![]() ![]() While the specific target organ that is affected may dictate some specifics of treatment, rapid lowering of blood pressure is the mainstay of therapy for hypertensive emergencies. The eye exam may reveal papilledema as well as exudates and flame-shaped hemorrhages.Īcute renal failure may also result in signs of pulmonary edema or peripheral edema. A careful neurologic exam that includes a cranial nerve exam, strength, and sensation testing, as well as cerebellar tests and gait testing should be done. Neurologic dysfunction may result in altered mental status, blurry vision, ataxia or other cerebellar dysfunction, aphasia, or unilateral numbness or weakness. In the event of a very rapid onset of hypertension, often seen with sympathomimetic abuse, marked dyspnea in the absence of peripheral edema due to flash pulmonary edema may be encountered. With cardiac dysfunction, rales may be heard on lung auscultation, jugular venous distention or peripheral edema may be noted, and extra heart sounds may be apparent. The expected exam findings vary depending on the specific target organ most affected. ![]() The source of the abrupt onset of hypertension should also be investigated to direct treatment. Symptoms such as a headache, dizziness, altered mental status, shortness of breath, chest pain, decreased urine output, vomiting, or changes in vision warrant further evaluation. In patients who present with markedly elevated blood pressure, a careful history and exam are necessary to determine which of these patients is having a true hypertensive emergency. ![]()
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