I. Answers A, C, D and E are true statements, whereas B is false.
II. Answers A, D, and E are true statements, whereas B and C are false.
1. The diagnosis is clearly arterial hypertension according to the WHO definition
2. The treatment of choice is to control the blood pressure, motivate the patient to stop smoking, and to start a normal life with daily walks. The patient probably needs antihypertensive drugs as well.
3. The main risk for this patient is cerebral infarction, which his father died from.
4. The smoke destroys the lungs. The end result is chronic bronchitis and emphysema. This is a tragic way to die, by a type of internal long lasting suffocation, much worse than most cases of lung cancer, with a rapidly fatal outcome. The left ventricle of the patient is hypertrophic because of the maintained high pressure in the systemic arteries.
5. The mean arterial pressure of the patient is: ((200 - 110)/3 + 110) = 140 mmHg. The left ventricular pressure-volume work rate of the patient is (5 l/min * 140 mmHg) = 700 l mmHg per min. The cardiac work rate of a healthy individual is (5 l/min * 90 mmHg) = 450 l mmHg per min.
6. 5 l of blood per min equals 83.3 ml per second (s) or (83.3 * 10-6) m3 per s. Patient: * 10-6) (m3 per s) * (140 * 133.3)(N/m2) = 1.55 Nm per s or watts. Healthy person: (83.3* 10-6) (m3 per s) * (90 * 133.3)( N/m2) = 0.999 Nm per s or watts.
The high and persistent mean pressure implies a large work burden on the cardiac muscle tissue, dilates the chamber and force the tissue to hypertrophy in order to meet the needs of the body for blood.
1.Acute myocardial infarction with cardiac pump failure and shock is a likely description of the condition. The cerebral bloodflow (CBF) and oxygen delivery is insufficient, and the patient is unconscious.
2.The arteriovenous glucose concentration difference (D C) is (0.5 * 3) = 1.5 mM. The net glucose flux to the brain equals (D C* CBF) or (1.5*0.65/2) = 0.4875 mmol min-1. The anaerobic contribution to brain metabolism is (2*0.4875*0.3) = 0.2925 mmol ATP min-1.
The aerobic contribution is (36*0.4875*0.7) = 12.285 mmol ATP min-1.
3.The net glucose flux to the normal brain equals (D C * CBF) or (0.5 * 0.650) = 0.325 mmol min-1. This is only 2/3 of the input to the brain of the patient. The aerobic ATP production of a normal brain amounts to (36 * 0.325) = 11.7 mmol ATP min-1. This is a metabolism of the same order of size as that of the patient.
1. The systemic hypertension is caused by renal artery stenosis. The high arterial pressure probably causes a raised intracranial pressure with so-called pressure headache.
2. The unilateral renal ischaemia is a strong stimulus of the juxtaglomerular apparatus, so large amounts of renin is released. Renin activates the renin-angiotensin-aldosterone cascade. Both angiotensin II and aldosterone increase the peripheral vascular resistance by arteriolar contraction, and aldosterone promotes the reabsorption of NaCl and water. All these effects combine to increase the arterial blood pressure.
3. The most likely cause of the renal artery stenosis is slowly progressing atherosclerosis with formation of atheromata in the arterial system - in particular in the left renal artery of this patient. Other locations are not excluded.
1. The hydrostatic pressure of a 900 mm blood column is: (900/13.6) = 66 mmHg or 10.1 kPa.
The hydrostatic component is maximal, since the muscular venous pump is passive. The venous pressure in the muscles is thus 66 plus the 10 mmHg at heart level, a total of 76 mmHg.
2. In the Poiseuilles law the radius is in the denominator in the 4.th potency. Thus the vascular resistance is reduced by a factor of 34, that is a resistance of only 1/81 of the arteriolar resistance at rest.
3. The mean arterial pressure (MAP) is (70 + 100/3) = 103 mmHg and the venous pressure is reduced to 20 mmHg. Thus the driving pressure is: (103 - 20) = 83 mmHg.
4. The total muscle bloodflow: (100 × 30)/170 = 17.6 l of blood per min.
The relative bloodflow is 17 600/300 = 59 FU.
The rise in muscle blood flow is thus: 59/3 = 19.7 fold.