In a hypertensive emergency a marked increase in arterial blood pressure is associated with end-organ damage. Changes in the T wave can be an early indicator of impending myocardial damage.


Patient selection: hypertensive crisis in a patient over 40 years of age


Early changes suggesting subendocardial ischemia:

(1) acute appearance of tall and symmetrical T waves

(1a) T wave >= 0.65 mV in lead II

(1b) T wave >= 1.0 mV in precordial leads

(2) angina symptoms


These changes will revert to normal as the blood pressure is reduced if the injury is reversible.


Signs of actual myocardial end-organ injury:

(1) persistence of findings despite correction of blood pressure

(2) T wave inversions

(3) ST segment changes


Prompt recognition of the T wave changes with appropriate management can prevent irreversible myocardial damage.


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