Question

Answer in the booklet provided. A 64-ycar-old male patient was admitted to a hospital. He complained of chronic headaches that lasted for days, chest pain and shortness of breath when performing physical activity. He was coughing a pink- tinged frothy sputum. On examination he had a blood pressure of 192/122 mm Hg and pulmonary oedema The following data were obtained from the patient: Patient values Left ventricular systolic pressure (mm Hg) Left ventricular end-diastolic pressure (mm Hg) Right atrial pressure (RAP) (mm Hg) Cardiac output (/min) 192 18 120-140 4-12 4.0 5.0-6.0 The patient was diagnosed with left and right heart failure caused uy the hypertension. The chest pain was attributed to myocardial ischaemia. . Showing calculations to support your answer, decide whether the patient has an increased total peripheral resistance compared to normal (normal range:12-18 mm Hg.min/M). 2. In the context of this case give a physiological explanation for the patient's: a) myocardial ischaemia. b) pink-tinged frothy sputum 3. Providing the physiological mechanism involved, explain whether the patient's blood pressure is likely to decrease with administration of an angiotensin-converting enzyme (ACE) inhibo (2)

Answer 1

1. Total peripheral resistance = (MAP- RAP)/CO

MAP mean arterial pressure= diastolic pressure-1/3(systolic-diastolic pressure)=122-(192-122)/3= 98.7 mmHg

RAP right atrial pressure=8 mmHg

Cardiac output =4l/ min

TPR= 98.7-8/4= 90.7/4= 22.675 mmHg

2.a. Myocardial ischaemia

The elevated BP presents as headache

The increase in BP leads to reduced perfusion to various organs including the coronary vessels leading to myocardial ischaemia . This myocardial ischaemia presents with chest pain

B. The pink frothy sputum is due to pulmonary edema

Due to increased peripheral resistance the left ventricular pressure increases this causes increase in the end systolic volume in the ventricle

This is transmitted to the left atrium which also shows increase in pressure

The increase in right atrial pressure leads to increased pressure in the pulmonary circulation leading to pulmonary edema