Dr. Ally, a 49-year-old professor, was diagnosed with essential hypertension 12 years ago and was on antihypertensive drugs. However, he did not take his medications last year because he was feeling just fine. In addition, he was very busy with work. Nevertheless, he felt tired after work and developed dyspnea while climbing the stairs. Recently, he had a bout of epistaxis (severe nose bleed) with dizziness and blurred vision. He went to the doctor for a checkup. His blood pressure was 180/110, and the doctor found rales or crackles on his chest upon auscultation. The doctor ordered rest and asked him to start his medication again.
What are the patientÂ’s problems?
What pathophysiological changes are happening in his eyes and heart?
According to the doctor, the patient might have developed congestive heart failure. Is it right-sided or left-sided?
What medications are likely to have been used? Describe the mechanisms of actions of at least two antihypertensive drugs.
-Sample Answer-
The patient’s problems include essential hypertension, which is high blood pressure that has no known cause, and congestive heart failure. It is not clear from the information provided which type of congestive heart failure the patient has developed, whether it is right-sided or left-sided.
In the patient’s eyes, the high blood pressure may have caused damage to the blood vessels in the retina, leading to blurred vision. In the heart, the high blood pressure may have caused the heart to work harder to pump blood, leading to heart muscle damage and eventual heart failure.
Antihypertensive medications that may have been used to treat the patient’s high blood pressure include beta blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), and calcium channel blockers.
Beta blockers work by blocking the effects of the hormone epinephrine, which can cause the heart to beat faster and blood vessels to narrow. This helps to lower blood pressure and reduce the risk of heart attacks and strokes.
ACE inhibitors work by blocking the production of angiotensin II, a hormone that causes blood vessels to narrow and increases blood pressure. By blocking the production of angiotensin II, ACE inhibitors help to relax blood vessels and lower blood pressure.
Calcium channel blockers work by blocking the movement of calcium ions into cells in the heart and blood vessels. This helps to relax the blood vessels and lower blood pressure.
