Cardiac Ischaemia

Patients presenting with a hypertensive emergency with evidence of cardiac ischaemia require rapid control of their BP to prevent progression to myocardial infarction, or to prevent further myonecrosis if evidence of infarction has already occurred. Intravenous nitrates which reduce preload on the heart and are also coronary vasodilators are generally used in this setting.

Intravenous nitrates are also used for symptom control in patients with ischaemic chest pain. BP reduction is often only modest with nitrates. Intravenous beta blockers are an ideal adjunctive therapy in this situation since they are known to be cardioprotective in the setting of acute coronary syndromes (even without hypertension).

Commonly used agents in the UK include intravenous atenolol or metoprolol.

Click on the ischaemic ECG to enlarge.