Case history
Case history #1
A 50-year-old black man with a history of untreated hypertension presents to the emergency department with substernal chest pressure. His symptoms started the previous day. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of dizziness and some shortness of breath. Apart from a history of hypertension diagnosed 1 year ago, the patient denies any past medical history. He is not taking any antihypertensive medications. The patient denies smoking, or alcohol or drug use. Family history is unremarkable. His blood pressure (BP) is 230/130 mmHg with otherwise normal vital signs and no other significant findings. ECG shows diffuse T-wave inversion and ST depression in lateral leads. Laboratory testing is significant for elevated troponin, signalling myocardial infarction.
Case history #2
A 35-year-old woman presents at 37 weeks' gestation with severe headache and acute abdominal pain. She had a routine antenatal visit 4 days previously with no signs or symptoms reported or observed. On examination, her BP is 165/110 mmHg and urinalysis reveals proteinuria (3+). She is admitted to hospital and is started on labetalol.
Other presentations
In addition to acute coronary syndrome or severe pre-eclampsia/eclampsia, hypertensive emergency can present as new or progressive damage to the following target organs: brain (e.g., stroke, seizure, transient ischaemic attack, cerebral infarction, intracerebral or subarachnoid bleed, hypertensive encephalopathy, posterior reversible leukoencephalopathy); heart/blood vessels (acute pulmonary oedema, acute congestive heart failure, acute aortic dissection, microangiopathic haemolytic anaemia); kidney (acute kidney injury); retina (papilloedema, haemorrhages, retinal oedema).
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