Hypertension in the post-bypass patient

Hypertension in the post-operative cardiothoracic patient

High blood pressure can also be a major problem in this population. This issue was explored in Question 10 from the first paper of 2008.

Why, you ask?

• Increased bleeding risk - particularly from the aortic cannulation site
• Extension of an arterial dissection
• Increased afterload and thus increased LV workload
  • Thus, increased risk of ischaemia
  • Increased risk of cardiac failure due to decompensated LV failure
• Increased stress on grafted valves or repaired aortic root
• Worsening of existing mitral regurgitation
• Increased need for sedation
• Bleeding from aortic cannulation site

Causes of hypertension in the post-cardiothoracic surgical patient

• Pain
• Inadequate sedation in a partially paralysed patient
• Pre-existing hypertension, and the perioperative cessation or regular medications
• Artifactual hypertension (measurement error)
• Unintelligent use of vasopressors
• The sudden improvement of aortic flow following the repair of a stenotic aortic valve, which exposes the systemic circulation to being bullied by a massively hypertrophied left ventricle.