This patient, particularly typical, is particularly well equipped with high blood pressure target organ damage.
Because the disease is more complicated and complex, I will write the process and do not make more comments.
The time when the patient found hypertension should be in his 50s, he did not notice it before, and he was not happy to check the physical examination or measure blood pressure at that time.
To say that the patient is an orphan, the parents died early, so whether there is a family history of cardiovascular disease is not clear. However, the early death of parents is also a hidden danger of disease.
Patients have almost no bad habits, do not smoke, do not drink alcohol, and do not even drink tea. In fact, drinking green tea is beneficial to the heart and cerebrovascular system. Not obese, also exercised, but not much; diet is not too clear, may be salty, in the eighties and nineties of the last century, eating canteen, oil and water is also average.
Patients usually treat people very well and have a good temper, but such people sometimes cannot vent negative emotions. The work is careful and careful, so it is often in a state of tension, such as walking on thin ice. Business research, love to learn, often stay up late.
Looking at it this way, there are still certain cardiovascular risk factors. These are all later reviewed and analyzed.
By the time the patient is nearly 60 years old, the blood pressure is very high, up to 180/110mmHg, and the antihypertensive treatment is more serious. But although it was treated, it was very irregular.
First, the pressure reduction is not up to standard. Because there was a period of time earlier when the criteria for diagnosing hypertension were relatively broad, especially for the elderly. Many people's traditional belief that the blood pressure of the elderly should be higher, and there is less emphasis on lowering blood pressure. Then there is the wrong view of patients, he believes that the kidneys of patients with high blood pressure will be ischemia, and keeping blood pressure higher will improve blood flow in the kidneys. In fact, it is wrong, high blood pressure causes high pressure in the glomeruli in the kidneys, which is a reason for the damage to the kidneys. In fact, by that time the patient's blood creatinine had begun to rise, and the kidneys had been damaged.
Second, antihypertensive therapy is not comprehensive. In addition to antihypertensive therapy, we should also pay attention to the control of blood lipids and blood sugar, and the control of multiple risk factors. This patient did not pay attention, so he had atherosclerosis at an early age.
Hypertension, atherosclerosis, patients have the first obvious target organ damage - coronary heart disease.
3 years later, at the end of the last century, patients developed angina, and the effect of drug treatment was not good. At that time, coronary angiography and stenting were not yet widespread, and the acceptance of patients was also poor. This patient was concerned and did not complete it once. First angiography, discuss, and then decide to put the bracket. So, do the imaging again. In this way, two contrasts, to inject iodine contrast agent, although the use of a good contrast agent, but the damage to the kidneys is still relatively large.
In addition, patients with coronary heart disease do not only have atherosclerosis in the coronary arteries, but also in the renal arteries. Sure enough, in the subsequent systemic blood vessel examination, the atherosclerosis and stenosis of the renal arteries were found.
On the basis of hypertension and atherosclerosis, and with the blessing of contrast agents, the patient's second target organ, kidney damage, is obvious.
After coronary angiography and stenting, the patient's kidney function was obviously poor, and the blood creatinine was significantly elevated to more than 300 μmol/L. However, there are no special symptoms in the early stage of poor kidney function, and patients do not care much, and because of the previous antihypertensive misunderstanding, patients do not want to lower blood pressure.
Hypertension persists, and kidney damage persists and worsens. The large blood vessels can't stand it anymore.
After another 4 years, the patient found a third target organ damage - aortic aneurysm - in a chest shot.
The chest x-ray found a tumor-like expansion at the top of the aortic arch, which is the occurrence of a large aneurysm. Because there is no chest pain, the patient does not care. After 4 months, the tumor was significantly enlarged. Surgically, the aortic arch needs to be replaced, and the patient's body cannot bear it. Therefore, after many consultations, using the technology that was still very advanced at that time, a membrane stent was placed at the site of the aortic arch to seal the aneurysm. The operation was a success.
However, stent surgery also involves injection of contrast agent. Before surgery, the patient's kidney function is on the verge of dialysis. Despite the use of the best contrast agent at the time, "Vision Parker", the preoperative and postoperative adequate hydration treatment did not prevent the patient's kidney function from deteriorating. One year after the aortic stent, the patient underwent hemodialysis.
In the examination of the large aneurysm, it was also found that the subclavian artery on the left side of the patient was also completely occluded due to atherosclerosis.
In the process of hemodialysis, the patient also had a dissection aneurysm of the thoracic and abdominal aorta, but fortunately the drug controlled it without rupture and enlargement.
In patients with poor renal function, blood pressure is not easy to control. Patients try to adjust their own antihypertensive drugs. But his veins were already full of holes. In the process of the patient's own antihypertensive drug, the blood pressure has a relatively large fluctuation, so the final target organ damage appears - cerebral hemorrhage, brainstem hemorrhage.
The brainstem is the center of life. After the brainstem hemorrhage, the patient's life also came to an end.
If patients with hypertension do not have good antihypertensive treatment, organ damage may not be so typical, so complex, so complete, but there will definitely be.
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