Hypertensive Emergency

More dyspnea

Step 1: View clinicals

A 53 year old lady presents with worsening dyspnea for 2 hours. There is no associated chest or back pain, headache, nausea or visual disturbances. This is her first such episode. She was diagnosed with essential hypertension 4 years ago, but defaulted on treatment shortly afterwards and has not been followed up. No other co-morbidities are present.


Step 2: Order all relevant investigations

ECG

Two ECGs are performed. Both show only left ventricular hypertrophy, with a strain pattern.

X-Ray Chest

The X-Ray reveals cardiomegaly, with bilateral congested lung fields.

Troponin-T assay

The Troponin-T assay comes as negative.

Echocardiogram

The echocardiogram shows a dilated left atrium and left ventricle with diffuse hypokinesia. There is left ventricular hypertrophy and the ejection fraction is 45%.


Step 3: Select appropriate management

ICU care
Thrombolysis
IV Nitroglycerin
IV Labetalol


Score: ★★☆