Page 68 - Clinical Pearls in Cardiology

56 Clinical Pearls in Cardiology

• Acceleration of previously well-controlled hyper-
tension
• Resistant hypertension
• Accelerated retinopathy
• Malignant hypertension
• Abdominal bruits
• Occurrence of ‘flash pulmonary edema’
• Acute renal failure with ACE inhibitor treatment
Hypertensive patients who display the typical
nocturnal decrease in blood pressure are termed ‘dippers’,
whereas patients in whom the nocturnal decrease in
blood pressure is absent or blunted are termed ‘non-
dippers’. Patients with renovascular hypertension fall
under the category of “nondippers”. The nondipper
profile appears to be of prognostic significance because
it is associated with increased target—organ damage and
a worsened cardiovascular outcome.
41. What is meant by flash pulmonary edema?
Flash pulmonary edema (FPE) is a term that is used
to describe a particularly dramatic form of acute
cardiogenic pulmonary edema. Flash pulmonary edema
is characterized by sudden and recurrent episodes of
dyspnea at rest resulting from acute pulmonary venous
congestion. The abrupt nature of this condition gives it
the name flash pulmonary edema.
Well-established risk factors for heart failure like
hypertension, coronary ischemia and valvular heart
disease are associated with flash pulmonary edema.
Endothelial dysfunction secondary to an excessive
activity of the renin-angiotensin-aldosterone system,
impaired nitric oxide synthesis, increased endothelin
levels and/or excessive circulating catecholamines
may cause excessive pulmonary capillary permeability