2011-09-13 042452 dr (1)

Dr. Ally, a 49-year-old professor, has been 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 check up. 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 patient's problems? The hypertension putting in pressures on the aorta has caused Dr. Ally’s heart has to work harder causing the heart muscles to become thicker and bigger to compensate for the extra tasks to keep its functions. The condition caused the heart muscles either too stiff or too weak to perform its pumping function leaving the fluids to flow back to the lungs causing shortness of breath. With inefficient blood supply to the body cells, Dr. Ally feels tired easily. • What pathophysiological changes are happening in his eyes and heart? The increased pressures on the blood vessels had affected and caused rupture of the network of vessels in the nose which lead to severe nose bleed. The high blood pressure also generated retinal pressure causing some damage of the retina, a condition called hypertensive retinopathy. Damage of retina caused blurring of vision. In some cases, it could even cause some loss of vision. • According to the doctor, the patient might have developed congestive heart failure. Is it right-sided or left-sided? The symptoms manifested by Dr. Ally indicate development of left-sided heart failure. The high pressure in the aorta exerted by the high blood pressure has caused post load problem which overtime has caused stiffening or weakening of that side of that heart reaching the state that it could no longer function efficiently. • What medications are likely to have been used? Describe the mechanisms of actions of at least two antihypertensive drugs. Dr. Ally most likely has used ACE inhibitors and Beta blockers. The ACE inhibitors are vasodilators with the capability to widen the blood vessels allowing the blood pressure to lower down while improving the blood flow and decreasing the workload of the heart. With its actions, the stress over the heard is reduced which can help prevent further damage and scarring of the muscles. Some commonly used CE inhibitors include Enalapril (Vasotec) and captopril (Capoten). Beta blockers on the other hand lower down the blood pressure and slow down the heart. The drug can improve the functioning of the heart and can reduce the signs and symptoms. Among the common bet blockers used include metoprolol (Lopressor) and carvedilol (Coreg). References Lusby, F. (2010). Hypertensive retinopthy. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000999.htm Mayo Clinic Staff. (2011). Treatment and drugs. Retrieved from http://www.mayoclinic.com/health/heart-failure/DS00061/DSECTION=treatments-and- drugs