Medical Emergencies · patient case question
His blood pressure and symptoms represent a hypertensive emergency. Which complication is he at risk of?
Patient case: Blood pressure, potassium and a pounding headache
demo: 63-year-old male
chief: Presents for extraction of a hopeless mandibular molar.
history: Hypertension for fifteen years. He tells you he ran out of his tablets ten days ago. His father died of a subarachnoid haemorrhage.
meds: Lisinopril 20 mg daily. Triamterene with hydrochlorothiazide, one tablet each morning.
findings: Blood pressure on arrival is 204/122 mmHg in both arms, repeated after five minutes of rest. He describes a severe occipital headache that began this morning and some blurring of vision.
Show answer and explanation
Correct answer: A. Rupture of a cerebral aneurysm
- A. Correct. Severe uncontrolled hypertension is the principal risk factor for rupture of an intracranial aneurysm, producing subarachnoid haemorrhage. His severe sudden headache, visual disturbance and family history make this the pressing concern. Defer all elective treatment and arrange urgent medical assessment.
- B. Orthostatic hypotension is a fall in pressure on standing. It is a real concern in medicated hypertensive patients when they rise from the dental chair, but it is not a complication of a hypertensive crisis.
- C. Hypovolaemic shock results from blood or fluid loss and presents with a low pressure and a compensatory tachycardia.
- D. Vasovagal syncope is a transient reflex event triggered by pain, anxiety or standing, in which vagal tone drops both heart rate and blood pressure. It is the opposite haemodynamic situation.
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