Differential Diagnosis for Hypertensive Urgency or Emergency
Single Most Likely Diagnosis
- Hypertensive Emergency: The patient's blood pressure is significantly elevated (240/85 mmHg) with symptoms of headache and bradycardia, suggesting end-organ damage, which is characteristic of a hypertensive emergency.
Other Likely Diagnoses
- Hypertensive Urgency: Although the blood pressure is high, the presence of symptoms like headache could also suggest hypertensive urgency, especially if there's no clear evidence of end-organ damage.
- Pheochromocytoma: This rare tumor of the adrenal gland can cause episodic hypertension, headaches, and bradycardia due to the excessive release of catecholamines.
- White Coat Hypertension: The elevated blood pressure reading could be due to anxiety or stress in a clinical setting, although the presence of symptoms like headache and bradycardia makes this less likely.
Do Not Miss Diagnoses
- Aortic Dissection: Although less likely, aortic dissection is a life-threatening condition that can present with severe hypertension and should always be considered, especially if there are symptoms like chest or back pain.
- Intracranial Hemorrhage: Severe hypertension can lead to intracranial hemorrhage, which would present with headache and potentially altered mental status, making it a critical diagnosis not to miss.
- Pregnancy-Induced Hypertension: In pregnant women, severe hypertension can be a sign of preeclampsia, a condition that can lead to significant maternal and fetal morbidity if not promptly addressed.
Rare Diagnoses
- Cushing's Syndrome: This rare endocrine disorder can cause hypertension due to excess cortisol production, but it would typically be associated with other signs like weight gain, moon face, and buffalo hump.
- Hyperthyroidism: Although more commonly associated with tachycardia, hyperthyroidism can sometimes present with hypertension and, less commonly, bradycardia, especially in the context of a thyroid storm.
- Adrenal Crisis: An acute deficiency of cortisol and aldosterone can lead to hypotension, but certain phases or types of adrenal insufficiency might present with hypertension, especially if there's an element of mineralocorticoid excess.