Future Cardiovascular Disease Risk For Women With Gestational Hypertension

Future Cardiovascular Disease Risk For Women With Gestational Hypertension

Case overview

The patient is a 55years old female who came for a regular gynecological review at the clinic. She had a cardiac stent at the age of 50 years and mild hypertension, currently on lisinopril, Zocor, and Plavix. She has a past surgical history of tonsillectomy and bunion removal. She is up to date with her colonoscopies and has a history of normal pap smear tests and mammograms with diagnostic investigations. Her menarche was at the age of 14 years and menopause at 52years. She has never been married nor had a child. She has been with her current partner for two years and they will get married in two months. The patient needs guidance because her partner would want a child. The patient has a medical history of hypertension and cardiac disease that she needs to consider before conception. Moreover, she is on drugs contraindicated in pregnancy. However, despite her medical condition, she is on preconception care folate supplementation. She conceives during the second cycle and returns to the clinic after 12 weeks complaining of high blood pressure, facial puffiness, pitting edema, and epigastric pain Future Cardiovascular Disease Risk For Women With Gestational Hypertension.

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What Are Your Differential Diagnoses?

1. Gestational hypertension
2. Preeclampsia
3. Eclampsia

Gestational hypertension is the elevated blood pressure of more than 140/90 mmHg in patients at less than 20 weeks gestation. It is common in pre-existing hypertension, mother age above 40 years, twin pregnancies, and kidney diseases. The presenting symptoms are high blood pressure, edema, pain in the right upper quadrant, and absence of protein in the urine (Lo, et al, 2020). It is the primary diagnosis because the patient is only twelve weeks pregnant, is 55years old, and has had pre-existing hypertension.

Preeclampsia is an endothelial malfunction disorder that presents with proteinuria ad hypertension in patients above 20 weeks gestation age. The symptoms are high blood pressure of more than 140/90 mmHg, persistent epigastric pain, visual disturbances, progressive renal insufficiency, thrombocytopenia, and pulmonary edema (Rana, et al, 2019). The risk factors are nulliparity, chronic hypertension, age of above 40years, and obesity. However, this is not the patient’s diagnosis despite similar symptoms because she has no proteinuria and is less than 20 weeks gestation. Eclampsia is the presence of convulsions in a patient with preeclampsia.

Why Did You Make This Diagnostic Decision?

Gestational hypertension is the patient’s diagnosis because she has high blood pressure, epigastric pain, lower limb edema, and facial puffiness. Additionally, her gestation age is 12 weeks, she is over 40years, and has never had children.

What Is Your Treatment Plan?

Diagnostic tests: according to Duhig, et al, (2018), renal function tests, liver function tests, urinalysis, and platelet levels help rule out preeclampsia and eclampsia.

Pharmacological treatment

1. Nifedipine 20mg PO once daily for hypertension
2. Magnesium sulfate for prophylaxis of preeclampsia and eclampsia

Non-pharmacological

Bed rest and fetal monitoring to check the health status of the fetus.

Ethical dilemma in this case study

The ethical dilemma in this situation is the respect for autonomy versus beneficence. Beneficence is having the best interests of patients when selecting a treatment method (Bester, J. C. 2020). In this case, the patient will have a difficult pregnancy due to her advanced age and the presence of chronic diseases like heart failure. Therefore, IVF or child adoption is the best option for the patient to have a child. This is contradicting the patient’s decision regarding the physical conception, pregnancy, and delivery. Autonomy is respect for a patient’s decisions Future Cardiovascular Disease Risk For Women With Gestational Hypertension.

Psychological issues in this case study

The patient is at risk of having depression and anxiety because she has pre-existing chronic diseases that would threaten her pregnancy. Moreover, hormonal fluctuations in pregnancy cause high and low mood changes.

Physical issues in the case study

The patient has chronic diseases like hypertension and heart disease that would physically affect her during the pregnancy. Chronic hypertension increases the risk for stroke and placenta abruption that would threaten the survival of her pregnancy.

Financial issues in the case study

The patient requires financial resources to help her in consulting a specialist, regular follow-up, and treatment.

References

Bester, J. C. (2020). Beneficence, interests, and wellbeing in medicine: what it means to provide benefit to patients. The American Journal of Bioethics, 20(3), 53-62.

Duhig, K., Vandermolen, B., & Shennan, A. (2018). Recent advances in the diagnosis and management of pre-eclampsia. F1000Research, 7.

https://doi.org/10.12688%2Ff1000research.12249.1

Lo, C. C. W., Lo, A. C., Leow, S. H., Fisher, G., Corker, B., Batho, O., … & Oliver‐Williams, C. (2020). Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association, 9(13), e013991.

Rana, S., Lemoine, E., Granger, J. P., & Karumanchi, S. A. (2019). Preeclampsia: pathophysiology, challenges, and perspectives. Circulation research, 124(7), 1094-1112 Future Cardiovascular Disease Risk For Women With Gestational Hypertension.