Fast Five Quiz: Review Key Information on Hypertensive Emergencies

Richard H. Sinert, DO


January 02, 2018

The presence of new retinal hemorrhages, exudates, or papilledema suggests a hypertensive emergency. Evaluate for the presence of heart failure, which may be indicated by jugular venous distention, crackles on auscultation, and peripheral edema.

Patients may complain of specific symptoms that suggest that end-organ dysfunction may be present. Chest pain may indicate myocardial ischemia or infarction, back pain may denote aortic dissection, and dyspnea may suggest pulmonary edema or congestive heart failure.

The physical examination should assess whether end-organ dysfunction is present. BP should not only be measured in both the supine position and the standing position (assess volume depletion), but it should also be measured in both arms (a significant difference may suggest aortic dissection).

The most common signs of hypertensive urgency include epistaxis, faintness, and psychomotor agitation. The most common signs of hypertensive emergency include chest pain, dyspnea, and neurologic deficit.

For more on the history and physical examination in patients with hypertensive emergencies, read here.


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