Author: Leon wood / Editor: Sarah Edwards / Codes: / Published: 18/04/2025
It is 02:15 and a 35-year-old male is brought in by ambulance with 2-day history of central chest pain, dull ache, radiating to his back with associated shortness of breath (SOB) at times. He was found to have ECG changes and a blood Pressure (BP) of 220/116mmHg at home, ambulance crew discussed with cardiology advised to send to the emergency department (ED) as a hypertensive emergency.
On arrival to the ED, he is having active chest pain with an 8/10 rating of his pain radiating to his back with no SOB. On further exploration his chest pain starts at rest, and he has noticed over past few days the breathlessness, but no fever or cough. Morphine 5mg is given for his pain intravenously (IV). His ECG shows sinus rhythm rate 101 with ST depression V4-V6 >2mm and ST elevation <1mmV1-V3) BP was 241/171mmHg.
There is no past medical history (PMH) but the patient has family history of hypertension (sister). He is active: plays sport, is a non-smoker, doesn’t drink alcohol, has no history of recreational drug use and isn’t on any regular medications. Originally, he is from Ghana and has been in the UK for over 1 year.
His examination is grossly normal.
Heart sounds are normal with no visual changes. (no retinal scans taken)
