A Clinical Study on Hypertensive Encephalopathy

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.

Studies on Hemodynamic Assessment and Ventricular Performance in Patients with Mitral Valvular Disease

The cardiac performance is regulated by the intergration of preload, afterload, contractility (inotropism), heart rate and synergy of ventricular contraction, which are the major determinants that govern the stroke volume and cardiac output. Valvular heart disease may be considered to impose two different types of stress on the cardiac chamber proximal to the lesion. There are either pressure overload(increased after load) or volume overload(increased preload). The compensatory mechanism of the pressure overload and volume overload offer to hypertrophy and dilatation of the chamber. Hypertrophy, increased muscle mass, calls upon the development of greater systolic force. Dilatation, overfilled chamber volume enables increased strength and extent of shortening by Frank Starling's mechanism. In these view, we shall discuss the hemodynamic parameters; cardiac output, stroke volume, ventricular end-diastolic pressure, and the rate of ventricular pressure rise(peak dp/dt), mitral valve gradient and pulmonary circulation. The authors had an opportunity to study 40 cases of mitral valvular heart disease which were accepted during the left ventricular angiography at the cardiac catheterization room and at the fields of operative findings during the period Jan. 1977, throught Sept. 1980, at the Department of Internal Medicine, National Medical Center. The following conclusions were drawn: 1) Cardiac index was 2.65 L/min/m2in average, among 18 cases with mitral stenosis and 2.54 L/min/m2 in average, among 15 cases with mitral valve area of less than 1.0 cm2. Cardiac index was 2.58 L/min/m2in average, among 19 cases with mitral stenoinsufficiency and 3.43 L/min/m2 in average, among 3 cases with pure mitral insufficiency. 2) The mean right ventricular end-diastolic pressure elevated more than 0-8 mmHg were found in 12 cases with mitral stenosis out of 18 cases and mean miral valve area was 0.8m2. The mean left ventricular end-diastolic pressure was also elevated more than 0-12 mmHg in 6 cases out of 12 cases with mitral stenosis in addition to right ventricular failure. These 12 cases of mitral stenosis had cardiac function more than class III clinically. 3) 15 cases with mitral valve area, less than 1.0cm2 demonstrated left ventricular diastolic filling pressure gradient (MVG) of 17.3mmHg in average, the pulmonary vascular resistance of 568 dyndsecd cm(-5) in average, and the right ventricular peak systolic pressure of 72mmHg in average respectively. In all instances, the right ventricular end-diastolic pressure was 11.2mmHg in average and right ventricular peak dp/dt was 571mmHg in average. 4) Among 22 cases with mitral insufficiency, and/or mitral stenoinsufficiency 16 cases showed mean left ventricular end-diastolic pressure elevated more than 0-12mmHg. 10 cases out of these 16 cases disclosed also right ventricular end-diastolic pressure elevated more than 0-8 mmHg. These 16cases of mitral insufficiency and/or mitral stenoinsufficiency had cardiac function more than class III clinically. 5) 16 cases with mitral insufficiency and/or mitral stenoinsufficiency who had mean left ventricular end-diastolic pressure more than 0-12 mmHg showed pulmonary vascular resistance, 358 dyndsecd cm(-5) in average, systemic vascular resistance, 1621 dyne/sec/cm5 in average and left ventricular peak dp/dt, 768-2102mmHg/sec in range. 6) Pulmonary hypertension elevated more than 50mmHg of pulmonary arterial systolic pressure was found in 14 cases out of 18 case with mitral stenosis and in 10 cases out of 22 cases with mitral stenoinsufficiency and/or mitral insufficiency. Pulmonary vascular resistance, however, was markedly variable.