Question: Thanks, I'm a 70 year old woman, history of breast Ca with recurrence. Recent isolated systolic high BP. Now have increasing high BP, stiff neck for 1 week, prominent left carotid, headaches and nausea. Medicated with hydrochlorothiazide and Ramipril. Episodes of left sided facial pain. Negative for dental etiology. Negative ENT consult. Some cardiac arrhythmia. Fatigue and loss of energy for last few weeks.

Current B.P range of 170 - 190 systolic, 65-85 diastolic. Rapid increase in BP from normal to high levels with even slight stress or moderate exercise. The pain in my neck is not pulsatile. I suffer from both photophobia and phonophobia, the latter seems to be getting worse. I forgot to mention I still suffer from migraine headaches relatively often, although less frequently than when I was younger. I have always suffered from Raynauds syndrome. I had an isolated episode of atrial fibrillation 5 days following one of the breast surgeries and an allergic reaction to the dressing. It was successfully cardioverted after 9 hours in the ER with propafanone. That was 2 years ago. I am not anticoagulated.Do you think it is worth exploring thepossibility of a carotid aneurysm? What is your opinion of the dilated carotid? And the left sides face pain and occasional paresthesia? I'm a bit disappointed you simply suggest adding two more potent medications without consideration of further investigation first. For example a carotid Doppler.

Thank you for your attention to my questions. Meredith