Ms. S.J., aged 48 years, has essential hypertension, diagnosed 4 years ago. She
ID: 163414 • Letter: M
Question
Ms. S.J., aged 48 years, has essential hypertension, diagnosed 4 years ago. She has not been taking her medications during the past 6 months because she has been feeling fine. Now she has a new job and has been too busy to enjoy her usual swimming and golf. She has decided to have a checkup because she is feeling tired and dyspneic and has had several bouts of dizziness, blurred vision, and epistaxis (nosebleeds) lately. On examination, her blood pressure is found to be 190/120, some rales are present in the lungs, and the retinas of her eyes show some sclerosis and several arteriolar ruptures. The physician orders rest and medication to lower the blood pressure, as well as an appointment with a nutritionist and urinary test to check kidney function.
1. Describe the pathophysiology of essential hypertension.
2. Explain the possible problems associated with the high diastolic pressure.
3. Explain the significance of the retinal changes.
4. The doctor suspects mild congestive heart failure. Explain how this can develop from hypertension.
5. Give two other possible signs of CHF.
6. List two medications that are helpful in treating hypertension and describe their actions.
Explanation / Answer
1. Describe the pathophysiology of essential hypertension.
Pathophysiology of essential hypertension includes:
a) overactivation of Renin-Angiotensin system that causes vasoconstriction of arteries and retains sodium causing more water retention and leading to hypertension
b) automatic Overstimulation of sympathetic nervous system that causes incerased stress response.
2. Explain the possible problems associated with the high diastolic pressure.
High diastolic pressure can cause angina(Chest pain), heart attack, shortness of breath,stiffning of heart muscle.
Hypertension can lead to angina as high BP damages coronary arteries causing their blockage and abnormal blood movementt to heart causing chest pain.
Stiffness of heart muscles is caused by extra amount of work muscles have to do to pump blood to the whole body.
Reduced supply of blood
3. Explain the significance of the retinal changes.
The changes in blood pressure leading to changes in atrerial circulation causes damage and changes in retina. The high blood pressure can also lead to retinal hemorrhages in nerve fibre layer.It also causes damage to arterioral endothelium causing further thickening of blood vessels and narrowing of its lumen.
4. The doctor suspects mild congestive heart failure. Explain how this can develop from hypertension.
Hypertension menas high blood pressure, which simply means heart needs to work harder to pump the blood through body. This extra work cause stiffness of heart muscles and they become hard. This leads to abnormal /irregular heart beat.Insufficient supply also accumulates flui in the body depending upon ventricular chamber being affected. This causes
5. Give two other possible signs of CHF.
Signs of Congestive Heart Failure: Shortness of breath,
Bloated feeling in stomach accompanied by necessity to urinate at night frequently
6. List two medications that are helpful in treating hypertension and describe their actions.
a. Angiotensin II Receptor Blockers :These work by blocking receptors that bind which chemical aniotensin . This leads to reduction of vasoconstriction and reduces hypertension.
b. Diuretics These are the substances that remove extra water and sodium ions from body and reduces blood volume reducing blood pressure.
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