Malignant hypertension physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Blood pressure must be checked in both arms to screen for aortic dissection or coarctation.
• Orthostatic vital signs

• A funduscopic examination may reveal silver wiring (Grade I retinopathy), AV nipping (Grade II) flame-shaped retinal hemorrhages, soft exudates (Grade III), or papilledema (Grade IV)

• Examination of jugular veins
• Carotid bruits

• Third or fourth heart sound or murmurs.

• Pulmonary rales

• Renal bruits

• Assessment of liver size

• Pedal edema

• Focal neurologic signs

• Focal signs of subarachnoid hemorrhage, infarct, or the presence of a mass.

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