Htn Heart Failure 2010

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pathophysiology

pathophysiology

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  • 1. Hypertension
  • 2. Objectives
    • Describe the mechanisms of blood pressure elevation
    • List risk factors for hypertension & CHF
    • Describe the clinical manifestations of hypertension & CHF and their significance for therapeutic management and nursing care
  • 3. Hypertension
    • A systolic blood pressure greater than 140mm Hg and a diastolic pressure greater than 90mm Hg over a sustained period
    • Heart is working harder putting heart & blood vessels under strain
    • High BP can contribute to myocardial infarction, stroke, renal failure & atherosclerosis
  • 4. Primary (Essential) Hypertension
    • Elevated BP without an identified cause
    • Accounts for 90 – 95% of all cases
    • Exact cause unknown
    • Contributing factors include increased SNS activity, overproduction of Na-retaining hormones & vasoconstrictors, ↑ Na intake, obesity, diabetes mellitus & excessive alcohol intake
  • 5. Pathophysiology of Primary Hypertension
    • For arterial pressure to rise there must be an increase in either CO or SVR
    • Hallmark of hypertension is a persistent elevation in systemic vascular resistance (SVR)
  • 6. Secondary Hypertension
    • Elevated BP with a specific cause that often can be identified & corrected
    • Causes include narrowing of aorta, renal diseases, endocrine disorders, neurological disorders, medications & pregnancy-induced hypertension
  • 7.  
  • 8. Risk Factors
    • Increasing age
    • Excessive alcohol intake
    • Smoking
    • Diabetes mellitus
    • Elevated serum lipids
    • Excessive dietary sodium
    • Gender (men & post-menopausal women
    • Family history
    • Obesity
    • Sedentary lifestyle
    • Lower socio-economic groups
    • Stress
  • 9. Clinical Manifestations
    • “ Silent killer” – frequently asymptomatic until severe & target organ diseases has occurred
    • Severe hypertension may produce symptoms as result of effects on blood vessels & increased workload of heart
    • Can include fatigue, reduced activity tolerance, dizziness, palpitations, angina & dyspnoea
    • Headaches, nosebleeds & dizziness usually only occur with very high or very low BP
  • 10. Risk factors for CV Problems in Hypertensive Pts
    • Major Risk Factors
    • Smoking
    • Lipidemia
    • Diabetes mellitus
    • Over 60yrs
    • Gender (men & postmenopausal women)
    • Family history
    • Complications -Target Organ Damage
    • Heart diseases
    • Stroke or TIA
    • Nephropathy
    • Peripheral arterial disease
    • Retinopathy
  • 11. Heart Failure
  • 12. Heart Failure
  • 13. Glossary
    • Cardiac Output
    • Stroke volume
    • Syndrome
    • Hypertrophy
    • Cardiomyopathy
    • Hepatomegaly
    • Splenomegaly
    • Tachypnoea
    • Orthopnoea
    • Rhonchi
    • Crackle
  • 14. Heart Failure
    • Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
    • A clinical syndrome characterized by signs and symptoms of fluid overload or of inadequate tissue perfusion
    • Signs & symptoms results when the heart is unable to generate a CO sufficient to meet the body’s demands
  • 15. Heart Failure
    • Most often this is a lif-long diagnosis that is managed with lifestyle changes and medications to prevent acute congestive episodes
    • Congestive heart failure (CHF) is usually an acute presentation of heart failure (HF)
  • 16. HF
    • Incidence increases with age
    • Incidence similar in men & women
    • The most common reason for hospitalization in adults over 65 yrs
    • Medical management is based on the type, severity and cause of HF
  • 17. Types of HF
    • Two types identified by assessment of left ventricular functioning
    • Diastolic heart failure – alteration in ventricular filling
    • Systolic heart failure – alteration in ventricular contraction
  • 18. Pathophysiology of HF
    • Results from a variety of CV diseases but leads to some common abnormalities that result in decreased contraction (systole), decreased filling (diastole) or both
    • Significant myocardial dysfunction usually present before patient experiences signs & symptoms of HF
  • 19. Systolic Failure
    • Most common cause of HF
    • Left ventricle loses ability to generate enough pressure to eject blood forward through the high pressure aorta
    • Caused by impaired contractile function e.g.. MI, hypertension, cardiomyopathy & cardiac valvular disease
  • 20. Diastolic HF
    • Impaired ability of ventricles to fill during diastole resulting in decreased stroke volume
    • Characterised by high filling pressures & resultant venous engorgement in both pulmonary and systemic vascular systems
    • Usually the result of LV hypertrophy from hypertension
  • 21. Diastolic & Systolic Heart Failure
  • 22. Mixed Systolic and Diastolic Failure
    • Seen in dilated cardiomyopathy
    • Biventricular failure
  • 23. Left-sided Failure
    • Most common form
    • Blood backs up through the left atrium into pulmonary veins
    • ↑ pulmonary pressure causes fluid to escape from the pulmonary capillary bed into the alveoli
    • Pulmonary congestion and oedema result
  • 24. Right-sided Failure
    • Primary cause is L) sided failure
    • Causes backward flow to the right atrium and venous circulation
    • Venous congestion in the systemic circulation results in peripheral oedema, hepatomegaly, splenomegaly, vascular congestion of GI tract & jugular vein distension
  • 25. Risk Factors
    • CAD
    • ↑ age
    • Hypertension
    • Obesity
    • Cigarette smoking
    • Diabetes mellitus
    • High cholesterol
    • Maori descent
  • 26. Acute Congestive Heart Failure Clinical Manifestations
    • Typically presents as pulmonary oedema
    • Most common cause is LVF secondary to CAD
    • Agitation
    • Pale or cyanotic, cold, clammy skin
    • Severe dyspnoea, tachypnoea, orthopnoea
    • Wheezing, coughing, production of frothy, blood-tinged sputum
    • Crackles, wheezes & rhonchi throughout lungs
  • 27. Heart Failure
  • 28. Chronic Congestive Heart Failure Clinical Manifestations
    • Depend on pt’s age, type & extent of heart disease & which ventricle is failing to pump effectively
    • Fatigue
    • Dyspnoea – Paroxysmal nocturnal dyspnoea
    • Tachycardia
    • Oedema
    • Nocturia
    • Skin changes
    • Chest pain
    • Weight changes
    • Behavioural changes – restlessness, confusion, ↓ attention span
  • 29. Pitting Oedema
  • 30. Heart Failure
  • 31. Signs & Symptoms
  • 32. Glossary
    • Cardiac Ouput = heart rate X stroke volume
    • Stroke volume = amount of blood pumped by ventricle with each contraction
    • Syndrome = collection of signs and symptoms
    • Hypertrophy = increase in the size of an organ
    • Cardiomyopathy = any disease that affects the structure and function of the heart
    • Hepatomegaly = abnormal enlargement of the liver
    • Splenomegaly = abnormal enlargement of the spleen
    • Tachypnoea = abnormal rapid rate of breathing
    • Orthopnoea = abnormal condition when a person must sit or stand to breathe deeply or comfortably
    • Rhonchi = abnormal sounds heard on auscultation of an obstructed airway
    • Crackle = abnormal respiratory sound heard on auscultation of the chest, characterized by discontinuous bubbling noises