A 40-year-old man presented with hypertension (188/112 mm Hg, seated). Previous

Question

A 40-year-old man presented with hypertension (188/112 mm Hg, seated). Previous exams noted blood pressures of 160/94 and 158/92. He noted episodes ~2x/month of severe headache, perspiration, rapid heartbeat, & facial pallor. These episodes had an abrupt onset & lasted 10-15 minutes. Thirty minutes after the initial BP measurement, the seated blood pressure was 178/110 & heart rate was 90 BPM. The blood pressure after 3 min of standing was 152/94 & heart rate was 112.
Routine hematology and chemistry studies were within the reference ranges, and a chest X-Ray & ECG were normal.

Patient’s Values Normal Values
Norepinephrine, Free (24 hr U) 1800 ug 15 - 80
Epinephrine, Free (24 hr U) 100 ug 0 - 20
Vanillylmandelic acid (VMA, 24 hr U) 12.5 mg 2 - 7
Metanephrines (24 hr U) 2.5 mg <1.0
Catecholamines (P)
Norepinephrine 2500 pg/ml 174 - 624
Epinephrine 85 pg/ml 0 – 114
(U = urine, P = plasma)

What is your diagnosis? Provide evidence (signs and symptoms) to support your answer completely.



How might you treat this patient?

Explanation / Answer

First of all, I am not a doctor, so do not base my answer as to be true and accurate. I think there is a possibility that the blood pools while the patient is in the seating position and the moment the patient stands up the blood pressure gets lowered with an increase in the heart rate. What I think it is happening is that while in seated position the difference between end diastolic volume and systelic volume creates a higher blood pressure because of the accumulation of the blood in the heart, but standing up the gravity comes in play which pulls the blood to the extremities easing the aortic pressure and because the blood is being pulled away the heart rate increases to compensate for the hypertension. So what this patient might have is a blockage in the vena cava or a very bad tricuspid valve, or even some blocked arteries since this patient suffers from hypertension continuosly. Probably this patient happens to be obese and the adipose tissue is affecting the circulatory system, not to mention plaque build ups. However, since the tests show no abnormal levels of hormones and a normal ecg the problem might lie way down in the extremities making it hard for the blood to circulate in the sitting position. If it was cancer the neuromessengers would have been messed up so yes i really believe it has to do with a clogged vein or artery somewhere in the lower extremities and forming higher blood pool volumes in the heart. Lol my major is computer science but i have a passion for bio so dnt judge me if I have whistled out of my rear. Hope this helps

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