Bruce is a 52 year old male. He is 5’10” and 387 pounds. He initially visited hi

Question

Bruce is a 52 year old male. He is 5’10” and 387 pounds. He initially visited his physician for fatigue and excessive daytime sleepiness. He reported going to bed each night around 10:30pm and awakening around 7:00am feeling as though he had not slept. With the exception of mild hypertension, Bruce’s vital signs are normal. When the physician questioned Bruce about his sleep patterns, he reported that 4 or 5 years ago his ex-wife had been “nagging” him about his increasingly loud snoring. Bruce was unsure about the degree of his snoring at the time of the visit, but he did report waking “in a fit” a few times a night and sleeping restlessly. However, Bruce considered this an old problem unrelated to his worsening fatigue. Due to his obesity and fatigue, the physician diagnosed Bruce with sleep-apnea associated with obesityhypoventilation syndrome.

1. What is sleep apnea and why might sleep apnea cause fatigue? Upon blood testing, over time, Bruce’s CBC results started to show signs of polycythemia.

2. What is polycythemia?

Explanation / Answer

1)First of all we will discuss what's the main physiology behind high blood presuure.

high blood pressure in aorta causes left ventricular hypertrophy.Left ventricular pressure increases because there is more pressure in aorta.This leads to pressure overload on left ventricle,which leads to left ventricle hypertrophy.Subsequent left ventricular hypertrophy it develop diastolic dysfunction and follow its coure if high blood pressure is not under control patient develop left sided heart failur,which causes fluid accumulation in lungs.

2)In this question cedric has risk factor for cardiovascular disorder.His elevated cholesterol and previous history of smoking predisposed him towards atherosclerosis.This is the reason behind his angina.Together all these risk factors he is also predisposed towards high blood pressure.High blood pressure in aorta causes left ventricular hypertrophy.Left ventricular pressure increases because there is more pressure in aorta.This leads to pressure overload on left ventricle,which leads to left ventricle hypertrophy.This increase in pressure in ventricle and hypertrophy causes decrese coronary flow from coronary sinuses during diastole,by this mechanism we can explain his angina.

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