Acute Myocardial Injury in the Setting of Hypertensive Emergency: A Case Report.

Hypertensive emergency can cause acute myocardial injury characterized by chest pain, elevated cardiac biomarkers, and ischemic electrocardiographic changes in the absence of obstructive coronary artery disease. This presentation reflects a mismatch between myocardial oxygen supply and demand, driven by severe afterload increase, microvascular dysfunction, and subendocardial ischemia. Differentiating this entity from type 1 myocardial infarction is critical, as management priorities differ significantly. Prompt but controlled blood pressure reduction remains the cornerstone of treatment and often leads to rapid clinical and biological improvement. Recognizing this underdiagnosed presentation helps avoid unnecessary invasive procedures and guides appropriate therapeutic strategies.