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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