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HYPERTONIC CRISIS (HC)
This is a sudden significant elevation of arterial pressure that is, almost always, accompanied by the appearance or intensification of disorders in target-organs or functions of vegetative nervous system.
The criteria of hypertonic crisis are as follows: a sudden onset, significant elevation of arterial pressure and appearance or intensification of symptoms in the target-organs.
Table 14 Choice of agents in cardiac rhythm disorders
| Character of disorder
| Conditions of origin
| Agents for treatment
| | Disorders of conduction:
| | 1. Partial A-V node block
| Intoxication with glycosides, POC, myocardial infarction, operations on the heart
| Isadrin, ephedrine
| | 2. Complete A-V block
| The same in a greater degree
| Artificial pacemaker
| | Disorders of automatism:
| | 1. Sharp sinus bradycardia
| The same, and in addition -hyperkalemia, acidosis
| M-ChL (atropine), isadrin, ephedrine, agents normalizing AAB (soda, Trisbuffer)
| | 2. Severe sinus tachycardia
| Activation of sympathoadrenal system, overdosage of cholinomimetics
| /3-adrenomimetics, anticholinesterase agents, cardiac glycosides
| | 3. Paroxysmal tachycardia
| •
| Inderal, quinidine, ajmalin, potassium chloride, panangin, ethmozin
| | 4. Atrial fibrillation and flutter
| a) on the background of cardiac failure;
b) wthout expressed cardiac insufficiency
| Cardiac glycosides. Quinidine, ajmalin, inderal, ethmozin, defibrillation in case of ineffectiveness of medicamentous therapy
| | 5. Ventricular extrasystole
| Hypoxia, hypokalemia, intoxication with glycosides, focal ventricular injuries
| Novocainamide, ajmalin, inderal, KC1, panangin
| | 6. Polytopic ventricular extra-systoles
| The same
| Novocainamide i/v, inderal i/v, ajmalin, xycaine
| | 7. Ventricular fibrillation
| Myocardial infarction, narcosis with halloid-containing agents and others
| Electrical defibrillation with maintenance of the effect with novocainamide or inderal
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Depending on the expression of target-organs affection and necessity of urgent AP decrease we distinguish:
— complicated crises with acute and progressing affection of target-organs that represent a direct threat for patient's life and demand urgent, in the course of 1 hour, AP decrease;
— uncomplicated crises without affection of target-organs represent a potential threat for patient's life and demand fast, in the course of a few hours, AP decrease.
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