Essential Initial Investigations
Appropriate initial investigations for patients presenting with a possible hypertensive emergency are as follows:
Biochemistry
- Renal function: to evaluate possible renal impairment
- Electrolyte panel: electrolyte abnormalities may precipitate arrhythmias in cardiac ischaemia, and may also occur in renal impairment
Urinalysis
- Haematuria, proteinuria or casts may indicate primary renal parenchymal disease or secondary renal impairment
- Pregnancy test
ECG
- To assess for myocardial ischaemia/infarction or evidence of left ventricular hypertrophy/strain
- The image shows a markedly ischaemic ECG
Chest x-ray
- To assess for evidence of left ventricular failure (pulmonary oedema, left ventricular enlargement)
- To assess for widening of the mediastinum (aortic dissection)
- The CXR shows cardiac enlargement and marked failure
CT medisatinum/aortogram
- If thoracic aortic dissection is suspected following clinical examination
- The CT shows true and false lumens associated with a thoracic dissection
CT Head
- When there is evidence of neurological dysfunction and cerebral encephalopathy, haemorrhage or infarction is suspected
- The CT shows a left middle cerebral artery sign in a patient who presented with a cerebral infarction and elevated blood pressure.