Left atrial Appendage Rupture Following Intraoperative Hypertensive Crisis

The acute and severe rise in systemic blood pressure during or after cardiac operations may be life-threatening and result in end-organ injury. This case is the first report of spontaneous left atrial appendage rupture following the hypertensive crisis in cardiac surgery

Dependence of cardiovascular diseases mortality on helioseismic indicators in the Sheki region of the Azerbaijan Republic

Aim. To study the dependence of cardiovascular diseases mortality on geophysical and seismic indicators in the Sheki region of the Azerbaijan Republic.Material and methods. In 2013, seismological information was obtained from 35 telemetry stations, which included a review of the seismic setting of the republic, the distribution of seismic waves, the dynamics of seismic processes, the intensity of earthquakes, magnitude, etc. Based on the spatial distribution of the focal zones identifi ed by weak seismicity and the magnitudes of the maximum possible earthquakes in them, a map of the seismic hazard of the territory of Azerbaijan was compiled. To analyze the connection with diseases in the Sheki region, 742 case histories of patients (48.8% — 362 men and 51.2% — 380 women) who died in 2013 from various diseases, were analyzed.Results and discussion. Statistically signifi cant (p < 0.001), more deaths among men were from acute coronary syndrome (63.3%), from acute heart failure (46.0%) and from hypertensive crisis (HС) (45.3%). 59.3% died from acute cerebrovascular accident, 54.7% died from a hypertensive crisis and 54,0% from acute heart failure among women. Statistically signifi cant number of deaths was in the age range of 70–79 years old and 80–89 years old.The largest number of deaths was at a depth of 11–20 km — 20.6%, 21–30 km — 16.7%, less than 10 km — 10.5%. When the depth of the process was less than 10 km, the largest percentage of mortality was from acute coronary syndrome — 24.4%, with the depth of 11–20 km — from hypertensive process (40.5%); 24.2% died from heart failure.Conclusion. Thus, there is a close correlation between geomagnetic changes and CVD mortality in Sheki region of Azerbaijan. It is realized in the form of an increase in the frequency of cases and deaths, and the number of these cases is highly dependent on patients’ age.

Complete Neurological Recovery In A 3 Year Old Presenting With Posterior Reversible Encephalopathy Syndrome Due To Idiopathic Hypertension – A Case Report

Posterior reversible encephalopathy syndrome is an acute neurological illness presenting with clinical symptoms and distinctive MRI findings. Symptoms include headaches, seizures, altered consciousness as well as visual impairment. PRES is always accompanied by peculiar radiological findings of edematous change affecting the rear cerebral area. It commonly occurs in settings where patients are undergoing hypertensive crisis, or there is the use of steroids, calcineurin inhibitors, in the nephritic state or end-stage renal disease. The management includes treating the underlying cause and symptomatic therapy. However, due to relatively fewer pediatric reports, its management isn’t specific and rather based on experience. Our patient is a 3-year-old male, who presented with hypertensive crisis and MRI findings confirmed it to be a case of PRES. He was managed with a combined regime of antihypertensive and steroids which lead to complete neurological recovery and resolution of PRES. There are a scarce number of case reports on the use of steroids for the treatment of vasogenic oedema in children.

Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

Dead space ratio as a tool in nitric oxide weaning: a study in pulmonary hypertensive disease

Objectives: To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis. Patients: Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years. Measurements and Main Results: Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12). Conclusions: Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

Robotic excision of interaortocaval paraganglioma: a case report with the literature review

Background Paragangliomas are rare neuroendocrine tumors of extra adrenal origin. The symptomatic paragangliomas require multimodal treatment approach. Case Presentation We report a case of 34-year-old female who presented with complains of headache and blurring of vision. Examination revealed Hypertensive crisis with grade 3 retinopathy. The patient was diagnosed as a case of extra-adrenal paraganglioma during evaluation for secondary hypertension. Magnetic Resonance Imaging of the abdomen revealed 23*28*28 mm mass lesion in the inter-aortocaval region at the level of L3–L4. The patient was started on medical management for hypertension and was managed safely with robot-assisted surgery, owing to enhanced visualization of feeding vessels and avoidance of excessive manipulation of tumor. Conclusions Our case report emphasizes on the robot assisted surgical technique for the removal of tumor in a vulnerable anatomical position and presents a review of the literature.