Cardiovascular Diseases.- Darshana Varma pptx

Introduction of Cardiovascular diseases and Hypertension along with etiopathogenesis, clinical manifestation, Pathophysiology and Management

1. Cardiovascular Diseases Presented by- Darshana S. Varma

2. Introduction:- Cardiovascular is diseases of heart and blood vessels which includes – hypertension, coronary heart diseases leading to angina , myocardial infarction and congestive heart failure etc Cardiovascular diseases Hypertension Angina and myocardial Hyperlipidaemia Congestive Heart Infraction Failure

3. Hypertension It may be defined as elevated in blood pressure more than 80-120mmHg is called hypertension and the drug which is used in treatment called antihypertensive drugs For eg :- Amlodipine OR Hypertension defined as systolic blood pressure greater than 140 mmHg and/ or diastolic blood pressure greater than 90mmHg Hypertension are classified as :- Primary hypertension:- unknown cause Secondary hypertension:- organ dysfunction detected Classification of hypertension as per grade BP grading Range( mm Hg) Normal 80-120 Prehypertension 86-130 Grade 1 hypertension 90-140 Grade 2 hypertension 100-160 Grade 3 hypertension ≥ 180 and/ ≥110 Isolated systolic hypertension ≥140 and < 90 Hypertension urgency > 180 and/ >110

4. Pathophysiology of hypertension Angiotensinogen by liver Renin Angiotensinogen -I ACE Angiotensinogen -II stimulate Adrenal cortex release Aldesteron responsible Na+ / H2O retention Incresed BP Vasoconstriction

5. Etiopathogenesis of HP- cause and abnormal condition Clinical manifestation of HP- symptom $ diagnosis Management of HP- Treatement Pharmacological Non Pharmacological

6. Etiopathogenesis Clinical manifestation Renal diseases:- eg polycystic kidney . Endocrine diseases:- eg primary hyperaldesteron . Vascular lesions:- eg renal artery disease. On untreated HP- coronary artery diseases, stroke, renal diseases, etc. Show no symptom( silent killer) Non specific:- headache, vomiting , breathless, fatigue , giddiness ( dizzines ), and palpitation (irregular heart rate), epistasis (genetic). Stroke, acute myocardial infraction due to vascular diseases. Sympton :- inner organ affected due to diseases. Spells of sweating . Tachycardia. Swelling indicate thyroid disorder. Diagnosis:- a)CMP b)CBC c) Lipid profile d) Thyroid stimulate

7. Management of HP Non Pharmacology Intake of Na+ should not more than 2.4gm or 6gm salt per day in diet. Adopt Dietary Approaches to Stop -(DASH) eg –fruits, vegetable, low fat diary product Physical activity –regular aerobic activity , brisk walking 30min/day Maintain weight- BMI 18.5-22.9kg/ m 2 Reduce alcohol consumption Stress management Stop smooking Yoga Reduce caffein consumption

8. Pharmacology Grade of hypertension Information Grade-1 HP- Grade-2 HP- Not control more than 3 month of lifestyl modification-risk factor- age:-M >55yr, F>65 yr, smoking, obesity etc at at 1 st stage drug use – ACEI/CCB or TD no adequate response . 2 nd drugs use- CCB+ACEI no adequate response 3 rd drug use are ACEI+CCB+TD duration dose time for all 2 nd &3 rd drugs within 2-4 month After grade 2 HP were diagnosed immediately therapy begin within yr,causes smoking, obesity etc at 1 st stage drug use – ACEI/CCB or TD no adequate response . 2 nd drugs use- CCB+ACEI no adequate response 3 rd drug use are ACEI+CCB+TD duration dose time for all 2 nd &3 rd drugs within 2-4 month

9. Pharmacology Grade of hypertension Information c) Grade 3 HP- d) All grade HP associated with clinical condition :- Use of 2 drug ACEI+ CCB or CCB+TD . If no response within 2-4 weeks either increased drug dose or add 3 rd drug ACEI+ CCB+TD 1)Congestive artery – β B + ACEI, CCB (only target BP) 2 ) Congestive heart failure- TD+ACEI+ Β b,MRA 3) Diabetes mellitus - ACEI or CCB,TD 4) Chronic kidney diseases- ACEI or CCB or TD ( in case of these diseases loop diuretic require if glomerular filteration rate low)

10. classification drugs use in pharmacological management Angiotensin converted Adrenergic receptor blocker Vasodilator Diuretics Enzyme inhibitor (ACE) β -Blocker – Atenolol eg - Na+ nitropruside , K+ sparing - Amiloride eg - Enalapril α -Blocker- Phentolamine Minoxidil Thiazide- chlorathiazide α + β - Blocker- Carvedilol loop - Furosemide Renin Angiotensin Centrally acting drugs Aldosterone sytem (RAAS) eg - α - Methydopa 1. Angiotensin - II receptor blocker (ARBs)- Lorsartan Calcium Channel 2 Renin inhibitor- Aliskiren blocker (CCB) eg- Amlodipine Nifedipine

11. Contraindication:- Amlodipine – Cardiogenic shock, unstable angina , increased in myocardial infraction Enalapril - Use of all ACE inhibitor contraindicated in pregancy , History of hypertension Hydrochlorothiazide :- hypercalcemia , hyponatremia , severe hypokalemia

12. Hypertension in pregnancy Tab Methyl dopa Tab Nifidipine extended preparation Other drugs - β - Blocker , Labetalol