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 of age. Interventional treatment facilitates the prognosis of patients. Hypertensive emergency and ineffective response to antihypertensive treatment may be influenced by carotid artery stenosis. Objective(s). of the study. 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 cardiorecovery Department SCM "Holy Trinity" with TA 240/110 mmHg, FCC 62 b/min. Clinical and paraclinical data were obtained from the discussion with the patient and the medical record. Investigated by ECHO, duplex-color Doppler of extracranial vessels, hematological, biochemical analyzes. Results. ECG: sinus rhythm with FCC 60 b/min. Signs of hypertrophy of the LV. ECHO: severe concentric hypertrophy of M-VS; FE 67%. Duplex 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.