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Abstract: A 66-year-old female presented to our hospital with “chest tightness and shortness of breath for more than half a month, and the symptoms have worsened in the past 3 days”. She had a history of hypertension for more than 10 years, and her blood pressure was not under control on weekdays. After detailed examination, the diagnosis of hypertensive heart disease was confirmed. After drug treatment, the condition was controlled and all indicators were improving, and the symptoms of chest tightness and shortness of breath basically disappeared.
Basic information】Female, 66 years old
Disease Type】Hypertensive heart disease
Hospital】Harbin First Hospital
Date of consultation】August 2020
Treatment plan】Medication (sakubatril valsartan sodium tablets, furosemide injection, sodium nitroprusside for injection, metoprolol succinate extended-release tablets)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up review
Treatment effect】The disease is under control, all indicators are improving, chest tightness, shortness of breath symptoms basically disappeared
I. Initial consultation
In August 2020, an elderly female patient, accompanied by her family, came to the clinic. She had been diagnosed with hypertension more than 10 years ago and had been taking amlodipine besylate tablets to lower her blood pressure, but she had not undergone any systematic physical examination in recent years. The patient had symmetric edema in both lower extremities, occasional paroxysmal dyspnea at night, and needed to sleep in a high pillow position. After settling the patient, an electrocardiogram was performed to examine sinus rhythm, high voltage ST-T changes in the left ventricle; cardiac ultrasound showed enlarged left atrium as well as left ventricle, septal thickening, and LVEF 45%. The preliminary diagnosis was hypertensive heart disease and heart failure.
II. Treatment history
After communicating with the patient and his family about his condition and treatment plan, the patient expressed his willingness to actively cooperate with the treatment. As ambulatory blood pressure monitoring showed that the patient’s overall blood pressure was not well controlled, the medication regimen was first adjusted by replacing amlodipine besylate tablets with sakubatril valsartan sodium tablets and adjusting the dose according to the degree of blood pressure tolerance after taking the medication, as well as by combining furosemide injection with intravenous pumping of sodium nitroprusside to correct heart failure and improve edema. Blood pressure should be controlled to below 130/80 mmHg and heart rate should preferably be below 70 beats per minute. Since the patient’s heart rate was not controlled to standard, the addition of metoprolol succinate extended-release tablets was used to both control the ventricular rate and prevent left ventricular remodeling. Meanwhile, in order to confirm the diagnosis of hypertensive heart disease, further coronary CT examination was performed, which showed a mixed plaque in the left anterior descending branch with mild luminal stenosis, which could exclude heart failure caused by coronary artery disease.
III. Treatment effect
After systematic adjustment of antihypertensive drugs, correction of heart failure treatment, and active combination of lifestyle interventions, the patient’s blood pressure was about 130/70 mmHg, and the heart rate could be controlled below 70 beats/min. The electrocardiogram was rechecked 7 days after admission, indicating that myocardial ischemia had improved, the edema of both lower extremities had completely improved, the quality of sleep at night was better, no paroxysmal dyspnea occurred, and the patient could basically lie flat and not wake up when sleeping. The symptoms of chest tightness and shortness of breath did not occur during normal activities, and the rest of the examination indexes had a tendency to improve, so he was discharged from the hospital. Before discharge, we were instructed to review the patient after 1 month.
IV. Notes
We are glad that the patient’s discomfort has been relieved and her condition has been controlled after active treatment. After discharge, the patient should pay attention to strict lifestyle control, pay attention to low-salt and low-fat diet, exercise to lose weight, eat more fresh fruits and vegetables, pay attention to increase the intake of whole grain foods, and pay attention to quit smoking and alcohol. Pay attention to come to the hospital for regular medical checkups and choose 1 day a week to monitor blood pressure as well as heart rate at home on weekdays, and monitor blood pressure daily when it is unstable. When patients experience chest tightness, shortness of breath or difficulty in breathing, they should seek medical attention promptly.
V. Personal insight
Long-term high blood pressure with poor control can gradually stimulate cardiomyocytes, leading to hypertrophy and interstitial fibrosis, resulting in changes in the morphology of the patient’s heart, which is the case in this patient. If you want to better prevent the appearance of hypertensive heart disease, you must pay attention to actively control your blood pressure and improve it with lifestyle interventions. For patients with hypertensive heart disease, especially those who are currently showing signs of heart failure, it is important to intensify secondary prevention medication treatment.