Hypertension and Congenital heart disorder Flashcards
Classification of hypertension
Primary hypertension: idiopathic (95%)
Secondary hypertension: renal disease, vascular disease, endocrin disorders, adrenal disorders, hyperthyroidism, coarctation of the aorta, excessive alcohol intake, use of oral contraceptive, NSAIDs, corticosteroids, cocaine, pregnancy, etc
Definition of Hypertension
Persistent elevation of diastolic blood pressure (higher than 90mg hg) systolic blood pressure (higher than 140mm hg) or both, measured on two separate occasions at least two weeks apart
Risk factors of Hypertensive vascular disease
Genetics, smoking, obesity, high cholesterol (LDL - Low Density Lipoprotein), ethnicity (African American), Diet (low K, Ca, Mg, high Na), Inadequate sleep
Hypertension involves
Increased Cardiac output (CO)
Increased peripheral vascular resistance (TPR)
Hypertension contributing factors
Abnormal sodium transport
Sympathetic nervous system stimulation
Renin-angiotensin-aldosterone system
Vasodilator deficiency
Pathology of Hypertension
- no pathologic changes occur early in hypertension
-severe or prolonged hypertension damages target organs (primarily the cardiovascular system, brain, and kidneys), increasing risk of coronary artery disease (CAD), myocardial infarction, stroke and renal failure
The mechanism involves development of atherosclerosis
Hypertension accelerates the development of atherosclerosis
Clinical manifestation of Hypertension
Asymptomatic Headache Vertigo Flushed face Blurred vision Nocturia Frequency Sleep apnea
Treatment for Hypertension
Quit smoking
Weight reduction
Exercise
Supplements
Diet (reduce intake of fat, salt, LDL, alcohol)
Medications: diuretics, adrenergic blockers, vasodilators, ACE inhibitors, calcium antagonists
Prognosis of Hyper tension
- The higher the BP and the more severe the retinal changes and other evidence of target-organ involvement, the worse is the prognosis
- Systolic BP predicts cardiovascular events better than diastolic BP
- CAD (Coronary artery disease) is more common cause of death among treated hypertensive patients
- Stroke is a common consequence of inadequately treated hypertention
- Effective control of hypertension prevents most complications and prolongs life
Congenital disorders of the heart Etiology
Idiopathic
Multifactorial - maternal diabetes, infections (TORCH), drugs, etc
Exogenous - viruses, alcohol
Endogenous - chromosomal defects
Toxoplasmosis, Others (Syphilis, Varicella zoster), Rubella, Cytomegarovirus, Herpes
Congenital heart disease clinical manifestation
Variable depending on the severity of the defect and single versus multiple defects
Can be asymptomatic, apparent at birth, life-threatening, non-compatible with life, etc
What is the most common form of congenital heart disease and which type is more common
Septal defects - ventricular septal defect is more common and serious than atrial (due to defects in the foremen ovale)
Can occur in isolation or in conjunction with other heart defect
Pathogenesis of Ventricular septal defect
- Pressure within the left heart chamber exceeds the pressure within the right heart chamber
- Arterial blood flows from left to right side of heart (left to right shunt).
- Backflow overburdens the right side of the heart.
- Hypertrophy of the right side of the heart
- Increased blood flow through pulmonary arteries leads to pulmonary hypertention leads to narrowing of pulmonary arteries
- These changes increase pressure in the right side of the heart, causing blood to flow to the left side of the heart (right to left shunt).
- Blood that flows to the left side of the heart is deoxygenated leading to cyanosis.
Clinical manifestation and treatment of Ventricular septal defect
Asymptomatic
Heart murmur
Cyanosis
Self-limiting
Surgery
Most common cause of cardiac cyanosis in newborns
Tetralogy of fallot
