Question

In: Anatomy and Physiology

Scenario: DW is a 65-year-old, 135 kg male who visited his primary care physician for a...

Scenario: DW is a 65-year-old, 135 kg male who visited his primary care physician for a routine examination. His blood pressure was 158/100 mmHg and his heart rate was 71 bpm. Stroke volume and cardiac output were normal. Serum renin levels were in the normal range. A chest x-ray revealed left ventricular hypertrophy. Other clinical findings were unremarkable.

For this problem, pharmacologic therapies include diuretics, ACE inhibitors, beta-adrenergic receptor antagonists, and vasodilators. Explain the physiological effects on the cardiovascular system for each of these 4 classes of drugs and why these could be helpful.

In the description of the case, serum renin is said to be in normal range. Elevated renin would indicate that vasoconstrictor hormone angiotensin II is elevated. Assume that this case indicated renin is elevated, and predict that angiotensin II would also be elevated. How would this hormone affect blood pressure?

Solutions

Expert Solution

The given patient seems to have hypertension (raise blood pressure) and hence was given the above set of drugs. The physiological effects of each of the above on the cardiovascular system are as follows:

Diuretics- these reduce the blood volume which in turn reduce the preload on the heart(in the form of venous return) and hence the workload on the heart muscles.

ACE inhibitors- these drugs inhibit the angiotensin converting enzyme which covert the inactive angiotensin to active form which causes vasoconstriction and also cause structural changes in the heart known as remodeling ( eg. Hypertrophy given in the question).

Beta adrenergic receptor antagonists also known as beta blockers are a group of drugs which causes a depression in the heart activity in the form of decreased heart reate and decreased conductivity. This results in decreased cardiac output (as cardiac output is the product of stroke volume amd heart rate).

Vasodilator- these drugs cause dilatation of both arteries and veins. The dilation of veins causes decrease in cardiac work load by a decrease in preload while the arteriolar dilation cause decrease in afterload by decreasing the peripheral resistance and also causes decrease in blood pressure.

If in case, renin was increased in the serum, it would mean an increased level of angiotensin II which is a potent vasoconstrictor. The net effect would be further higher value of systolic blood pressure and may be more changes in the left ventricular structure due to its effects of remodeling on the heart muscles.

Sydney Mullin answered 1 year ago
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