SYSTEMIC ARTERIAL HYPERTENSION, MANRÍQUEZ JIMÉNEZ GABRIELA 3C - Coggle…
SYSTEMIC ARTERIAL HYPERTENSION
Mr. S is an 80 year old African American with a history of smoking, ETOH (claims he no longer drinks), epileptic seizures from a right fronto-temporal region and a history of heart failure with preserved ejection fraction.
Echocardiogram on this visit revealed: left ventricular hypertrophy and abnormal relaxation, left ventricular end-systolic and end-diastolic diameters of 2.6 cm and 3.6 cm, respectively (normal), EF 50%, and right ventricular systolic pressure 38 mm Hg (mild pulmonary hypertension)
He denies chest pain, palpitations, lightheadedness, dizziness, nausea, edema, or difficulties with eating. He follows a low sodium diet. Mr. S has no known allergies.
Alert, cooperative, no jugular venous distension, no hepatojugular reflux, no peripheral edema. Lungs clear, abdomen is soft and nontender. Heart rate and rhythm are regular, has a 2/6 systolic murmur at the left lower sternal border.
BP, 142/64 mm Hg; pulse, 64 bpm; weight, 132 lbs (60 kg); NYHA FC II-III.
Most recent echocardiogram (6 months later): EF, 55%, right ventricular systolic pressure 42 mm Hg (mild pulmonary hypertension). Left ventricular hypertrophy and abnormal relaxation. Left ventricular end-systolic and end-diastolic diameters are 2.5 cm and 3.6 cm, respectively (normal).
metoprolol succinate (Toprol XL) 150 mg/daily ; paroxetine (Paxil) 10 mg/daily; levetiracetam (Keppra) 500 mg/ twice daily; amlodipine (Norvasc) 10 mg/daily; ramipril (Altace) 10 mg/ twice daily; aspirin 325 mg/daily; Magnesium oxide (Mag-Ox) 400 mg/twice daily; gabapentin (Neurotin) 300 mg/twice daily
Serum laboratory history
Sodium, 136 mmol/L; Potassium, 4.7 mmol/L; BUN, 22 mg/dL; creatinine, 1.3 mg/dL; total cholesterol, 174 mg/dL; HDL, 62 mg/dL; LDL, 93 mg/dL; triglyceride, 96 mg/dL
Blood pressure is suboptimal. Will add hydrochlorthiazide 25 mg/daily to reduce systolic blood pressure.
Outcome at 4 weeks: At next visit, NYHA FC was reduced; less fatigue with activities and now sleeping on one pillow. BP, 102/50 mm Hg. Eating better; has gained 1 kg (now 61 kg). Current echocardiogram with this visit shows RVSP down to 38 mm Hg. No complaints of dizziness or lightheadedness. Treatment regime maintained
Chronic degenerative disease characterized by a sustained increase in blood pressure levels in the arteries (systolic). Generally, hypertension is defined as blood pressure above 140/90 and is considered serious when it is above 180/120.
Overweight and obesity are considered a predictor of morbidity and mortality for cardiovascular diseases such as cerebrovascular disease, myocardial infarction, heart failure, peripheral arterial disease, and kidney failure.
MANRÍQUEZ JIMÉNEZ GABRIELA 3C