Differential Diagnosis for Hypertensive Emergency with Decompensated Heart Failure and Pulmonary Edema
Single Most Likely Diagnosis
- Hypertensive Heart Disease (HHD): This is the most likely diagnosis given the presentation of hypertensive emergency with decompensated heart failure and pulmonary edema. Chronic uncontrolled hypertension leads to left ventricular hypertrophy, which can eventually result in heart failure.
Other Likely Diagnoses
- Chronic Kidney Disease (CKD): CKD is a common cause of secondary hypertension and can lead to fluid overload, contributing to heart failure and pulmonary edema.
- Primary Aldosteronism: This condition, characterized by excessive aldosterone production, can cause resistant hypertension and lead to heart failure.
- Pheochromocytoma: Although rare, pheochromocytoma can cause episodic hypertension leading to heart failure and pulmonary edema.
- Sleep Apnea: Sleep apnea is associated with hypertension and can exacerbate heart failure.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely, aortic dissection is a life-threatening condition that can present with hypertensive emergency and must be ruled out.
- Pulmonary Embolism: Large pulmonary embolism can cause acute right heart failure and pulmonary edema, mimicking the presentation of hypertensive emergency.
- Cardiac Tamponade: Cardiac tamponade can cause acute heart failure and pulmonary edema, and its diagnosis is critical due to its high mortality if untreated.
Rare Diagnoses
- Thyroid Storm: Thyrotoxic crisis can cause severe hypertension and heart failure.
- Cushing's Syndrome: Excess cortisol can lead to hypertension and contribute to heart failure.
- Hyperparathyroidism: Rarely, primary hyperparathyroidism can cause hypertension and contribute to heart disease.
- Vasculitis (e.g., Takayasu Arteritis): These conditions can cause secondary hypertension and are important to consider in younger patients or those with suggestive symptoms.