Differential Diagnosis for Hypertensive Urgency
The patient presents with severely elevated blood pressure, which is a medical emergency. The following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Hypertensive Emergency: The patient's blood pressure is significantly elevated, which can lead to end-organ damage. The symptoms of headache, vision changes, and floaters are consistent with hypertensive emergency, particularly hypertensive encephalopathy or retinopathy.
- Other Likely Diagnoses
- White Coat Hypertension: Although the patient's blood pressure is elevated, it's possible that the stress of being at the dentist or urgent care is contributing to the high readings.
- Secondary Hypertension: The patient's age and lack of medical history make secondary hypertension less likely, but it's still possible that an underlying condition, such as renal disease or sleep apnea, is contributing to the elevated blood pressure.
- Pheochromocytoma: This rare tumor can cause episodic hypertension, but it's less likely given the patient's lack of other symptoms, such as palpitations or sweating.
- Do Not Miss Diagnoses
- Aortic Dissection: Although the patient denies chest pain, aortic dissection is a life-threatening condition that can present with hypertension and should not be missed.
- Intracranial Hemorrhage: The patient's headache and vision changes could be indicative of an intracranial hemorrhage, which is a medical emergency.
- Pulmonary Embolism: Although the patient denies shortness of breath, pulmonary embolism can present with hypertension and should be considered, especially if there are other risk factors.
- Rare Diagnoses
- Hyperthyroidism: Thyroid storm can cause hypertension, but it's less likely given the patient's lack of other symptoms, such as weight loss or exophthalmos.
- Cushing's Syndrome: This rare endocrine disorder can cause hypertension, but it's unlikely given the patient's lack of other symptoms, such as weight gain or striae.
- Renal Artery Stenosis: This condition can cause secondary hypertension, but it's less likely given the patient's age and lack of other symptoms, such as abdominal bruit.