Arterial hypertension

An overview anatomy physiology for disease AF

1. Arterial hypertension

2. Introduction A rte ri a l hyp e rt e n s i on i s d efi n e d as b o r d e r li n e wh e n i t r e a c h e s 1 4 / 95 mm H g and h y p e r te n s i v e w h e n i ts 1 6 5/ 9 5 mm H g. T h e e l e v a t i on of s y s t oli c p r e s su r e a l on e ( s y s tol i c hyp e rte ns i on) o r e l e v at i on of b o th s y s t oli c and d i a s t oli c p r e s su r e ( d i a s t ol i c h y p er t e n s i o n), b o th h a ve a n i n c r e a s e d r i s k of c o m p l ic a t i o n , b u t d i a s t ol ic h y p er t e n s i on i s m o r e d a n g e r ou s .

3. Classification Primary or essential hypertension in which the cause of increase in blood pressure is unknown. This hypertension constitutes about 90-95% patient with hypertension. Secondary hypertension, remaining 5–10% of cases are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system.

4. Essential arterial hypertension is arterial hypertension of unknown origin and not associated with other diseases. Symptomatical (secondary) arterial hypertension is symptom disease of the kidneys, endocrine system , heart, nervous system, exogenous(salt-,alcohol- ,medicament drugs-,toxin associated), pregnancy associated and other.

5. Causes Unknown cause (idiopathic pulmonary arterial hypertension) A genetic mutation passed down through families (heritable pulmonary arterial hypertension) Use of some prescription diet drugs or illegal drugs such as methamphetamines — and other drugs Heart problems present at birth (congenital heart disease) Other conditions, such as connective tissue disorders (scleroderma, lupus, others), HIV infection or chronic liver disease (cirrhosis)

6. Factors of blood regulation Cardiac output, Peripheral vascular resistance, Blood circulating volume.

7. Risk factors A family history of the condition Being overweight Blood-clotting disorders or a family history of blood clots in the lungs Exposure to asbestos Genetic disorders, including congenital heart disease Living at a high altitude Use of certain weight-loss drugs Use of illegal drugs such as cocaine

8. Complication Right-sided heart enlargement and heart failure ( cor pulmonale ) In cor pulmonale , your heart's right ventricle becomes enlarged and has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries. Blood clots Having pulmonary hypertension makes it more likely you'll develop clots in the small arteries in your lungs, which is dangerous if you already have narrowed or blocked blood vessels.

9. Arrhythmia Pulmonary hypertension can cause irregular heartbeats (arrhythmias), which can lead to a pounding heartbeat (palpitations), dizziness or fainting. Certain arrhythmias can be life-threatening. Bleeding in the lungs Pulmonary hypertension can lead to life-threatening bleeding into the lungs and coughing up blood (hemoptysis). Pregnancy complications Pulmonary hypertension can be life-threatening for a woman and her developing baby.

10. Diagnosis Blood tests Include HIV, thyroid tests, autoimmune disease panels (test for systemic lupus erythematosus, scleroderma, and rheumatoid arthritis), liver tests and blood chemistry tests. Electrocardiogram Shows the electrical activity of the heart and may help detect abnormalities. Doctors may also be able to detect signs of strain on the right side of the heart. Lung function tests (breathing tests ) Check for diseases like asthma or emphysema.

11. 6-Minute Walk Test Objectively measures how far you can walk and to see if your oxygen levels drop when you exert yourself. Echocardiogram Ultrasound of the heart to check the size and condition of the chambers of the heart. It can also be used to estimate the blood pressure in the pulmonary arteries. Right Heart Catheterization This test is invasive, so it is not usually performed unless other tests cannot produce a firm diagnosis. It involves inserting a catheter (small tube) into a large vein in either the neck, arm, or groin, and threading it through the right side of the heart and into the pulmonary artery.

12. Sildenafil and tadalafil Sildenafil ( Revatio , Viagra) and tadalafil ( Adcirca , Cialis) are commonly used to treat erectile dysfunction. Also open the blood vessels in the lungs and allow blood to flow through more easily. Side effects can include an upset stomach, headache and vision problems. Guanylate cyclase (GSC) stimulators Riociguat ( Adempas ) increases nitric oxide in the body, which relaxes the pulmonary arteries and lowers pressure within them. Side effects include nausea, dizziness and fainting. You should not take GSC stimulators if you're pregnant.

13. Ace inhibitors C a p t o pril , 2 5 - 5 m g , 2 - 3 t i m e s p e r d a y E n a l a pril , 1 - 2 m g , 1 - 2 t i m e s p e r d a y L i s i n o p ril , 10 - 2 m g , 1 - 2 ti m e s p e r d a y P er i nd o p ril , 4 -8 m g , 1 ti m e s p e r d a y

14. calcium channel blockers High-dose calcium channel blockers These drugs help relax the muscles in the walls of your blood vessels. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac , others) and nifedipine (Procardia, others). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension improve while taking them Digoxin Digoxin ( Lanoxin ) helps the heartbeat stronger and pump more blood. It can help control the heart rate if you have arrhythmias.

15. Anticoagulant Warfarin D octors generally prescribe warfarin (Coumadin, Jantoven ) to help prevent blood clots in the lung's arteries. This medication delays the clotting process and might put you at risk of bleeding, especially if you're having surgery or an invasive procedure. Blood tests while taking warfarin are suggested to check how well it's working.

16. Diuretics Diuretics Commonly known as water pills, these medications help kidneys remove excess fluid from the body. This reduces the amount of work your heart has to do They may also be used to limit fluid buildup in your lungs, legs and abdomen. Oxygen therapy doctor might suggest to breathe pure oxygen to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people who have pulmonary hypertension eventually need continuous oxygen therapy.