A 56 year old woman 1 hr post cardiac surgery has a high blood pressure in the ICU. Give likely causes for her high blood pressure and the potential complications this may cause in the early post operative period.
Causes:
Previous hypertension
Pain
Inadequate analgesia or sedation vs paralysis
Measurement error
Hypercarbia
Endotracheal tube intolerance
Wrong dosing of inotropes/vasopressors
Blocked IDC
Post AVR for AS
Potential complications:
Bleeding from aortic cannulation site
Generalised ooze
Heart failure
Myocardial ischaemia
Arrhythmias
Graft dislodgement
Extension of a dissection
Hypertensive crises
Apparently, hypertension can occur in 15-40% of post-cardiac surgery patients. It receives a little less interest than hypotension. Note how the college answer has few points which are actually specific to cardiothoracic surgery. And where is hypothermia? That surely plays a role.
The college answer then goes on to mention arrhythmias and hypertensive crises as potential complications. I would have added the effects of increased afterload on myocardial oxygen consumption, the additional stress on new valve components, increase of pre-existing mitral regurgitation, increased sedation demands and thus potentially a delay of extubation, and complications related to the use of antihypertensive polypharmacy.
Anyway; the complete list of causes and consequences looks like this:
Causes
Consequences
Estafanous, Fawzy G., and Robert C. Tarazi. "Systemic arterial hypertension associated with cardiac surgery." The American journal of cardiology 46.4 (1980): 685-694.
Roberts, A. J., et al. "Systemic hypertension associated with coronary artery bypass surgery. Predisposing factors, hemodynamic characteristics, humoral profile, and treatment." The Journal of thoracic and cardiovascular surgery 74.6 (1977): 846-859.