Cadiovascular Case 1?
A 5’6", 210 lb., 64-year-old male business executive had a physical exam prior to his retirement from corporate work. His blood pressure was >180/115 on three separate days. Further examination showed normal to low plasma renin activity, elevated total peripheral resistance (TPR), cardiac output (CO) of 7.2 L/min, x-ray evidence of left ventricular hypertrophy, retinal hemorrhages, and mild polyuria. Recommended therapy was weight reduction to his ideal level, a low-salt diet (<2 gm/day sodium), prudent exercise, and a reduction in alcohol consumption (<3 oz whiskey/day). This change in lifestyle did little to change the condition. Medication was initiated in the form of an oral diuretic and progressed to a beta-blocker; eventually a vasodilator was included to reduce the blood pressure to <140/90.
1. What is the diagnosis for this individual?
2. What should this individual’s ideal body weight be? (Assume he is of medium body frame.)
3. Explain the sites of action for the three pharmacologic agents prescribed for this individual.
Oral diuretic:
Beta-blocker:
Vasodilator:
4. Why was the vasodilator not used before the other drugs were added?
5. Outline the usual steps in the medical treatment of hypertension.
6. What was the cause of the retinal hemorrhages?
7. Define and indicate the causes of the cardiac hypertrophy and polyuria.
8. Write the formulas for determining mean arterial blood pressure, blood pressure, and pulse pressure.
MABP =
BP =
PP =
Tagged with: alcohol consumption • arterial blood pressure • beta blocker • body frame • business executive • cardiac hypertrophy • cardiac output • left ventricular hypertrophy • low salt diet • lt 2 • mean arterial blood pressure • medium body • pharmacologic agents • plasma renin activity • pulse pressure • recommended therapy • retinal hemorrhages • total peripheral resistance • treatment of hypertension • vasodilator
Filed under: how to lower blood pressure
Case 1
CARDIOVASCULAR UNIT
Congenital Heart Diseases
http://www.uchsc.edu/pathology/smallgroups/cardiovascular/cvc-cong-c1.htm
1 low renin hypertension or stage 3 hypertension 2 176 maximum, 118 to 155 is the suggested. 3kidney, beta receptors and vascular smooth muscle. 4 experimental studies have demonstrated impaired nitric oxide-mediated bioactivity in these states. 5 read washington manuel of medical therapeutics 30th edition page 76 to 95. 6 A retinal haemorrhage can be caused by hypertension, retinal vein occlusion (a blockage of a retinal vein), or diabetes mellitus (which causes small fragile blood vessels to form. 7 Cardiac hypertrophy occurs because of pressure and/or volume overload on the heart. Possible causes include high blood pressure, heart valve disease, weakness of the heart muscle (cardiomyopathy), abnormal heartbeat, anemia, thyroid disorders, excessive iron in the body, protein buildup in the heart (amyloidosis) and cocaine use.
Polyuria is often associated with hypertension. It may result from large fluid intake, caffeine, alcohol, lithium, diabetes, polydipsia (excessive thirst), kidney failure, kidney defects, sickle cell anemia, low blood potassium, anxiety, Cushing’s syndrome or certain drugs (e.g., diuretics).
8 MABP is equivalent to diastolic pressure+1/3systolic pressure, BP Hutchison’s clinical methods 21st edition page 86 PP difference between systolic and diastolic bp, shall i ask you why u took this much trouble, you could have asked your seniors or refer text books,
thank you, Dr aziz