The decision to use glucocorticoids in this case was based on the diagnosis of rheumatic myocarditis. Glucocorticoids, such as prednisone, have anti-inflammatory and immunosuppressive effects. They are commonly used in the treatment of inflammatory conditions, including myocarditis, to reduce inflammation and suppress immune response.
Glucocorticoids can cause hypertension (high blood pressure) as a side effect. This is known as glucocorticoid-induced hypertension. The exact mechanism behind this is not fully understood but it is believed that glucocorticoids can affect multiple systems involved in blood pressure regulation. They may increase sodium retention and fluid volume, stimulate vasoconstriction, impair nitric oxide-mediated vasodilation, and alter the sensitivity of blood vessels to various vasoactive substances.
Gastric ulcer bleeding can also be a side effect of glucocorticoid use. Glucocorticoids can interfere with the protective mechanisms of the gastric mucosa, leading to decreased production of mucus and bicarbonate secretion. This impairs the defense against gastric acid and increases susceptibility to injury from acid or other irritants. Additionally, glucocorticoids can also inhibit prostaglandin synthesis, which plays a role in maintaining mucosal integrity.
In this particular case, the patient developed hypertensive crisis and gastric ulcer bleeding as complications of long-term glucocorticoid therapy. Prompt management was necessary to address these complications and mitigate further harm to the patient’s health.
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