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Common Congenital Heart Lesions - page 54 / 126





54 / 126

54 of 126

  • Uneven distribution in racial groupsÆhigher in blacks

  • Lower socioeconomic and education status Æhigher

  • Older age Æ higher prevalence. (more on this later)

  • Defects in heart, blood vessels and kidney can be involved in ET

  • Kidney is really important: it has to be messed up for the defects in other systems

to produce sustained hypertension.

  • Insulin resistance was mentioned: insulin can increase BP

  • Obesity and leptin: increased leptin can increase BP

OBJECTIVE # 1: Changes in BP with Age In younger patients (age 40 and younger), essential hypertension is driven by increased CO with normal resistance. This is called the hyperkinetic phase of ET. As we age, the increased CO tends to decline in importance and peripheral resistance increases. This is because the heart and vessels adapt to the stress: LV hypertrophy and medial hypertrophy of the vessels.

  • Two stages: “hyperkinetic phase” at younger age Æ high CO, low TPR

  • Later stage Æ normal CO and high TPR

Consequences of Hypertension


  • ***mostly ASYMPTOMATIC***

  • Headache ?

  • Nosebleed ?

  • Dizziness ?

  • Flushing

  • Sweating

  • Blurred vision

Organ Damage: heart, cerebrovascular system, aorta, peripheral vasculature, kidney, retina

  • heart in brief

    • o

      problems result from increased afterload AND atherosclerosis in coronary arteries (HTN disrupts protective mechanisms)

      • concentric hypertrophyÆ increased stiffnessÆ DIASTOLIC DYSFUNCTION Æ pulm congestion

      • SYSTOLIC DYSFUNCTION Æ reduced CO, coronary art disease

      • Coronary artery disease: accelerated atherosclerosis cause plaque formation in coronaries = decreased supply of O2, increased demand for O2 (due to the increased workload) Æ MI

  • Cerebrovascular system

      • o

        Hemorrhagic or atherothrombotic hypertension strokes

        • Atherothrombotic: bits of plaque from carotid break off

        • Cause lacunae: cavities in middle and posterior brain circ.

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