, the most commonly used intravenous drug is nitroprusside. An alternative for patients with renal insufficiency is IV fenoldopam. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Hydralazine is reserved for use in pregnant patients, while phentolamine is the drug of choice for a pheochromocytoma crisis.

Prognosis

Prior to effective therapy, life expectancy was less than 2 years, with most deaths resulting from stroke, renal failure, or heart failure. The survival rate at 1 year was less than 25% and at 5 years was less than 1%. With current therapy, including dialysis, the survival rate at 1 year is greater than 90% and at 5 years is 80%. The most common cause of death is cardiac, with stroke and renal failure also common.

Source: adapted by the editor from Wikipedia, the free encyclopedia under a copyleft GNU Free Documentation License (GFDL) from the article "Malignant hypertension."

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Frequency of Internet Keywords: Malignant Hypertension

The following statistics estimate the number of searches per day across the major English-language search engines as identified by various trade publications. Hyperlinks lead to commercial use of the expression at Amazon.com.

Expression	Frequency per Day
malignant hypertension	27
Source: compiled by the editor from various references; see credits.

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Modern Translations: Malignant Hypertension

Language		Translations for "malignant hypertension"; alternative meanings/domain in parentheses.
Danish		malign hypertension. (various references)

Dutch		maligne hypertensie (renal hypertension), maligne arteriële hypertensie, bleke hypertensie. (various references)

Finnish		maligni hypertonia, pahanlaatuinen verenpainetauti, hypertonia maligna. (various references)

French		hypertension maligne, hypertension artérielle maligne. (various references)

German		maligne Hypertonie. (various references)

Greek		κακοήθης υπέρταση, κακοήθης αρτηριακή υπέρταση, ωχρή υπερτονία. (various references)

Italian		ipertensione pallida (renal hypertension), ipertensione maligna (renal hypertension), ipertensione arteriosa maligna. (various references)

Pig Latin		alignantmay ypertensionhay.(various references)

Portuguese		hipertensão maligna. (various references)

Spanish		HTA maligna, hipertensión maligna (renal hypertension), hipertensión arterial maligna, hipertensión acelerada. (various references)
Source: compiled by the editor from various translation references.

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Ancestral Language Translations: Malignant Hypertension

Language	Period	Translations
Latin	500 BCE-Modern	hypertonia maligna. (various references)
Source: compiled by the editor from various references.

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Anagrams: Malignant Hypertension

Scrabble® Enable2K-Verified Anagrams
	Words within the letters "a-a-e-e-g-h-i-i-l-m-n-n-n-n-o-p-r-s-t-t-y"
	-3 letters: hyperalimentations.
	-4 letters: hyperalimentation.
Source: compiled by the editor from various references; see credits. SCRABBLE® is a registered trademark. All intellectual property rights in and to the game are owned in the U.S.A and Canada by Hasbro Inc., and throughout the rest of the world by J.W. Spear & Sons Limited of Maidenhead, Berkshire, England, a subsidiary of Mattel Inc. Mattel and Spear are not affiliated with Hasbro.