Hypertensive Crisis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of elevated blood pressure

Blood pressure up to ‍

Pattern ‍persistentintermittent



Associated symptoms: *Try using right-click for negatives*

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍blurred vision

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍dizziness

‍fainting

‍nosebleeds

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍back pain

‍confusion

‍seizures

‍anxiety



Contributing factors:

‍non-adherence to medication

‍anxiety

‍high salt diet

‍excessive caffeine intake

‍alcohol use

‍cocaine use

‍amphetamine use

no history of: ‍hypertension, ‍diabetes, ‍kidney disease, ‍heart disease, ‍stroke, ‍obesity, ‍pheochromocytoma

no use of: ‍NSAIDs, ‍over-the-counter cold medication, ‍oral contraceptives, ‍corticosteroids, ‍stimulant drugs





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Hypertensive crisis ‍likelysuspectedpossible

DDx: anxiety, white-coat hypertension, stimulant drug abuse, medication noncompliance, salt restriction noncompliance, secondary hypertension, pheochromocytoma, acute stress response, thyroid/parathyroid disease, stroke, myocardial infarction, aortic dissection





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍lipid profile, ‍TSH, ‍troponin

- Urinalysis

- ECG

- Cardiac monitoring

- Chest X-ray

Treatments:

- ‍IV antihypertensives

- ‍ACEs

- ‍ARBs

- ‍Beta-blockers

- ‍Calcium-channel blockers

- ‍Diuretics

- ‍Others anti-hypertensives

- Lifestyle modifications: ‍weight loss, ‍exercise, ‍low salt diet, ‍low fat diet, ‍smoking cessation, ‍alcohol cessation, ‍stress reduction

Further care:

- Home blood pressure monitoring

- Referral to cardiologist

- Referral to internist

- Follow-up in ‍ days

- Return if blood pressure remains above target despite treatment

- Referral to ER if severe chest pain, severe shortness of breath, or fainting occurs