CaSo 6/2010 - mulher de 70 anos, hipertensa e diabética, com infiltrado intersticial e alveolar pulmonar bilateral, tosse seca, dispneia, inapetência e sem febre

Abstract

A 70-year-old, hypertensive, diabetic woman sought treatment for dry cough, dyspnoea, loss of appetite and prostration.The patient knew she had had high blood pressure since the age of 37, diabetes mellitus since the age of 56 and hypertriglyceridemia.On the first visit to the hospital (June/92), when she was 56 years old, she complained of palpitations that lasted 20 minutes, without syncope. She used 75 mg of captopril, 50 mg of chlorthalidone, 600 mg of quinidine and 0.25 mg of digoxin.The physical examination revealed weight of 54 kg, height of 1.49 m, blood pressure of 170/110 mmHg. In the physical examination, systolic murmur of +/4+ was identified in the mitral area. The remaining part of the physical examination revealed no abnormalities. The electrocardiogram (June/92) showed sinus rhythm, left ventricular overload, ST depression in V 5 and V 6 and the presence of U wave (Figure 1).The chest x-ray (June/92) revealed a +/ 4+ increase in the heart area. The laboratory evaluation (June/92) showed: creatinine of 0.8 mg/dL, sodium of 143 mEq/L , potassium of 3 mEq/L, blood glucose of 178 mg/dL, total cholesterol of 203 mg/dL and triglycerides of 536 mg/dL. Twenty-five mg of hydrochlorothiazide, 20 mg of enalapril, 25 mg of spironolactone and 240 mg of verapamil daily were prescribed.The echocardiogram (Aug/92) showed mild concentric hypertrophy (Table 1). A laboratory evaluation during the treatment (1995) showed blood glucose of 145 mg/dl, cholesterol of 253 mg/dl, HDL of 28 mg/dl and triglycerides of 702 mg/dl. Five mg of glibenclamide, 400 mg of bezafibrate and 20 mg of simvastatin were introduced.During the treatment, the records of blood pressure obtained in the consultations revealed high blood pressure, despite the prescription of alpha methyldopa, hydralazine, clonidine and amlodipine. The diabetes also remained out of control and the dose of glibenclamide was increased to 10 mg, and later, NPH insulin was introduced. According to the patient herself, it was difficult to follow the prescriptions.