Assignment Problem: A 30-year old respiratory therapist went to her doctor asking for information about high blood pressure. She had been told 3 years ago at the time of her pre-employment examination that she had mild hypertension. She returned several times for follow-up visits. Her blood pressure was normal on these check-ups and moderately elevated during the last one. She was informed that she had "labile" hypertension (her hypertension was only intermittently increased) and was encouraged to have her blood pressure checked every 6 months or so.
A. What pathophysiology (abnormal physiological) mechanisms could produce hypertension on some occasions and not on others just a few weeks later?
B. She had no further problem until 6 months ago. Then she began to experience "spells" during which she became nauseous (sometimes to the point of vomiting), had headaches, and exhibited nervousness, sweating, and a rapid pulse. A fellow therapist took her blood pressure during several of these "spells". It was usually elevated. On one occasion her blood pressure was 200/140 mmHg. Can any of the pathophysiology mechanisms you previously identified give rise to the additional signs and symptoms that appear during her "spells"? Explain how each could lead to these signs and symptoms.
C. The physician decided that the patient needed further evaluation. Her previous medical history was unremarkable, as were the histories of her immediate family members.
On examination, she was found to be a normally developed white female in no obvious distress. her BP was 158/95 mmHg standing, and 160/98 mmHg sitting. her pulse was 90/min, and her respiratory rate 16/min. Her temperature was 98.6 F. The rest of her physical examination was unremarkable. Complete blood count and blood chemistry were normal, and urine samples were normal, as was her ECG and chest X-ray. Does this additional information enable you to eliminate any of the possible pathophysiological mechanisms you had previously identified? What do you think is wrong with this patient?