Hypertension Flashcards
hypertensive heart disease
old, AA
concentric LVH: diastolic dysfunction (impaired compliance and filling)
myocytes: expanded cytoplasm and enlarged boxcar nuclei
Tx: medical
hypertrophic cardiomyopathy
young (genetic)
autosomal dominant: structural protein, beta myosin heavy chain most common
asymmetric hypertrophy of septum, sometimes murmur
can get fibrosis and myocyte disarray
Tx: varies
aortic stenosis
old, male
LVH, murmur
cause: calcifications on sinuses of valsalva, rheumatic valvulitis (young-mid adults, fibrosis), bicuspid valve (young-mid adults, calcifications)
Tx: surgical or stent
cor pulmonale
acute or chronic pulmonary HTN disease RVH cause: lung disease (emphysema, chronic pulmonary embolisms, foreign material from IV drugs, tumor) chronic: elderly acute: dilation without hypertrophy NO angina Tx: medical
types of hypertrophic heart disease
- hypertensive heart disease
- hypertorphic cardiomyopathy
- aortic stenosis
- cor pulmonale
presentation of hypertrophic heart disease
dyspnea, angina, sudden death
all chronic
interstitial myocardial fibrosis
TGF-B, hypertrophic heart disease
HCOM
hypertrophic obstructive cardiomyopathy
1/3 of of hypertrophic cardiomyopathies
valves meet at bodies rather than tips: anterior leaflet overlap is dragged in front of aorta and obstructs flow into it and get mitral regurgitation
fibrosis: mitral valve and subaortic upper septum
Tx: surgery, inject EtOH into septum to infarct upper hypertrophied part
How thick should LV be? RV?
1.5 cm or less
1/3 of LV
Why would a person with hypertrophic cardiomyopathy die after an intense workout?
obstruction is relieved by exercise because the heart dilates to accommodate venous return
after exercise myocardial O2 demand remains high, but the dilation subsides causing ischemia and fatal heart arrhythmia
normal BP
120/80
HTN Tx goals
140/90
older 150/90
causes of HTN
most: primary or essential multifactorial: genetic predisposition, salt, alcohol, obesity
secondary: renal disease, excess mineralocorticoids, pheochromocytoma
Why is HTN a problem?
leading cause of preventable death
MI, CHF, Stroke, end stage renal disease
prehypertension
120-139/80-89
stage 1 hypertension
140-159/90-99
stage 2 hypertension
> /= 160/100
lifestyle changes that Tx HTN
diet, weight loss, exercise
no alcohol or tobacco
DASH diet
reduced salt
fruits, vegetables, low fat dairy
as effective as mono therapy drug tx
What things are important in obtaining an accurate BP?
- proper technique: cuff, position, timing, both arms, avoid caffeine and tobacco, device
- properly record
- repeat on multiple occasions
Causes elevated BP not due to HTN
stress, anxiety, pain, drugs, nicotine, alcohol, caffeine, white coat
How do you assess the significance of elevated BP?
- magnitude of BP
- end organ damage: heart, brain, kidney, eye, vasculature
- other CVD risk factors: hyperlipidemia, DM, tobacco, older, male
obtain: targeted Hx and physical, serum electrolytes, creatine, fasting glucose, fasting lipid panel, Hct, urinalysis (with micro albumin), resting EKG
How would you identify secondary causes of HTN?
- age of onset less than 20 or greater than 50 yrs
- target organ damage
- poor response to Tx (3 or more drugs)
- Fam or personal Hx of renal disease
- labile pressure with tachycardia, sweating, tremor: pheochromocytoma
- unprovoked hyopkalemia: hyperaldoseronism
- abdominal bruit/extensive vascular disease: renal artery stenosis
HTN emergency
ongoing end target organ damage, BP >180/120
parenteral drugs: reduce no more than 25% of pretreatment level in 2 hours
gradually reduce over 24 hours to avoid compromising perfusion
