(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Sudden headache, recurrent dizziness, and nosebleeds may be clinical manifestations of hypertensive disorders. Early treatment of this disease through a combination of lifestyle interventions and medications will result in improvement of headache and other symptoms in most patients. As in this case, the patient came to the clinic with sudden onset of headache, dizziness, persistent posterior occipital swelling and pain, and occasionally severe blast-like pain.
Basic information】Male, 70 years old
Disease Type】Simple systolic hypertension
Hospital】The First Affiliated Hospital of Anhui Medical University
Date of Consultation】January 2022
Treatment plan】Nasal cavity filling to stop bleeding + medication (felodipine extended-release tablets + ramipril tablets + hydrochlorothiazide tablets)
Treatment period】7 days of hospitalization, 3 months of outpatient follow-up
Treatment effect] Headache and dizziness relieved, nasal bleeding stopped
I. Initial consultation
The patient reported sudden onset of headache and dizziness 1 week ago, initially intermittent, and in the past 3 days, he had persistent posterior occipital swelling and pain, with occasional sharp pain like cracking, and had been treated with ibuprofen at a local clinic for analgesia, but the effect was not good. Examination: BP 186/80 mmhg, P64 times/min, clear consciousness, poor mental health, clear breath sounds in both lungs, no dry and wet rales. The heart borders were slightly enlarged, the heart rate was 64 beats/min, the rhythm was uniform, and no pathological murmur was heard in each valve auscultation area. Physiological reflexes were present, and no pathological signs were elicited. The patient was judged to have simple systolic hypertension.
II. Treatment history
We explained to the patient and his family that the headache and dizziness should be alerted to stroke, and that high blood pressure was considered to be the cause. On the second day, the renal function, urine protein test, electrocardiogram and cardiac ultrasound were further improved according to the condition.
III. Treatment effect
On the day of admission, the patient’s bleeding nasal cavity was immediately filled with gauze and antihypertensive treatment was started. 6 hours later, the patient’s bleeding stopped and symptoms such as headache and dizziness were significantly relieved, and the blood pressure was monitored at 156/78 mmhg at that time. on the second day, the ECG showed sinus rhythm, left ventricular hypertrophy, and cardiac ultrasound showed left ventricular wall and septal thickening. Considering that the patient’s symptoms were clearly relieved and there were no other uncomfortable symptoms, the patient was discharged at 7 days of hospitalization. After 3 months of follow-up after discharge, all of them reported no headache and dizziness, and the blood pressure was controlled at about 130/70 mmhg, and the ventricular wall thickening improved on repeat cardiac ultrasound.
IV. Notes
We are glad that the patient’s condition has improved significantly after drug treatment and close clinical monitoring, but we suggest that the patient should still pay attention to strictly limit sodium intake to no more than 6g per day after discharge; eat more fresh vegetables and fruits to keep bowel movement smooth; do not be anxious, keep your mood relaxed, ensure sufficient sleep and regular rest and rest; increase exercise in moderation, such as brisk walking, aerobics, mountain climbing, etc., to improve cardiovascular If your blood pressure is fluctuating, you should seek medical attention as soon as possible.
V. Personal insight
The elderly are susceptible to hypertension, and simple systolic hypertension occurs mostly in the elderly over 60 years of age. This disease can lead to a series of complications such as left ventricular hypertrophy, heart failure, myocardial infarction, stroke, etc. Early intervention can effectively avoid. Therefore, high systolic blood pressure should be treated as soon as possible. Although the patient in this case did not seek medical attention in time after the onset of discomfort, her condition fortunately improved significantly through drug treatment.