Hypertensive emergency caused by severe carotid stenosis, clinical case

Abstract

Background. Carotid stenosis is diagnosed in 25% of hypertensive patients, more commonly in men over 50 years old. Interventional treatment facilitates the prognosis of patients. Hypertensive emergency and ineffective response to antihypertensive treatment may be influenced by carotid artery stenosis. Objective(s). Presentation and analysis of the clinical case of the patient (man, smoker) with uncontrolled hypertension, hypertensive emergency and severe stenosis of the carotid artery. Materials and methods. Man, 66 years old, urgently hospitalized in the Cardiology Department CMH "Holy Trinity" with BP 240/110 mmHg, FCC 62 b/min. Clinical and paraclinical data were obtained from the discussion with the patient and the medical record. Patient was investigated on ECOCG, duplex-color doppler of extracranial vessels, hematological, biochemical blood tests. Results. Paraclinical: ECG sinusal rhythm with FCC 60 b/min. Signs of left ventricular hypertrophy. EcoCG: severe concentric left ventricular hypertrophy; EF 67%. Duplex of brachiocephalic vessels: obliterating atherosclerosis with bilateral artery damage. On the right: stenosis ACC 20%, carotid bulb – 35%, ACI – 65%, ACE – 25% on the left: stenosis ACC – 20%, carotid bulb – 80%, ACI – 50% general analysis of urine and blood within normal limits, dyslipidemia. Combined treatment with ARB, CCB, diuretic, antiaggregants, statins. Surgical intervention: percutaneous transluminal angioplasty of the left carotid artery with its stenting. Conclusion(s). Ineffective antihypertensive treatment, complicated by hypertensive emergencies, may be caused by carotid stenosis. Smoking patients with hypertension and dyslipidemia require Doppler of extracranial vessels to detect carotid artery stenosis and its interventional treatment.