Sudden Increase In Blood Pressure Research Articles

Nursing Care for Mrs. W Diagnosed with Hypertensive Urgency using Foot Massage Therapy in the Emergency Department

Hypertensive emergency is a hypertensive crisis characterized by a sudden increase in blood pressure of 180/110 mmHg without organ damage. Hypertensive disease has increased every year due to low awareness of compliance in taking medication and maintaining a healthy lifestyle in hypertensive patients. The purpose of this case study is to provide nursing care to patients experiencing hypertension urgency. This research method uses a qualitative approach with case studies as the main method, using observation sheets, interviews, and documentation studies. This case study chose one patient as the research subject, namely a patient with hypertensive urgency in the emergency room of Gunung Jati Hospital, Cirebon City. Nursing care management is based on meeting the needs of patients carried out in 1 day. The results of the case study showed that after being given nursing care there was a decrease in blood pressure from 195/110 mmHg to 187/104 mmHg. The conclusion is that the nursing care provided is effective in emergency hypertension patients and meets the needs of patients. The implication of this study is the importance of nursing care in managing hypertension emergencies, which can help in the effective monitoring and management of this disease. In addition, this study also strengthens the understanding of the importance of patient compliance in managing hypertension to prevent complications that can arise.

Case of functional paraganglioma with intraoperative hypertensive crisis during robot-assisted thoracoscopic resection

BackgroundMediastinal paragangliomas are rare. Their dangerousness may unfold during surgery, especially if hormonal activity was previously unknown. We report our experience with this case in context to the incidence and localization of atypically located mediastinal paragangliomas in the literature.Case presentationA 69-year-old female patient who was scheduled for thoracoscopic resection due to a posterior mediastinal tumor that had been progressing in size for several years and increasing symptoms. The induction of anesthesia, the ventilation of the lungs and the gas exchange after lung separation was uneventful. After initially stable circulatory conditions, there was a sudden increase in blood pressure up to 300/130 mmHg and tachycardia up to 130/min. This hypertensive phase was difficult to influence and required a rapid and consistent use of antihypertensive medication to bring down the blood pressure to reasonable values. The patient stabilized after tumor resection. The postoperative course was unremarkable. During the intraoperative blood pressure crisis, blood was drawn for analysis. These samples showed elevated concentrations of normetanephrine and metanephrine. The tumor subsequently presented as a catecholamine-secreting paraganglioma.ConclusionIn order to avoid life-threatening blood pressure crises, hormone activity should be ruled out preoperatively in the case of mediastinal tumor, in which a paraganglioma could be considered in the differential diagnosis, especially if there are indications of hypertension in the medical history. Robotic-assisted thoracoscopic resection of the posterior mediastinal tumor was a feasible surgical method, even in the case of unexpected functional paraganglioma.

CLINICAL PROTOCOLS OF DENTAL TREATMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES (REVIEW OF SCIENTIFIC RESEARCH)

There is an increased probability of the coexistence of cardiovascular diseases in dental clinic clients, especially in the older group, which is associated with the dominance of diseases such as hypertension and coronary heart disease in the general morbidity structure of the population. A key feature of managing the treatment of this category of patients is the increased risk of sudden development of emergency conditions against the background of dental procedures, even if the initial condition of the patient seemed satisfactory. Such patients are also at increased risk of specific dental complications, such as bleeding, which can be caused by both a sudden increase in blood pressure and prolonged use of anticoagulants or disaggregants. Modern clinical guidelines, based on data from major international studies and regularly updated, play an important role in ensuring that dentists prevent cardiovascular emergencies and provide the necessary first aid, which helps to minimize the negative consequences of such acute clinical episodes.

Exploration of Information Needs for 3rd Trimester Pregnant Women with Severe Preeclampsia at Banyumas Hospital

Background: Preeclampsia is a munciton characterized by high blood pressure during pregnancy, with symploms such as body weling, especially in the face and hands, a sudden increase in blood pressure, and high protein levels in the une, several rise factors can increase the Molhood of developing preeclampsia/eclampsia at an individual level including a history of chronic hypertension, obesity, and severe anemia. Liteacy of the pregnant women can influence their behavior toward preventing severe preeclampsis Providing information is expected to enhance knowledge and reduce anxiety among pregnant woment. Methods: This study aims to explore the information needs of tri-mester pregnant women with severe preeclampsia at Banyumas Hospital. This qualitative exploratory study used interview methods. The subjects were 10 pregnant women with severe preeclampsia at Banyumas Hospital, selected through purposive sampling. The data analysis involved qualitative techniques, including data reduction prosentation, and conclusion. Results: The research results show that most informants (8 women) are adults (aged 26-45). Their educational level is primarily high school (SMA), with 8 individuals Moat are housewives (fi individuals), and 9 have more than one child or are mutparous. Conclutions: Overall, all informants require information to support their pregnancy up to the delivery process, such as education on understanding severe preeclampsia, managing atuty and fear of preeclampsia risks, and being aware of matomal health.

Blood pressure cut-offs to diagnose impending hypertensive emergency depend on previous hypertension-mediated organ damage and comorbid conditions.

Background Hypertensive emergencies (HTN-E) are important due to a high risk of mortality. However, a sudden increase in blood pressure (BP) can damage target organs before the BP reaches cut-offs to diagnose HTN-E. We (i) analyse HTN guidelines for recommendations of treatment individualization, such as adjusting BP cut-offs for hypertensive urgency or impending HTN-E according to patient's susceptibility to complications (because of previous hypertension-mediated organ damage [HMOD], cardiovascular events and comorbid conditions), and (ii) provide a rationale for the inclusion of patient's susceptibility in protocols for treatment of acute HTN-E. Methods We searched PubMed, SCOPUS, Science Direct, Springer, Oxford Press, Wiley, SAGE and Google Scholar for the following terms: arterial hypertension, impending, emergency, target organ damage, hypertension-mediated organ damage, and comorbidity. Results The available guidelines do not recommend that when we estimate the probability of HTN-E in a patient with very high BP, we take into account not only the 'aggressive factor' (i.e. history of HTN, absolute BP values and rate of its increase), but also the 'vulnerability of the patient' due to previous major adverse cardio-vascular events, HMOD and comorbid conditions. Conclusion The risk does not depend only on the aggressiveness of the health threat but also on the strength of the host's defence. It is, therefore, surprising that one side of the natural interaction (i.e. susceptibility of a patient) is overlooked in almost all available guidelines on HTN.

Acute and Resistant İntraoperative Hypertension during Mitral Valve Replacement: A Case Presentation

Background: Intraoperative hypertension continues to be a significant cause of morbidity and mortality for patients undergoing surgery. In this case presentation, an instance of sudden, unexpected, and resistant hypertension during surgery will be discussed in a patient who underwent mitral valve replacement. Case report: A 75-year-old patient with known coronary artery disease and advanced mitral stenosis underwent mitral valve replacement surgery. During the intraoperative process, after the completion of cannulation procedures and transitioning to partial bypass, a sudden increase in blood pressure was observed in the patient. Blood pressure was only brought under control through the intravenous administration of a triple antihypertensive agent. Upon postoperative evaluation following a smooth completion of the surgery and discharge, findings suggested that the cause of the hypertension in the patient might be renovascular hypertension. Conclusions: Intraoperative hypertension, when unexpected and sudden, can lead to an increase in mortality and morbidity. During the intraoperative process, efforts should be made to identify the underlying causes promptly, and appropriate interventions should be carried out. In the postoperative period, patients should be thoroughly evaluated for underlying reasons.

A case report of reversible cerebral vasoconstriction syndrome with thunderclap headache significantly exacerbated in the supine position and alleviated in the standing position

BackgroundReversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden onset thunderclap headache and multiple segmental reversible cerebral vasoconstrictions that improve within 3 months. The postpartum period is a well-known precipitating factor for the onset of RCVS. Cerebral venous thrombosis (CVT) causes thunderclap headaches in the postpartum period. While headache in CVT is sometimes exacerbated in the supine position, the severity of the headache in RCVS is usually independent of body position. In this study, we report a case of RCVS with thunderclap headache exacerbated in the supine position, and headache attacks that resolved quickly in the standing position during the postpartum period.Case presentationA 33-year-old woman presented with a sudden increase in blood pressure and thunderclap headache on the fifth postpartum day (day 1: the first sick day). The headache was severe and pulsatile, with onset in the supine position in bed, and peaked at approximately 10 s. It was accompanied by nausea and chills but there were no scintillating scotomas or ophthalmic symptoms. The headache resolved in the standing or sitting position but was exacerbated and became unbearable within a few seconds when the patient was in the supine position. Therefore, she was unable to lie supine at night. Computed tomography angiography (CTA) of the head on day 2 and magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) on day 3 showed no abnormalities. However, considering the possibility of RCVS, verapamil was initiated on day 3. The headache resolved the following day. MRA of the head on day 10 revealed diffuse and segmental stenoses in the bilateral middle and posterior cerebral arteries and basilar artery. Therefore, the patient was diagnosed with RCVS. The headache gradually resolved and disappeared completely on day 42. Cerebral vasoconstriction was also improved on MRA on day 43.ConclusionsThis postpartum RCVS case was notable for the exacerbation of headaches in the supine position. For the diagnosis of thunderclap headache in the postpartum period, RCVS should be considered in addition to CVT when the patient presents with a headache that is exacerbated in the supine position.

Abstract P203: Microvascular Imaging As Early Predictor For Cardiac Dysfunction After Preeclampsia

Preeclampsia (PE), the most common pregnancy disease, is the main cause for maternal and fetal mortality and morbidity worldwide. The disease is characterized by a sudden increase in blood pressure in combination with signs of end organ damage, e.g. proteinuria and the underlying mechanisms are poorly understood. Immune dysregulation and endothelial dysfunction are important pathomechanisms leading to PE, we hypothesize that anti-angiogenesis and dysregulation of microvascular perfusion postpartum lead to the increased cardiovascular risk in later life. In addition, we will test if the examination of retinal vessels can be used as a diagnostic window for early risk prediction of cardiovascular alterations. In a well-established transgenic rat model for PE, we performed speckle tracking echocardiography, immunostaining, RNA sequencing and small vessel imaging by micro-computed tomography of the heart and the eyes in former preeclamptic rats (PEpp) and healthy controls (WTpp). A reduction of cardiac vessels (AUC 0-200 μm: WTpp 77.19±4.64 vs. PEpp 62.59±2.72) in combination with an increase of small vessels in the retina (AUC 0-50 μm: WTpp 52.89±1.47 vs. PEpp 59.54±1.09) is shown postpartum. Data from echocardiography (Global longitudinal strain: WTpp -22.03±2.47 % vs. PEpp -14.50±1.80 %) and histological staining (CD31: WTpp 292.7±30.9 per fov vs. PEpp 219.0±10.5 per fov) support the hypothesis of persistent cardiovascular alterations after PE. Performing RNAseq, 65 genes were found to be permanently altered in the left ventricle of the heart of preeclamptic rats compared to 4 genes in controls. In the retinal tissue, 39 genes in PEpp and no genes in WTpp were identified postpartum compared to never pregnant animals (adjusted p-value < 0.05,

Myocardial Infarction in Young Athletes.

Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.

Anesthetic management by combined spinal and epidural anesthesia for a case of ectopic bladder pheochromocytoma

Background: We report a safe anesthetic management of a patient with preoperatively diagnosed ectopic pheochromocytoma who underwent bladder tumor resection with combined spinal subarachnoid anesthesia and epidural anesthesia (CSEA). Case presentation: The patient was an 85-year-old male, 152 cm in height and weighing 65 kg. The patient was admitted to our hospital with a complaint of anemia. Ectopic pheochromocytoma was suspected because of the different shape of the tumor and increased rerum noradrenaline. Due to complications of interstitial pneumonia, we planned to perform CSEA for this case. When surgical manipulation was applied to the bladder, a sudden increase in blood pressure above systolic pressure of 200mmHg was observed, and nicardipine 1 mg was administered. Afterwards, the surgery was completed without any major circulatory changes and postoperative course was uneventful. Conclusion: In patients with appropriate preoperative diagnosis and blood pressure control, spinal anesthesia or CSEA may be an alternative for ectopic pheochromocytoma in the bladder.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME: DIVERSE ETIOLOGIES

Objective: Posterior Reversible Encephalopathy, called PRES, is a clinico-radiological entity individualized for the first time in 1996 as a special form of hypertensive encephalopathy. Design and method: We collected retrospectively 8 cases of PRES Syndrome either on-specific or followed in Internal Medicine service. All patients had a confirmed diagnosis by brain MRI. Results: There were 5 women and 3 men, mean age was 30 years (range 16–66 years). Three patients had a past history of arterial hypertension. Two patients had moderate chronic renal failure, three had a chronic renal failure on hemodialysis, one had normal renal function and the two others were transplanted. Hypertension with diastolic blood pressure greater than 120 mmHg was noted in two patients. For the others, it was an acute and sudden increase of blood pressure usually well balanced. Neurological manifestations are on-specific, such as confusion, a prolonged critical post coma or seizure initially focal (Braved-Jacksonian) limited to brain lobe affected by the PRES which become generalized secondarily. All patients had seizures, one presented a status epilepticus. They all underwent magnetic resonance imaging (MRI). Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Involvement of the white matter is constant. To equilibrate the systemic blood pressure, we used calcium channel blockers in all cases (nicardipine in the electric syringe pump in one case). The therapeutic goal was to maintain a mean arterial pressure between 105 and 125 mmHg. Conclusions: PRES is highly diverse in terms of etiologies. Our series is particular by the large number of cases of PRES compared to the literature but especially by the diversity of the etiologies of PRES. All our patients had chronic renal failure and / or underlying nephropathy.

Autonomic Dysreflexia following Spinal Cord Injury.

Autonomic dysreflexia (AD) is a potentially life-threatening condition of the autonomic nervous system following spinal cord injury at or above T6. One of the most common symptoms is a sudden increase in blood pressure induced by afferent sensory stimulation owing to unmodulated reflex sympathetic hyperactivity. Such episodes of high blood pressure might be associated with a high risk of cerebral or retinal hemorrhage, seizures, heart failure, or pulmonary edema. In-depth knowledge is, therefore, crucial for the proper management of the AD, especially for spine surgeons, who encounter these patients quite often in their clinical practice. Systematical review of the literature dealing with strategies to prevent and manage this challenging condition was done by two independent reviewers. Studies that failed to assess primary (prevention, treatment strategies and management) and secondary outcomes (clinical symptomatology, presentation) were excluded. A bibliographical search revealed 85 eligible studies that provide a variety of preventive and treatment measures for the subjects affected by AD. As these measures are predominantly based on noncontrolled trials, long-term prospectively controlled multicenter studies are warranted to validate these preventive and therapeutic proposals.

Wanita Usia 39 Tahun dengan Ensefalopati Hipertensi: Laporan Kasus

Hypertensive encephalopathy is an acute reversible syndrome caused by a sudden increase of blood pressure so crosses the limits of brain auto-regulation. The objective of writing this scientific paper was to present clinical manifestations of hypertensive encephalopathy and report the favorable clinical outcomes in hypertensive encephalopathy patients with comprehensive therapy. This paper is an empirical case study investigates the symptoms of Hypertensive Encephalopathy in real life. Female, 39 years old complaints of sudden seizures, before the seizure she felt of non-throbbing headache all over her head. There was an increase in blood pressure of 200/130 mmHg. On neurologic-ophthalmologic examination, her right eye had no light perception (NLP), while on other neurological functions there were no abnormalities. She was hospitalized and treated with antihypertensive drugs, that are Amlodipine and Lamipril, during inpatient the DASH diet was given. The patient showed improvement, then was discharged on the 5th day of treatment. Diagnosis of hypertensive encephalopathy was made in this patient built upon high blood pressure plus neurologic symptoms and the exclusion of other conditions that could cause similar symptoms. Antihypertensives were used carefully at a target blood pressure of 150/100 mmHg (20% of MAP). Application of DASH diet has an effect for lowering blood pressure due to the restriction of sodium intake from food. Management of hypertensive encephalopathy includes lowering blood pressure but it’s not recommended aggressively because it can cause ischemia. Preventive measures are very important, research is needed on predictive factors for hypertension encephalopathy and a high level of alertness in risk groups.

HIPERTENSI EMERGENSI DI INTENSIVE CARE UNIT (ICU) RUMAH SAKIT UMUM DAERAH (RSUD) TUGUREJO SEMARANG

A sudden increase in blood pressure reaching> 180/120 mmHg accompanied by involvement of organ damage is called hypertensive emergencies. Nationwide Emergency Department recorded visits of hypertensive emergency cases as much as 3309 million in 2006 and 6178 million in 2013. The Hospital data information system (SIMRS) in Tugurejo Regional Hospital Semarang in 2017 found that the number of patients diagnosed with hypertension reached 1,125 patients. The aim of this study was to evaluate the use of antihypertension in hypertensive emergency patients in the Intensive Care Unit (ICU) of Tugurejo Hospital Semarang in the period January - December 2018. This study is a descriptive observational study using retrospective data. Data retrieval was done by looking at the medical record data of patients with hypertensive emergencies who received hypertension therapy in the ICU Tugurejo Hospital in the period January - December 2018. Data were analyzed based on patient characteristics, antihypertensive use patterns and evaluation of antihypertensive use. The number of patients who fulfilled the inclusion and exclusion criteria were 58 patients. The results of this study indicate that the suitability of antihypertensive use in decreasing systolic blood pressure at 1 hour, 2 – 6 hours, 24 – 48 hours in a row is 81.03%; 24.14%; 20.93%. Whereas for a decrease in diastolic blood pressure at 1 hour, 2 – 6 hours, 24 – 48 hours respectively 77.59%; 43.10%; 74.42% according to the ACC / AHA guidelines (2018).

Comparison of two different doses of intravenous remifentanil on cardiovascular response to endotracheal intubation: a randomized controlled trial

Background & Objectives: Endotracheal intubation is one of the most potent stimuli as an integral part of general anesthesia with several risks such as a sudden increase in blood pressure and pulse rate. One of the drugs that can be used to prevent hemodynamic spikes in endotracheal intubation is remifentanil. It has rapid onset and peak effect with short duration of action. Various authors have used different doses of this drug. We compared the effect of two different doses of remifentanil on hemodynamic response to endotracheal intubation.
 Methodology: It was a randomized clinical trial on 35 patients, aged 19-65 y, physical status ASA I-II, body mass index (BMI) 18.5-29.99 kg/m2, who underwent elective surgery under general anesthesia. Subjects were randomly assigned into 2 groups, Group R1, who received remifentanil 0.5 µg/kg intravenously (IV), followed by an infusion @ 0.1 µg/kg/min; and Group R2, who received remifentanil 1 µg/kg followed by 0.1 µg/kg/min intravenously. Systolic, diastolic and mean arterial pressure, and pulse rates were noted on arrival in the operating room T0, then measurements were performed 2 min after induction (T1), 1 min after intubation (T2), and continued at 3 and 5 min after intubation (T3 and T4). The data was analyzed with SPSS v21.0 for Windows. T-test or Mann-Whitney U test was performed to analyze the data.
 Results: Based on this study, the hemodynamic parameters were significantly lower in systolic blood pressure (113.35 ± 4.66 vs. 107.83 ± 6.37, P = 0.008), diastolic blood pressure (68.88   vs. 61.83  P = 0.004), mean arterial pressure (83.76  vs. 77.28 ± 5.84, P = 0.001) and pulse rate (83.71 ± 8.20 vs. 76.11 ± 9.70, P = 0.013) after 1 min of endotracheal intubation in the remifentanil 1 µg/kg group compared to the 0.5 µg/kg remifentanil group.
 Conclusion: Administration of remifentanil 1 µg/kg followed by maintenance of 0.1 g/kg/min can cause a statistically significant decrease in blood pressure and heart rate compared to remifentanil 0.5 µg/kg followed by maintenance of 0.1 µg/kg/min, when administered for endotracheal intubation.
 Abbreviation: BMI: body mass index; IV: intravenously; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MBP: Mean arterial blood pressure;
 Key words: Endotracheal intubation; Hemodynamic insult; Remifentanil
 Citation: Suwarman, Prihartono MA, Azhari GA. Comparison of two different doses of intravenous remifentanil on cardiovascular response to endotracheal intubation: a randomized controlled trial. Anaesth. pain intensive care 2022;26(6):778−783; DOI: 10.35975/apic.v26i6.2047

Syncytiotrophoblast stress in early onset preeclampsia: The issues perpetuating the syndrome

Preeclampsia is a pregnancy-specific syndrome characterized by a sudden increase in blood pressure accompanied by proteinuria and/or maternal multi-system damage associated to poor fetal outcome. In early-onset preeclampsia, utero-placental perfusion is altered, causing constant and progressive damage to the syncytiotrophoblast, generating syncytiotrophoblast stress. The latter leads to the detachment and release of syncytiotrophoblast fragments, anti-angiogenic factors and pro-inflammatory molecules into maternal circulation, resulting in the emergence and persistence of the characteristic symptoms of this syndrome during pregnancy. Therefore, understanding the origin and consequences of syncytiotrophoblast stress in preeclampsia is vital to develop new therapeutic alternatives, focused on reducing the burden of this syndrome. In this review, we describe five central characteristics of syncytial stress that should be targeted or prevented in order to reduce preeclampsia symptoms: histological alterations, syncytiotrophoblast damage, antiangiogenic protein export, placental deportation, and altered syncytiotrophoblast turnover. Therapeutic management of these characteristics may improve maternal and fetal outcomes.

Pharmacovigilance of COVID-19 vaccines in the context of Nepal: an assessment based on early adverse drug reaction reports

ObjectiveThe objective of this study was to assess the ongoing pharmacovigilance of coronavirus disease-19 (COVID-19) vaccines in the Nepalese context based on the available preliminary adverse drug reaction (ADR) reports and suggest approaches for strengthening pharmacovigilance mechanisms.MethodsCurrently, many COVID-19 vaccines are under advanced development and some have begun to be administered. In Nepal, the vaccination programme was initiated with Oxford/AstraZeneca COVID-19 AZD1222 (Covishield) vaccine on January 27th targeting frontline healthcare professionals, sanitary staff and security workers. Newspaper reports and ADR reports received at a regional pharmacovigilance centre in Nepal were analysed. Nepal initiated a national pharmacovigilance programme 15 years back and has 14 functioning regional pharmacovigilance centres. The authors examine the strengths and challenges facing the current pharmacovigilance system in ensuring the safety of COVID-19 vaccines.Key findingsThe news coverage has not mentioned any deaths till date with COVID-19 vaccination. Some patients reported vomiting, urticaria and sudden increase in blood pressure. Few people suffered from headache, fever and myalgia after being vaccinated. A vaccine, approved in an accelerated manner may have safety concerns. The vaccine may cause several types of reactions, but serious reactions have not been reported. Occurrence of adverse effects due to the vaccine is being studied.ConclusionsInvolving key stake holders, training health professionals and strengthening existing reporting procedures are important. Developing a system of reporting and analysing ADRs daily can help generate actionable intelligence to improve the safety of the vaccination programme. Establishing functioning communication channels between regulatory authorities and other stakeholders is crucial.

Effects of Micro Vibration Therapy Nursing Care on Muscle Hardness and Skin Blood Flow: A Pre/Post Group Comparison Study

Purpose: The purpose of this study was to investigate the effects of Micro Vibrational therapy (MVT) on muscle stiffness and blood flow in the skin before and after Micro Vibrational therapy in healthy subjects in order to scientifically verify the effects of MVT. Methods: Micro Vibrational therapy is nurse care use in Japan. It was performed on the backs of 30 subjects (8 males and 22 females) in their 20 s to 50 s according to the eligibility criteria. The resting state before implementation was set as the baseline for the control group, and after 30 seconds of MVT was set as the intervention group. The effects of the MVT were statistically analyzed by these factors and subjective sensation by Visual Analog Scale. Results: The muscle hardness of the area where the MVT was applied for 30 seconds decreased to 29.54 (SD 5.04) after the application, compared to 30.45 (SD 5.05) before. A corresponding t-test showed a significant difference (p = 0.019). Skin blood flow increased from a median of 0.76 (variance 0.062) before to a median of 0.86 (variance 0.16) after the procedure. The Wilcoxon rank test showed a significant difference (p = 0.000). Circulatory response was confirmed by SBP, DBP, and HR. SBP of 108.6 mmHg (SD 14.8) before the study decreased to 105.7 mmHg (SD 15.0) after the study, and DBP of 65.6 mmHg (SD 11.1) before the study decreased to 62.7 mmHg (SD 11.8) after the study. HR decreased from 71.6 beats per minute (SD 10.3) before to 69.2 beats per minute (SD 11.7) after. There was a significant difference in all cardiovascular indices (p < 0.05). VAS (pain, stiffness, and fatigue) was significantly decreased after MVT (p < 0.05). Conclusion: Micro Vibrational therapy tended to decrease muscle hardness and increase skin blood flow even in the short time of 30 seconds. The results suggest that local vibration stimulation is not likely to cause a sudden increase in blood pressure or pulse rate fluctuation. These results suggest that hand vibration nursing care may be applicable to acute patients with unstable circulatory conditions.

Hypertensive emergency: an overview of heart as target organ damage

Hypertension is currently still a global problem in the cardiology and vascular fields with an increasing trend. One of the emergency conditions related to an increase in blood pressure is emergency hypertension. Emergency hypertension is a condition where blood pressure rises rapidly and severely, resulting in new or progressive organ damage. Symptoms can range from chest pain, shortness of breath to delirium. The heart is one of the organs that can be damaged by hypertensive emergencies. The availability and demand for oxygen from the coronary blood vessels to the heart muscle cells will experience an imbalance due to a sudden increase in blood pressure. Lack of oxygen that occurs can cause heart muscle cells' death affected heart structure and its function. The symptoms that appear can be in the form of acute coronary syndrome or acute heart failure. Some modalities can detect heart structure changes, like electrocardiography for general and echocardiography for specific examination. Hypertensive emergencies can be treated by several rapid-acting antihypertensive agents, which can be selected based on the clinical manifestations. As the symptoms related to heart damage are acute coronary syndrome and acute heart failure, so the treatment will be specific, respectively. Good knowledge related to emergency hypertension management and early treatment will reduce patient morbidity.

Clinical characteristics of the pregnancies and deliveries of patients with moyamoya disease: A single-center analysis over three decades.

As moyamoya disease in pregnancy is clinically rare, it is poorly understood. We therefore analyzed our experiences of moyamoya disease pregnancies and deliveries over three decades. The clinical data of 78 pregnancies and 77 deliveries among 62 moyamoya disease cases at Tokyo Medical and Dental University Hospital from 1991 to 2019 were retrospectively reviewed. There were six, 17 and 55 pregnancies in the first, second, and last decades, respectively. The mean patient age at delivery was 29.3 ± 5.0 years. The primary symptoms of moyamoya disease at diagnosis were ischemia in 50 cases (64.1%) and intracranial hemorrhage in eight cases (10.2%). Cesarean section was performed in 75 cases (96.2%). Fifteen pregnancies (19.2%) developed hypertensive disorders of pregnancy; of these, 13 (86.7%) developed hypertensive disorders of pregnancy after 34 weeks of gestation and 9 (60%) required emergency cesarean section because of a sudden increase in blood pressure. Four (5.1%) women experienced renal artery stenosis complications and three of them developed hypertension during pregnancy. Two (2.6%) experienced cerebral infarctions several days after delivery, both of whom had no subsequent aftereffects. No cases of hemorrhagic stroke were reported in the peripartum period. To date, this is the largest single-center analysis. It showed the number of moyamoya disease pregnancies has risen rapidly over the last decade. The hypertensive disorders of pregnancy and emergency cesarean section rates were high among moyamoya disease patients. Minor ischemic stroke was observed, but its prevalence was low. Therefore, pregnant women with moyamoya disease should be managed with the understanding that hypertensive disorders of pregnancy is a common complication.