A 53 year old man with blurred vision
A 53 year old man presented to the emergency department complaining of a two week history of blurry vision, particularly while reading the newspaper and television text. He felt well and denied associated headaches, limb weakness, or slurred speech. His medical history was uneventful and he was not currently taking medication.
On examination his respiratory rate was 14 breaths per minute, oxygen saturation was 100% on room air, and vesicular breath sounds on chest auscultation. He had a regular pulse of 80 beats per minute, a hyperdynamic apex beat on palpation, and normal heart sounds were auscultated. The average of several repeated blood pressure measurements were 271/179 mm Hg in the left arm, and 265/183 mm Hg in the right. Electrocardiography showed a combined S wave in lead V1 and R wave in lead V6 of >35 mm, suggestive of left ventricular hypertrophy on voltage criteria. His abdomen was soft,