Abstract
Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography. We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6 h.
Highlights
An estimated 26% of emergency department (ED) patients will have an elevated blood pressure (BP) with half of these patients having a BP > 160/100 [1, 2]
Distinguishing hypertensive urgency and emergency is challenging as both conditions involve marked elevation of blood pressure (BP, i.e., systolic BP ≥ 180 and/ or diastolic BP ≥ 120)
Unlike conventional 2D echocardiography which relies on visual estimation to assess cardiac contractility, strain echocardiography utilizes computerized speckle-tracking to measure actual tissue deformation of the myocardium
Summary
An estimated 26% of ED patients will have an elevated BP with half of these patients having a BP > 160/100 [1, 2]. Distinguishing hypertensive urgency and emergency is challenging as both conditions involve marked elevation of blood pressure (BP, i.e., systolic BP ≥ 180 and/ or diastolic BP ≥ 120). Strain can be measured in the longitudinal, radial and circumferential planes of the left ventricle (LV). Peak longitudinal strain (PLS) is a measurement of the overall longitudinal deformation of the left ventricle from diastole to systole. An electrocardiogram (EKG), a chest radiograph, and bedside echocardiogram (BSE) performed by ultrasound trained EPs. An apical four-chamber was obtained to calculate peak longitudinal strain (PLS) using only this view. 1 and 2 are quad displays of an apical 4-chamber image demonstrating peak longitudinal strain (PLS) of the left ventricle (white arrow). The y-axis, where the red color represents more negative strain
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