angina clinical manifestations
Hypertension a disease that destroys
Hypertension is a disease of different causes. And as evidenced by the steady increase Pressure pressure, or systolic and diastolic in both.
The increase in blood pressure (hypertension) is an important cause, but more likely processing, disease and is divided into elementary and secondary. In the general population, blood pressure is a continuous variable and its increase is associated with increased risk of disease. Hypertension is arbitrarily defined as a sustained diastolic pressure above 90 mmHg. However, there is no risk of a disease in which blood pressure is a pathogenic factor.
primary hypertension (essential) is the elevation of blood pressure with age, but without apparent cause. It represents over 90% of cases and usually appears after age 40 years, the phenotype of hypertension in hypertension is due to an interaction between a genetic predisposition genetics, obesity, alcohol, physical activity and other factors still unidentified.
Hypertension secondary, which represents approximately 10% of cases, is due to an identifiable cause, the most common disease renovascular, which increases blood pressure by activating the renin-angiotensin-aldosterone system. Depending on their clinical course, primary and secondary hypertension can be classified into two types. In mild hypertension, there is a lift blood pressure stable for many years, hypertension, while accelerating the rise in blood pressure is intense and growing rapidly.
The factors that regulate blood pressure
Blood pressure can be increased to increase the volume of cardiac or vascular disease peripheral resistance. The first raises the blood volume or increased contractility and heart rate, the second can be enhanced by humoral factors, nervous and me.
Depending on of biological damage produced, hypertension can be found in different stages:
PHASE I: No change functional.
PHASE II: The patient has one of the following signs, even if they are asymptomatic.
a) hypertrophy Left ventricular (palpation, chest radiograph, ECG, echocardiography).
b) Angiotonía in the arteries of the retina.
c) Proteinuria and / or light rise in creatinine (up to 2 mg / d).
d) the plaque (x-ray, ultrasound) in carotid arteries, aorta, iliac and femoral arteries.
PHASE III: symptomatic manifestations of organ damage:
a) angina pectoris, myocardial infarction, or heart failure.
b) transient ischemic attack, thrombosis Brain and hypertensive encephalopathy.
c) exudates and retinal hemorrhages, papilledema.
d) failure Chronic kidney.
e) obstructive aortic aneurysm or atherosclerosis of the lower limbs.
Thickening of the arterial wall and arteriolosclerosis are signs of mild hypertension
High blood pressure in benign changes vascular occur gradually in response to stable and sustained hypertension. These degenerative changes in the walls of small vessels and arterioles reduce the effective light. ischemia and a consequent increase vascular fragility in the brain bleeding risk.
In hypertension malignant destruction of walls of small vessels
When blood pressure increases both sudden acute destructive changes occur in walls of small blood vessels, with correction for proliferative responses
the walls of small arteries. The disturbance produced by lack of blood in small boats, with formation of multiple foci of necrosis, for example, stone glomeruli.
High blood pressure affects mainly heart, brain, kidneys and aorta
The pathological consequences of hypertension are mainly seen in four tissues:
• Heart. With increasing pressure, ventricular hypertrophy of the myocardium. Since hypertension is often associated with a higher intensity of atherosclerosis, coronary flow may be insufficient, and has produced a
ischemic heart disease. Left ventricular failure is a consequence normal hypertensive heart disease.
• Brain. Hypertensive patients are particularly vulnerable to an intracerebral hemorrhage due to rupture of blood vessels intracerebrally. The small lesion vessels microinfarctions cerebral hemispheres occurs as small areas of destruction in the brain filled with fluid ("gaps hypertensive).
• Kidneys. Ischemia arteriolosclerosis progressive nephron, which eventually destroys glomeruli, and atrophy of the tubular system. The disease progresses slowly, as the injured nephron at a time. When the number of nephron function by ischemia is not high enough, the patient developed chronic renal failure slowly
progressive. If hypertension arterial ischemia was produced significant nephron, the kidney is said to have suffered a mild hypertensive nephrosclerosis. This is an important cause renal
Chronic Middle and old age.
• Aorta. Hypertension predisposes to the development of large aortic aneurysms abdominal dissections average.
Secondary hypertension is less than 10% of cases
In a minority of cases, it is considered there is no structural alterations responsible for the development of hypertension. For example, stenosis
the artery kidney (usually the root) can cause atherosclerosis by hypertension, possible surgical treatment. Hypertension pressure is associated with high levels of renin and angiotensin II in the circulation of the ischemic kidney and may be cured in the first stages through
renal elimination of the state. Hypertension is also a symptom of kidney disease such as diffuse glomerulonephritis and pyelonephritis. High blood pressure is transitory in the initial phase of acute glomerular disease (P eg.,
nephrotic syndrome) but standing diffuse chronic kidney disease.
Pheochromocytoma, a tumor secreting epinephrine norepinephrine usually arises in the adrenal medulla, produces hypertension
paroxysmal first.
Aortic coarctation is a congenital malformation increased peripheral resistance due to stenosis of the aortic structural. In these cases, systemic hypertension is not really that only affects the blood system before the coarctation, usually the arms, head and neck.
Hypertension is a symptom of the disease cortex adrenal associated with excessive production of glucocorticoids and mineralocorticoids (Cushing's syndrome and Conn síndromede).
It is also a symptom of preeclampsia, and may be associated with endocrinopathies such as hyperthyroidism, acromegaly, hypothyroidism, and sometimes, or causes neurogenic such as intracranial hypertension.
treatment
a) In patients with hypertension Grade I or II treatment, you should start with one medication. If the patient has hypertension hyperkinetic syndrome, the best option is a beta-blocker, impractical and the use of vasodilators such as alpha-blockers or calcium channel blockers exacerbate circulatory hyperkinesis. In patients who are suspected to extend the extracellular space (especially women) is the best option is diuretic monotherapy less effective as beta-blockers and vasodilators are against the deterioration of water retention and expansion of the intravascular space. Maybe as effective as ACE inhibitors. In older people with hypertension Systolic is preferable to use calcium antagonists the drugs of choice.
b) Patients with essential hypertension grade III, requires the use of multiple medications to achieve effective control of hypertension. This form is preferable to begin treatment with beta-blockers and diuretics (thiazides and economical potassium). In the absence of effective control of blood pressure can add an ACE inhibitor. When not affected by the normalization Blood pressure can be used vasodilator (Hydralazine, minoxidil, prazosin), which reduces vascular resistance. Calcium antagonists may be used in these patients are not able to control hypertension with drugs and / or because there are two states to end its administration of undesirable side effects, such as gout (thiazide), asthma or heart failure (beta) or a persistent cough (inhibitors ACE). Anta onist calcium can also produce undesirable side effects (swelling, redness) that binds to the suspension or switch to another drug another family.
In general conclusion we can say that the treatment of hypertensive patients should be individualized, taking into account the age, the clinical and hemodynamic effects of drugs.
c) The patient with grade IV hypertension is a hypertensive emergency or urgency, so that their treatment requires hospitalization and immediate treatment.
Hypertensive crisis
with) the patient was asymptomatic but with values pressure diastolic blood pressure of 140 mmHg or more should be hospitalized for observation and bed rest, under the administration of sublingual nifedipine 10 mg.
b) patients with hypertensive crisis, with a blood pressure of 180/140 and acute pulmonary edema should be treated with the position Fowler, sitting on the edge of bed, turning the turnstiles, IV furosemide at a rate ranging between 20 and 60 mg IV and sodium nitroprusside dissolved in dextrose solution at a rate of 0.3 to 8 mg / kg / min, and in some cases, these measures runs the table jugular, but others must also examine the patient at the right time (or C lanata ouabain). When the patient is already in clinical conditions acceptable to start oral antihypertensive.
c) The patient with hypertensive crisis which is associated with hypertensive encephalopathy is presented to the doctor with a headache something very flashy, nausea, vomiting, blurred vision and drowsiness progressive mental all this coincides with elevations of pressure exaggerated numbers pressure (> 180/140). Procedures appropriate will also be treated with sodium nitroprusside as mentioned in the preceding paragraph, although such cases also Diazoxide can be used with an initial dose of 300 mg IV, which may be repeated with 4 or 6:00, depending on the response. Remember that the administration prolonged drug produces sodium and water retention, so when its use is extended beyond 24 hours must fall into administration diuretics. As soon as possible to begin treatment by oral route.
d) The hypertensive crisis is complicated aortic dissection is presented as a acute illness where the patient may have chest pain or back pain accompanied by feelings of death, paleness, sweating, and spirit exaggerated the high number (> 180/140 mmHg). This table should be treated with sodium nitroprusside is the drug of choice to alphamethyldopa a speed of 250-500 mg IV v. 4-6 hours and monitored oral to start antihypertensive therapy.
e) If referring to a hypertensive crisis due to a pheochromocytoma patient headache palpitations, and met with pallor and sweating, tachycardia Sinus and too many (> 180/140 mmHg), in which case the ideal treatment should be done with phentolamine, inject an initial bolus of 5-15 mg IV, then a continuous infusion to maintain blood numbers of pressure to acceptable levels. If heart rate exageradeamente high (> 150 per minute) or atrial tachyarrhythmias appear paroxysmal atrial fibrillation by propranolol should be administered intravenously at 1 mg / min at 3-5 mg total dose.
Patients with hypertension grade III essential need multiple medications to achieve the desired control. In summary, the treatment must be individualized according to age, the clinical and hemodynamic sensitivity to drugs.
Prevention Methods
* Quitting reduces the mortality of half of those who continue to smoke.
* The control of hypertension.
* Reduction of body weight.
* Increase physical activity.
* Control of diabetes
* Changes in eating food.
The onset may be abrupt, such as myocardial infarction or may be a chronic disease, with a growing loss of heart function. In turn, this can be compensated disease where the activity remains normal or decompensated, in which the patient suffers from dyspnea and chest pain, in this case to rest and receive drugs and diuretics.
From a nutritional point of view is the application of a low sodium diet (containing less than 5grs. Daily salt).
In CHD Avoid foods rich and abundant that they impose an excessive burden on the heart and circulation.
When you make a food choice for these patients should be to replace the salt and no abdominal distension, constipation and flatulence.
Bibliography:
• Pathology 2007 Roobina
• Pathology Rubin
• Web Journal of Cardiology hypertensive crisis
• Institute of Cardiology http://www.drscope.com/cardiologia/pac/arterial.htm
• Goodman and Gilman, Farmacologia.
• National Institute of Cardiology – Ignacio Chávez, Hypertension Articles
• National Association of Cardiologists Mexico
• Society of Interventional Cardiology of Mexico
• National Society of echocardiography in Mexico
Nutrition zonadiet.com 2004 • Hypertension
• vascular health. is
Paper • Guyton Physiology
• Pathology Stevens
About the Author
Student: School of Medicine Ignacio Santos. Committee member of medical research. Member of the EMC Updates medicas JOURNAL CLUB. Member and Supervisor of medical items since 2007. Member of The Neurology Service On-Line Journal Club. Contributor Renal Pathology MCQs
angina clinical manifestations
