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SYSTEMIC ARTERIAL HYPERTENSION, MANRÍQUEZ JIMÉNEZ GABRIELA 3C - Coggle…
SYSTEMIC ARTERIAL HYPERTENSION
Case study
Background
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.
Physical exam
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).
Medication
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
Plan
Blood pressure is suboptimal. Will add hydrochlorthiazide 25 mg/daily to reduce systolic blood pressure.
Outcome
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
Concept
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.
Risk factor's
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