Malignant Hypertension is a rare but preventable cause of death. In this article we present a short report on a case of malignant hypertension presenting with heart failure in a 37-year-old male. The swift response to therapy in this case highlights the improved outlook for this condition with currently available medical therapy. The treatment and epidemiology of this condition is further discussed. Case Report A 37-year-old man presented with a 10-day history of chest pain, increasing breathlessness and ankle swelling. He had an 18-month history of cough and breathlessness. He had been managed on several occasions during this period with oral antibiotic therapy for presumed respiratory tract infection. He had a 20-pack year history of smoking but drank no alcohol and took no recreational drugs. He had no obvious symptoms related to sleep apnoea. On registration with his general practitioner, 9 years prior, his blood pressure was 145/90 mmHg, however no further blood pressure recordings had been undertaken. Clinical examination revealed an obese man (body mass index, 39), who was pale, sweaty and clearly unwell. He appeared to be fully orientated, with a resting sinus tachycardia of 100/min. His blood pressure was 205/125 mmHg, seated, using a large cuff and equal in both arms. Jugular venous pressure was elevated to 6 cm with a 3rd heart sound, but there were no cardiac murmurs or peripheral bruits. He was tachypnoeic with a respiratory rate of 32 breaths/min and had bilateral basal lung crepitations with pitting peripheral oedema to his knees. Fundoscopy was performed (fig 1). Urine dipstick was normal. A 12 lead electrocardiogram (fig 2) and chest x-ray (fig 3) were undertaken. Other baseline tests were unremarkable, accept for evidence of mild renal impairment: urea 12.3mmol/L (normal 3.0-7.6 mmol/L) and creatinine 137 mol/L (normal 60-120 μmol/L). Questions 1. What is shown on fundoscopy (Fig 1)?
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