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Anisha Khanna

on 9 January 2014

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Transcript of Hypertension

What is Hypertension?
General Diagnostics
General Diagnosis
-20 year old male
-recently graduated high school
-obese (185 lbs)
-poor diet
-smokes occasionally
-parents smoke
-dad has heart disease
-younger sister
Christopher Patterson
commonly referred to as "high blood pressure"
occurs when blood pressure in arteries is abnormally high
-as a result your heart must work harder to circulate blood through blood vessels
Normal blood pressure: 120/80
Hypertension: 140/90
known as the "silent disease" because you usually don't know that you have it until you are tested
usually no symptoms or signs
may experience headache, dizziness, blurred vision, nausea, vomiting, chest
Even when completing short tasks such as walking down the stairs, Christopher is short of breath

Experiences frequent dizziness

His ankles are swollen
pains, shortness of breath, nervousness, sweating, difficulty sleeping or facial flushing
Patient's Symptoms
Blood pressure is measured in millimeters of mercury (mm Hg) and is written systolic over diastolic (Systolic = heart contracts, diastolic = heart relaxes)
Normal blood pressure: less than 120/80 mmHg
Hypertension: 140/90 mmHg

Often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve
-painless, non-invasive,quick
Remember, you don't know you have hypertenstion until you get tested, so there are now many convenient ways to check your blood pressure

Blood pressure measured by a health care provider, at a pharmacy, or you can purchase a blood pressure monitor for your home

Blood pressure machines are available in grocery stores and drugstores, but are not always dependable and accurate because of the one size arm cuff
A physical exam is also necessary
-A stethoscope is used to listen to the heart for any unusual sounds, and your arteries for a whooshing or swishing sound that can indicate that the artery may be somewhat blocked
-Pulses are checked in arm and ankle to determine if they are weak or even absent
-Blood work is checked as well
Blood Test
General Diagnosis
If the patient has an abnormally high blood pressure, the doctor will prescribe an EKG
Electrocardiogram (EKG or ECG): A noninvasive test that measures the electrical activity, rate, and rhythm of your heartbeat through electrodes (electrical sensing devices) attached to your arms, legs, and chest while lying down
It detects electrical signals (rhythm of the heart beat) through the electrodes and the results are recorded on graph paper
Stress Test (excercise EKG)
Resting EKG
General Diagnosis
This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made
There are 2 kinds of Echocardiogram

In this invasive test, the probe is inserted down the esophagus. A TEE shows clearer pictures of your heart, because the probe is located closer to the heart and the lungs and bones of the chest wall do not block the sound waves produced by the probe. A sedative and an anesthetic is applied to the throat for comfort.
During this test, an echocardiogram is done before and after your heart is stressed by exercise or by injecting a medicine that makes your heart beat harder and faster. This is usually done to determine if there is decreased blood flow to the heart (coronary artery disease, or CAD)
This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The direction and speed of the blood flowing through your heart and blood vessels is measured
Patient Diagnostic
The DASH (Dietary Approaches to Stop Hypertension) diet is an eating plan to reduce blood pressure up to 14 mmHg

reduce sodium (salt) to 1500mg a day (2/3 tsp)

Eat less red meat, processed meat, sweets

Avoid eating foods that are high in saturated fat, cholesterol, and trans fats

Eat whole grains, fish, poultry and nuts

Exercise 30-60 minutes per day can lower blood pressure 4-9 mmHg

Limiting alcohol consumption lowers blood pressure 2-4 mmHg

Avoid tobacco and second hand smoke that raises blood pressure by 10 mmHg
Patient Causes
General Treatment
Breakfast: 1 cup fresh mixed fruits, (grape, banana, apple and berries) with 1 cup fat-free, low-calorie yogurt, 1/3 cup walnuts,1 bran muffin, herbal tea

Lunch: Curry chicken wrap with: 1whole wheat tortilla, 2/3 cup cooked chicken, 2 tbsp fat-free mayonnaise, and ½ tsp curry powder. Handful baby carrots, 1cup fat free milk

Dinner:1 cup cooked whole-wheat spaghetti with 1 cup tomato sauce, no added salt, 2 cups of romaine lettuce, 1 tbsp low-fat salad dressing1 whole-wheat roll, 1 tsp trans-free margarine1 nectarine, sparkling water

Snack (throughout the day): ¼ cup raisins, handful of unsalted pretzels and sunflower seeds
RESTING EKG: quick, very safe, painless, and inexpensive tests that are routinely performed with no risk. An electrical current does not go through the body. The only risk however, is from your heart’s response to exercise, not the ECG itself.
EXERCISE STRESS TEST: preformed when the symptoms of chest pain, shortness of breath, dizziness or fainting, palpitations are present, and/or the risk of heart disease is present
A regular check up was conducted that included using the stethoscope and sphygmomanometer
Using sphygmomanometer, he had a reading of 143/92 meaning he had hypertension
We then conducted a blood test to confirm that he had hypertension
We then took Christopher’s EKG, and we determined that he has hypertension as his heart rhythm was irregular, and his heart beats were too slow
We chose that he take an EKG as opposed to other methods because:
Quick (takes only 5-10 minutes)
Christopher was scared. He did not want to get hurt during the process as he is very sensitive. He also did not want it it to take time as he wanted to get back to his video games as soon as possible.
EKG is:
Non-invasive (nothing physically enters your body)
Risk Free
Echocardiogram is:
TTE is:
Long (40-60min)
More Expensive
Invasive (probe goes through throat)
General Treatment
Change Lifestyle
Diet- decrease salt intake
Be physically active
Patient Treatment
Decreases blood volume by causing more water and salt to be excreted in the urine
Sympathetic nervous system blocking drugs:
Causes the heart to slow down and beat less forcefully
ex: alpha, beta, and adrenergic blockers
Acts directly on blood vessel walls or through other mechanisms to increase blood vessel diameter
ex: ACE inhibitors, calcium channel blockers, angiotensin II inhibitors, and angiotensin receptor blockers
In terms of medication:
In terms of Lifestyle:
Patient Lifestyle
*Sphygmomanometer and blood test are necessary
Christopher agreed to stop smoking, and his parents are on board to stop smoking around him

We encouraged Christopher to exercise more, and we even conducted a plan that he goes on walks
every other day for 30 mins, and that he slowly increases the walks by 5 min every week, until it gets to 60 mins. The first two weeks he will walk every other day, and then he will start walking everyday. This is so that Christopher can ease into this routine with an easy plan that someone his weight can follow

reduce sodium (salt) intake by tracking how much salt is in your diet
keep a food diary to estimate how much sodium is in what you eat and drink each day
Patient Lifestyle
We even constructed the perfect DASH diet for Christopher that still adheres to the food cravings of people his age:
Hypertension is an Important Issue
About one in every four American adults has hypertension
Leading causes include, smoking, being obese, drinking too much alcohol, stress, older age (35+), genetics, family history
If not treated, hypertension can lead to a stroke, heart disease leading to a heart attack, kidney disease, and much more!
Remember, it is a SILENT KILLER so you don't know you have it until you get tested, so get tested!
By: Anisha Khanna and Dana Li
Gave medication in stages. First gave an ACE inhibitor, however signs of hypertension did not improve after a few weeks, so we increased the dosage and added calcium channel blockers, and then after a few weeks prescribed diuretics
1. ACE inhibitor
We recommended this vasodilator first to Christopher because it directly GETS RID of the problem in the most effective way, compared to other medication
works well with other drugs
lowers renovascular resistance; and increases excretion of sodium in the urine
easy, safe for someone his age
This method would not be recommended if the patient was pregnant
2. Calcium Channel Blockers
This is the second stage of Christopher's treatment, because it is the most effective, and most risk free way that increases arterial diameter
This pill decreases calcium, which thus increases arterial diameter
3. Diuretics
Increases the rate of urination to excrete sodium
Very effective
Risk factor includes that there might be too much sodium being released, however Christopher's sodium intake is so high, that this is not an issue
We didn't choose any other forms of medication because:
They are usually meant for elder people
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"Hypertension." Symptoms of Hypertension. N.p., n.d. Web. 2 Jan. 2013.

"Treatment of High Blood Pressure." BLOOD PRESSURE. N.p., n.d. Web. 29 Dec. 2012.
<www.webmd.com/hypertension-high-blood-pressure/guide/dash-diet >

"DASH Diet." High Blood Pressure. N.p., n.d. Web. 23 Dec. 2012.

"What Is an Electrocardiogram (EKG or ECG) Test?." WebMD - Better information. Better
health.. N.p., n.d. Web. 16 Jan. 2013. <http://www.webmd.com/heart-disease/electrocardiogram>.

"Hypertension - Public Health Agency Canada." Public Health Agency of Canada (PHAC) |
Agence de la sante publique du Canada (ASPC). N.p., n.d. Web. 16 Jan. 2013. <http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/hypertension-eng.php>.

"Hypertension." Diuretics. N.p., n.d. Web. 3 Jan. 2013.
We chose to conduct a rest EKG, as a stress EKG is not recommended for overweight patients like Christopher
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