1
|
Bosisio FG, Mingardi D, Moretti E, Muzi G, Russomanno F, Tassani N, Stassaldi D, Agabiti Rosei C, De Ciuceis C, Salvetti M, Muiesan ML. Case report: Area of focus in a case of malignant hypertension. Front Cardiovasc Med 2023; 9:1108666. [PMID: 36712261 PMCID: PMC9880852 DOI: 10.3389/fcvm.2022.1108666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Malignant hypertension (MH) is characterized by severe hypertension (usually grade 3) associated with fundoscopic changes (flame hemorrhages and/or papilledema), microangiopathy and disseminated intravascular coagulation. In addition encephalopathy, acute heart failure and acute deterioration in renal function may be present. The term "malignant" reflects the very poor prognosis for this condition if untreated. When severe hypertension is associated with hypertension-mediated organ damage (HMOD) a life-threatening situation that requires immediate but careful intervention occurs (hypertensive emergency). In the last few years an increase in the number of patients with malignant hypertension has been observed, especially among those patients with black ethnicity. Limited access to treatment and the poor adherence to anti-hypertensive therapy may contribute to the development of hypertensive emergencies. It is considered appropriate to study patients in order to rule out thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. In fact, the microvascular damage caused by malignant hypertension can favor intravascular hemolysis like Thrombotic Microangiopathies (TMs). TMs may present in three different clinical conditions: typical hemolytic uremic syndrome (HUS), atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP). TMs can arise in the context of other pathological processes, including malignant hypertension.
Collapse
Affiliation(s)
- Francesca Gaia Bosisio
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Desirè Mingardi
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisabetta Moretti
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giorgia Muzi
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Russomanno
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Tassani
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Claudia Agabiti Rosei
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carolina De Ciuceis
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Salvetti
- Emergency Medicine ASST Spedali Civili Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Brescia, Italy,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,*Correspondence: Maria Lorenza Muiesan,
| |
Collapse
|