Atherosclerosis and hypertension Flashcards
Atherosclerosis
Characterized by irregularly distributed, lipid deposits in the intimal layer of medium and large arteries
atherosis
fatty streak of lipid laden macrophages in the subendothelial cells
Exposure of subendothelial layer causes platelets aggregation, and thrombus formation
sclerosis
responsible for reduction of blood vessel compliance
Organization of fibrous cap of thrombi over advanced plaques that have developed on endothelial lining
Risk factors of atherosclerosis
male
Family history
Lipids triglycerides
Diabetes
Obesity
Hypertension
Increased homocysteine
Inflammatory markers c reactive protein
infectious agents, chlamydia
Physical inactivity
Hematological factors, fibrinogen factor seven
Pathogenesis of atherosclerosis
lipid hypothesis
Chronic endothelial injury hypothesis
Elevated plasma LDL levels
Lipid accumulation and smooth muscle cells, and macrophages
Migration of cells into sub, intimal, and intimal regions
Synthesize connective tissue growth factors platelet aggregation
manifestations of atherosclerosis
vasospasm
Hypertension
Coronary artery disease
Coronary heart disease
-myocardial ischemia
-myocardial infarction
-Heart failure
Sudden death
management of atherosclerosis
Pharmacological statins
Diet alteration
Exercise
Risk factor management
Education
Follow up with MD
hypertension definition, and prevalence
Chronic elevation in arterial blood pressure excess of 130/80
34% of US population
Most prevalent modifiable risk factor
1/3 of Americans have hypertension
2/3 age over 60 hypertension
categories of hypertension
Primary essential-present in the absence of disease
Secondary nonessential - occurs due to the presence of a disease
resistant bp- despite three medications including a diuretic, BP is over 140/90
etiology of hypertension
Genetic
Obesity
Dietary sodium excess
Stress
Alcohol consumption
Physical inactivity
Tobacco
pathophysiology of blood pressure
Major determinants are cardiac output and peripheral vascular resistance
Baroreceptors in carotid sinus and aortic arch
endothelial cells
Vasodilators- endothelial derived relaxing factor like nitric oxide, prostaglandins
vasoconstrictor - endothelin
Consequences of hypertension
left ventricle hypertrophy
Diastolic dysfunction with impairment of left ventricular relaxation develops early
Inhibits coronary blood flow
Myocardial ischemia
Aneurysms
Goals of treatment of hypertension
normalize BP both at rest and during exertion
Reverse LVH and myocardial dysfunction
Pharmacological therapy for hypertension
diuretics
Beta blockers
vasodilators
Calcium channel blockers
Ace inhibitors
Angiotensin II receptor blockers
Lifestyle modifications for hypertension treatment
Weight reduction
Sodium restriction
Regular aerobic exercise
Moderate alcohol consumption
Relaxation training, stress management
Exercise is reduced by how much because of hypertension
15 to 30%
Stroke volume increases
Peak heart rate is lower reducing cardiac output
Exercise leads to reductions in both systolic and diastolic bp
Exercise for hypertension
aerobic and resistance training
3 to 4 sessions per week of moderate intensity
40 minutes
12 weeks
pulmonary hypertension
increase in pressure in the pulmonary arteries
Normal pressure and pulmonary capillaries and pulmonary veins
causes of pulmonary hypertension
Congenital heart disease
Lupus, HIV, thyroid diseases
Lead to pulmonary edema and right ventricular, hypertrophy, and right heart failure
Shortness of breath
Exercise induced hypertension
Blood pressure is
greater than 190 for females
greater than 210 for males during exercise
likely due to arterial sickness from constantly high-pressure system
Often with left atrial and ventricular thickening
