A 45-year-old man with a history of chest pain, headache, narcotic dependency, and uncontrolled hypertension presented to the emergency department at Lakeview Hospital, in Anaheim, California, with a 3-day history of worsening chest pain and headache. He completed a 3-day hospitalization with negative objective findings a month previously when he presented with headache and chest pain. Following that discharge he felt well and reported home blood pressures in the 140s/80s mm Hg. Three days prior to admission, throbbing left-sided chest pain radiating to the left shoulder returned, accompanied by worsening right occipital headaches. Home blood pressures were above 200/100 mm Hg despite self-titration of labeto-lol to 800 mg 3 times a day per instructions of his former primary care physician in northern California. Additionally, vision in the baseline "85% blind" right eye had worsened. He complained of dry heaves along with chronic left-sided weakness and numbness from a past stroke. Initial emergency department blood pressure was 229/143 mm Hg. The patient stated adherence to an antihypertensive regimen of lisinopril 40 mg, spironolactone 25 mg, labetolol 800 mg twice a day, minoxidil 10 mg twice a day, furosemide 40 mg twice a day, amlodipine 10 mg, and terazosin 20 mg at bedtime.
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机译：一名有胸痛，头痛，麻醉依赖和高血压不受控制的病史的45岁男子被送往加利福尼亚州阿纳海姆市湖景医院急诊室，有3天的病史，加剧了胸痛和头痛。当他出现头痛和胸痛时，他在一个月前完成了为期3天的住院治疗，客观结果阴性。放电后，他感觉良好，并报告家庭血压为140s / 80s mm Hg。入院前三天，returned动的左侧胸痛放射至左肩，并伴有右枕头痛加剧。根据他在加利福尼亚北部的前初级保健医生的指示，尽管拉贝特洛尔每天自行滴定至800 mg，但家庭血压仍高于200/100 mm Hg。此外，基线“ 85％失明”右眼的视力已恶化。他抱怨起床干dry，以及由于过去的中风而导致的慢性左侧虚弱和麻木。最初的急诊科血压为229/143毫米汞柱。该患者表示在睡前遵守抗高血压方案：赖诺普利40 mg，螺内酯25 mg，拉贝洛尔800 mg每天两次，米诺地尔10 mg每天两次，呋塞米40 mg每天两次，氨氯地平10 mg和特拉唑嗪20 mg。
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