Wanita 75 Tahun dengan Hipertensi Emergensi dan Unstable Angina Pectoris

Abstrak

Pendahuluan: Hipertensi emergensi adalah peningkatan tekanan darah secara substansial dan dihubungkan dengan adanya hypertensive mediated organ damage (HMOD) akut. Kondisi ini sering memerlukan intervensi menurunkan tekanan darah segera tetapi hati-hati, biasanya secara intravena. Kasus: Perempuan, usia 75 tahun, mengeluh tiba-tiba nyeri dada 4 jam sebelum masuk rumah sakit. Nyeri seperti ditindih dan menjalar hingga ke lengan kiri. Keluhan tidak berkurang dengan istirahat, disertai keringat dingin dan sesak napas. Tekanan darah 230/110 mmHg, nadi 122 kali/menit, pernapasan 26 kali/menit, saturasi oksigen 97%.
Tidak ada gallop dan murmur pada auskultasi jantung. Pada EKG didapatkan irama sinus takikardia, prolonged QTc, ST depresi lead II, III, aVF, aVL, dan V4-V6. Pada pemeriksaan foto toraks PA, didapatkan adanya kardiomegali (ventrikel kiri) dan bronkopneumonia. Hasil laboratorium darah didapatkan leukositosis, tanpa peningkatan kadar enzim troponin I dan CKMB. Pasien didiagnosis hipertensi emergensi dengan unstable angina pectoris. Simpulan: Hipertensi emergensi merupakan salah satu kasus kegawatdaruratan yang memerlukan diagnosis yang cepat dan tepat serta memerlukan intervensi segera, biasanya dengan terapi
intravena serta pengawasan di ICU. Pilihan obat dan target tekanan darah tergantung pada organ target yang terkena dan manifestasi klinisnya.

Introduction: Hypertensive emergency is a substantially elevated blood pressure associated with acute hypertensive mediated organ damage (HMOD). This condition is often life-threatening, requiring immediate but careful intervention to lower blood pressure, usually with intravenous therapy. Case: A 75 year-old female presented with acute-onset chest pain started 4 hours before admission to the hospital. The chest pain was crushing in nature and radiating to the left arm accompanied by cold sweats and shortness of breath, not relieved with rest. Blood pressure was 230/110 mmHg, heart rate was 122 bpm and regular, oxygen saturation was 97%. No heart murmurs on cardiac auscultation. ECG showed sinus tachycardia rhythm, prolonged QTc, ST segment depression in lead II, III, aVF, aVL, and V4-V6. Chest X-ray showed cardiomegaly (left ventricle) and bronchopneumonia. Blood laboratory findings showed elevated white blood cells and normal level of troponin I and CK-MB. The diagnosis was hypertensive emergency with unstable angina pectoris. Conclusion: Hypertensive emergency requires a fast and accurate diagnosis with immediate intervention, usually with intravenous therapy and ICU monitoring. The choice of drug and blood pressure target depends on the affected target organ and its clinical manifestations.