Essential Initial Investigations

• Renal function: to evaluate possible renal impairment
• Electrolyte panel: electrolyte abnormalities may precipitate arrhythmias in cardiac ischaemia, and may also occur in renal impairment

Urinalysis

• Haematuria, proteinuria or casts may indicate primary renal parenchymal disease or secondary renal impairment
• Pregnancy test

ECG

• To assess for myocardial ischaemia/infarction or evidence of left ventricular hypertrophy/strain
• The image shows a markedly ischaemic ECG

Chest x-ray

• To assess for evidence of left ventricular failure (pulmonary oedema, left ventricular enlargement)
• To assess for widening of the mediastinum (aortic dissection)
• The CXR shows cardiac enlargement and marked failure

CT medisatinum/aortogram

• If thoracic aortic dissection is suspected following clinical examination
• The CT shows true and false lumens associated with a thoracic dissection

CT Head

• When there is evidence of neurological dysfunction and cerebral encephalopathy, haemorrhage or infarction is suspected
• The CT shows a left middle cerebral artery sign in a patient who presented with a cerebral infarction and elevated blood pressure.