Salient Features of India constitution especially power and functions
Hypertensive heart disease presentation.pptx
1. INSTITUTE OF HEALTH SCIENCE
SCHOOL OF NURSING AND MIDWIFERY
PROGRAM:PCHN
PROGRAM: ADVANCED PEDIATRICS NURSING 1
SEMINAR PRESENTATION ON HYPERTENSIVE
HAERT DISEASE
By Garoma Tegegne……Id no 1500329
Feb, 2023
Nekemte,
Ethiopia
3/26/2024 1
2. Presentation out line
Anatomy and
physiology of heart
Definitions of HHD
Epidemiology of HHD
Etiology of HHD
Pathogenesis of HHD
Pathophysiology of
HHD
C/M of HHD
DDX of HHD
Diagnostic of HHD
Management of HHD
Complications of HHD
Prevention of HHD
Conclusion
Reference
3/26/2024 2
3. Objectives
At the ends of this Presentation, the students will able to:
Discuss Anatomy and physiology of heart
Define HHD
Describe Epidemiology of HHD
Identify Etiology of HHD
Discuss Pathogenesis of HHD
Explain Pathophysiology of HHD
Identify C/M of HHD
Explain DDX of HHD
Discuss Diagnostic of HHD
Discuss Management of HHD
Identify Complications of HHD
Describe Prevention of HHD
3/26/2024 3
4. Anatomy and physiology
The heart muscle pumps blood through the body:
Right side pumps oxygen-poor blood to the lungs
Left side pumps the oxygen-rich blood to the rest of
the body
Blood enters right side of heart and flows through the
right atrium and right ventricle to the lung
3/26/2024 4
5. Anatomy and physiology …
Oxygen-rich blood in the lung returns to the heart and
enters the left sventricle, where it is pumped
3/26/2024 5
6. Hypertension
Is defined as average SBP and/or DBP that is greater
than or equal to the 95th percentile, and height on
three or more occasions
Pre-hypertension is average SBP or DBP levels that
are greater than or equal to the 90th percentile, but
less than the 95th percentile.
3/26/2024 6
7. Hypertensive Heart Disease (HHD)
HHD refers to a constellation of changes in the left
ventricle, left atrium, and coronary arteries as a result of
chronic blood pressure elevation
HTN increases the workload on the heart inducing
structural and functional changes in the myocardium
3/26/2024 7
8. HHD…
Overweight and obesity in youth is increasing the
prevalence of prehypertension and hypertension among
children and adolescents.
Uncontrolled BP can lead to a variety of changes in the
myocardial structure, coronary vasculature, and
conduction system of the heart.
3/26/2024 8
9. HHD …
Uncontrolled BP leads to the development of:
Left ventricular hypertrophy
Coronary artery disease
Systolic and diastolic dysfunction of the myocardium
Cardiac arrhythmias (especially atrial fibrillation) and
Congestive heart failure
3/26/2024 9
11. Epidemiology of HHD
Hypertensive heart disease (HHD) is a condition where
high blood pressure causes damage to the heart.
The prevalence of HHD in children and young people is
increasing worldwide, owing to the rise in obesity and
Type 2 Diabetes
According to a recent study, the prevalence of
hypertension in children is increasing globally, with
more than 1 billion people being hypertensive
3/26/2024 11
12. Cont…
In Africa, the estimated number of people with
hypertension has increased steadily from 54.6 million
in 1990 to 130.2 million in 2010
A cross-sectional study from Brazil involving 794
children aged 6-13 years reported a prevalence of 7%
of pediatric hypertension
In China, the overall prevalence of elevated blood
pressure (≥95th percentile) among school-age children
(6-13 years) was 18.4%
3/26/2024 12
13. Cont..
A systematic review and meta-analysis of
institutional and community-based studies in
Ethiopia reported:-
• In Ethiopia, the prevalence of cardiovascular
disease (CVD), which includes HHD, was
found to be 5%
• a prevalence of 23% in systolic and/or
3/26/2024 13
17. Cardiovascular effects of hypertension
Thus, hypertensive heart disease is a term applied generally to heart
diseases, such as
I. Left ventricular hypertrophy (LVH )
II. Coronary artery disease
III. Cardiac arrhythmias, and
IV. CHF that are caused by the direct or indirect effects of elevated
BP.
These diseases generally develop in response to chronically
elevated BP
3/26/2024 17
18. Based systemic hypertension
Systolic and or diastolic pressure levels greater than 95th
percentile for age & gender on at least three occasions.
Normal blood pressure at birth 70/50 (increase 10 systolic & 5
diastolic every 3 years).
Degrees of hypertension: (according to increase above normal
range for age)
Mild hypertension: systole increase by 10 mmHg or diastole
increase by 5 mmHg
Moderate hypertension: systole increase by 20 mmHg or
diastole increase by 10 mmHg
3/26/2024 18
19. Pathophysiology of HHD
HHD focused on left ventricular hypertrophy (LVH)
Target-organ damage beyond LVH
HHD is characterized by micro- and macroscopic myocardial
alterations:
Structural phenotypic adaptations
Functional changes include cardiac fibrosis
Remodeling of the atria and ventricles
Heart valve hypertrophy and failure to pump
3/26/2024 19
20. Pathophysiology …
Left ventricular hypertrophy
structural and functional changes of LA are very common
with HTN.
Left atrial abnormalities
Diastolic dysfunction, may precipitate overt heart failure
Valvular disease
HTN is accelerate the process of aortic sclerosis and cause
mitral regurgitation
Heart failure
3/26/2024 20
22. Type of HHD
HHD is a condition where high blood pressure causes
damage to the heart.
There are two types of HHD in children:
1) Primary Hypertension:
This type of hypertension occurs in children with no
underlying medical condition
It is also known as essential hypertension and is the
most common type of hypertension in children
3/26/2024 22
23. Type of HHD cont…
2) Secondary Hypertension:
This type of hypertension occurs as a result of an
underlying medical condition such as kidney disease,
heart disease, or endocrine disorders
It is less common than primary hypertension in
children
3/26/2024 23
24. Classification of HTN in children &
adolescents
I SBP or DBP %ile
NORMAL < 90th
PREHYPERTENSION 90th to 95th
>120/80mmHg
STAGE 1 95th to 99th
>5mmHg
STAGE 2 >99th + 5mmHg
Urgency /Emergency stage 2 with clinical Sn/Sx
3/26/2024 24
25. HHD with marked concentric
thickening of the left
ventricular wall causing
reduction in lumen size
3/26/2024 25
26. Clinical manifestations
Cough, Fast heart beat & fast breathing
Working hard to breathe when feeding
Restlessness or irritable
Sweating, SOB and fatigue
Edema, or swelling in the ankles or abdomen
Decreased amount of urine..a baby may have fewerwet diapers
(<6-8 a day)
3/26/2024 26
27. Differential diagnosis
Newborn
Thrombosis stenosis
Coarctation of the aorta
Pheochromocytoma
Cushing disease
Children < 6 years
Renal parenchymal
disease
Other vascular disease
3/26/2024 27
30. Cont…
β-blockers
• Examples of β-blockers include atenolol, metoprolol,
and propranolol
Calcium-channel blockers
• Examples of Calcium-channel blockers include
amlodipine, diltiazem, and verapamil
Diuretics
• Examples of Diuretics include furosemide,
3/26/2024 30
31. β-blockers
Pediatric dose: The dose of β-blockers depends on the
child’s age, weight, and medical condition.
The recommended starting dose of propranolol for
infants is 0.5-1 mg/kg/day in divided doses
Side effects: Common side effects of β-blockers
include fatigue, dizziness, and cold hands and feet.
Less common side effects include depression,
nightmares, and hallucinations
3/26/2024 31
32. Calcium-channel blockers
Pediatric dose: The dose of Calcium-channel blockers
depends on the child’s age, weight, and medical
condition.
The recommended starting dose of amlodipine for
children aged 6-17 years is 2.5-5 mg/day
Side effects: Common side effects of Calcium-
channel blockers include headache, dizziness, and
flushing.
3/26/2024 32
33. Diuretics
Pediatric dose: The dose of Diuretics depends on the
child’s age, weight, and medical condition.
The recommended starting dose of furosemide for
children is 1-2 mg/kg/day in divided doses .
Side effects: Common side effects of Diuretics
include dehydration, electrolyte imbalances, and low
blood pressure.
Less common side effects include hearing loss, skin
3/26/2024 33
35. Complications of HHD
Without appropriate mgt: HHD leads to:
Heart failure may develop
Thickening of the blood vessel walls
When combined with cholesterol deposits in the
blood vessels
Heart attack and
Stroke
3/26/2024 35
37. Prevention
Weight loss in children with obesity or overweight
Reduction of salt intake and caloric foods and
Children ages 6 to 17 should get at least 60 minutes
of moderate to vigorous physical activity daily
Early treatment of HTN
Don’t expose kids to cigarette smoke
3/26/2024 37
38. Conclusion
• The review also highlights that hypertension in children is on
the rise in both developed and developing countries
• The diagnosis of hypertension in children is based on the
average blood pressure readings taken over three or more
visits.
• A child or adolescent is diagnosed with hypertension when
their average blood pressure is at or above the 95th percentile
for their age, sex, and height
• It is important to monitor and manage hypertension in children
to prevent long-term complications.
3/26/2024 38
39. References
• Dr. Usman Shams HHD
• Cynthia S. Bell, et. Al. prevalence of HTN in
children
• Chike C. Nwabuo & Ramachandran S. Vasan
Pathophysiology of Hypertensive Heart Disease
• Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli
S, Hense HW, Joffres M, et al. Hypertension
prevalence and blood pressure levels in 6
European countries, Canada, and the United States
• Sepiso K. Masenga et al. Hypertensive heart
disease: risk factors, complications and
mechanisms
3/26/2024 39