Question

1. A 54-year-old woman presents in a hospital with complaint of chest pain associated with forceful activities. The pain is dull but poorly localized and disappears few minutes of rest. No history of smoking but there is a positive history of hyperlipidemia. and admits that she has not been following the recommended diet. There was family history of heart attacks and cardiac diseases. Physical examination reveal blood pressure of 150/95 mm Hg, and heart rate of 80 bpm and nothing else is contributory; an electrocardiogram is normal except for slight left ventricular hypertrophy.

a. what is your working diagnosis?

b. what are drug (s) of choice for the treatment? why

c. what counselling will you give to the patient

d. write a summary on your diagnosis

Answer 1

1 a). The working diagnosis is Hypertensive Heart disease due to the presence of symptoms like High Blood pressure, left ventricular hypertrophy, hyperlipidemia and supporting history.

b).

The drugs for hypertension involves the following class of antihypertensive medications:

• Thiazide diuretics mainly chlorthalidone are the first line for hypertension.

• Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers are the first line for hypertension patients with comorbidities such as diabetes or chronic kidney disease

• Calcium channel blockers are another class of first-line hypertension medicine.

• Beta blockers are recommended for use when symptoms of heart failure, ischemic heart disease, atrial fibrillation are present.

Since the patient has Stage 2 Hypertension ( above 140/90 mmHg), two or more of the drugs(from diiferent classes mentioned above) are administered for effective control and the responsiveness is checked every month.

c). Hypertension is a chronic disease that progresses over time but can be controlled by educating the patients. The patient should be counselled to closely monitor their blood pressure by routine check-ups or home monitoring with an automatic blood pressure cuff. It is also important to reduce the risk of heart diseases by adopting lifestyle changes. There must be a strict implementation of the recommended diet ( low sodium diet consisting of under 2g/day and low cholesterol diet). Decreased alcohol intake and increased physical activity (at least three times a week) will promote weight loss and provide significant cardiovascular benefit.

d). Hypertensive heart disease indicates a collection of modification in the left ventricle, left atrium and coronary arteries caused mainly due to elevation in Blood pressure (higher than 120/80 mmHg). It is usually accompanied by hypertrophy of left ventricle which can lead to heart failure. Patients with left ventricular hypertrophy generally present with anginal or ischemic chest pain due to an increase in oxygen demand.

The history of the patient and family history gives us a clearer picture of the co morbidities and risk factors associated with the hypertension. A personal history of hyperlipidemia, and family history of heart attacks and cardiac diseases puts the patient in high risk of associated cardiovascular diseases that may progress to heart failure if not controlled.