Cardiovascular System Case Study John is an 18 year-old male that woke up in the
ID: 3513628 • Letter: C
Question
Cardiovascular System Case Study
John is an 18 year-old male that woke up in the middle of the night, attempted to stand up and passed out. He hit his desk on the way down and got a large laceration on the back of his head. He called 911 for assistance. You show up with the other paramedics and find him lying on the floor. You ask him if he is taking any medication. John gestures weakly to his nightstand. You examine the bottles of pills there and find two ACE inhibitors and one beta blocker. You take his blood pressure and find it to be 90/50. You administer fluid IV while on route to the emergency room. But John’s blood pressure continued to decline and by the time the ambulance reached the hospital his blood pressure is 60/40 and he is barely conscious.
1.) Explain the most likely scenario of what occurred to John, e.g. why John is having severe hypotension? Also, include in your description what the ACE inhibitors and the beta blocker are specifically doing to John’s body as well as the mechanism by which each medication affected John. Please be specific.
2.) Why did the fluid IV fail to bring John’s blood pressure up? There could be at least two reasons here.
Explanation / Answer
1). ACE inhibitors (angiotensin-converting enzyme inhibitors) inhibit the conversion of angiotensin- I to angiotensin- II. Angiotensin II is a vasopressor drug, so, the prevention of its formation blocks this mechanism of raising blood pressure and leads to fall in blood pressure, which is a desired therapeutic effect in those with hypertension. ACE inhibitors cause natriuresis and diuresis (i.e. loss of sodium and water), which reduces the fluid volume.
Beta blockers act by inhibiting the effects of adrenaline (a sympathetic agonist), which helps to reduce the blood pressure (by causing vasodilatation).
The hypotension of John was might be because of the excessive dose or accumulated effect of hypotensive drugs (ACE inhibitors and beta blockers).