Shortness of Breath (Dyspnea): Difficulty breathing.

Pathophysiology: In severe hypertension, the heart has to work much harder against increased systemic resistance. This can lead to left ventricular hypertrophy (thickening of the heart's main pumping chamber) and eventual heart failure, where the heart cannot pump enough blood to meet the body's needs. This can cause fluid to back up into the lungs (pulmonary edema), leading to shortness of breath.

Chest Pain: A feeling of pressure, tightness, or aching in the chest.

Pathophysiology: Can be due to increased myocardial oxygen demand (the heart muscle needs more oxygen to pump against high pressure) potentially leading to angina (chest pain from reduced blood flow to heart muscle) or even myocardial infarction (heart attack). Also, severe hypertension can cause aortic dissection (a tear in the inner layer of the aorta), which presents with sudden, severe chest or back pain.

Palpitations: A sensation of a rapid, strong, or irregular heartbeat.

Pathophysiology: Can be due to increased sympathetic activity, or in response to the heart working harder against high pressure, potentially leading to arrhythmias (irregular heart rhythms).

Signs (Objective findings observed by the examiner)

Elevated Blood Pressure Readings: The most direct sign. Multiple readings over time confirm the diagnosis.
Retinal Changes (on fundoscopy): Examination of the back of the eye with an ophthalmoscope may reveal:
- Arteriolar Narrowing: Blood vessels in the retina appear constricted due to sustained vasoconstriction.
- Arteriovenous (AV) Nicking: Where a retinal artery crosses over a retinal vein, the artery appears to indent or "nick" the vein, indicating hardening of the arterial wall.
- Hemorrhages: Small bleeds (dot and blot hemorrhages, flame-shaped hemorrhages) from ruptured capillaries.
- Exudates: Yellowish deposits of fluid and lipids that have leaked from damaged vessels.
- Papilledema: Swelling of the optic disc (where the optic nerve enters the eye), indicating very severe hypertension and increased intracranial pressure.
Cardiac Murmurs/Gallops (on auscultation): Listening to the heart with a stethoscope.
- S4 Gallop: An extra heart sound heard just before S1 (first heart sound), often indicative of a stiff, non-compliant left ventricle due to chronic hypertension and left ventricular hypertrophy. The sound is produced by atrial contraction against a stiff ventricle.
- Aortic Regurgitation Murmur: In severe, long-standing hypertension, the aortic root (part of the aorta near the heart) can dilate, preventing the aortic valve from closing properly, leading to a diastolic murmur.
Bruits (on auscultation): A whooshing sound heard over an artery, indicating turbulent blood flow.
- Renal Artery Bruit: Heard over the abdomen, particularly in the flanks, suggests renovascular hypertension (narrowing of the renal artery). The turbulence is created as blood rushes through the narrowed vessel.
- Carotid Bruit: Heard over the carotid arteries in the neck, suggests carotid artery stenosis (narrowing), which can be associated with generalized atherosclerosis, a risk factor for hypertension and its complications.
Peripheral Edema: Swelling, usually in the ankles or legs.
- Pathophysiology: Can be a sign of heart failure (right-sided heart failure) or kidney disease, both