The #1 Resources For Heart Diseases

By admin 　http://www.angirx.com/blog/ischemic-heart-disease-myocardial-infarction/

ischemic heart disease myocardial infarction

Hypertension, a disease that kills

Hypertension is a disease of different causes. And, as evidenced by the persistent increase blood pressure, or both systole and diastole.

Increased blood pressure (hypertension) is a major cause, but more appropriate for treating disease, and is divided into primary and secondary schools. In the general population, blood pressure is a continuous variable and its increase is associated with an increased risk of disease. Hypertension can be 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.

The primary hypertension (essential) is rising blood pressure with age, but without apparent cause. Represents over 90% of cases and usually occurs after 40 years, the phenotype of hypertension in hypertension is due to an interaction between genetic predisposition genetics, obesity, consumption alcohol, physical activity and other factors not yet identified.

Secondary hypertension, which represents about 10% of cases, is due an identifiable cause, renovascular disease most common, which raises blood pressure through activation of the renin-angiotensin-aldosterone. Depending on their clinical course, both primary and secondary hypertension can be classified into two types. In hypertension benign, there is a rise in blood pressure stable for many years, whereas hypertension accelerated rise blood pressure is intense and worsens in a short time.

The factors that regulate blood pressure

Blood pressure can be raised by increasing the volume of vascular resistance or cardiac device. Rose's first blood volume or increased contractility and heart rate, the latter may be enhanced by humoral factors, nervous and me.

Depending on the degree of damage produced organic, hypertension can be found at different stages:

PHASE I: No functional changes.

PHASE II: The patient has one of the following, even if they are asymptomatic.

hypertrophy) of the left ventricle (palpation chest radiograph, ECG, echocardiogram).
b) Angiotonía in the arteries of the retina.
c) Proteinuria and / or slight elevation creatinine (up to 2 mg / d).
d) arterial plaque (radiography, ultrasound) in the carotid arteries, aorta, iliac and femoral arteries.

PHASE III: symptomatic manifestations of organ damage:

safe) angina pectoris, myocardial infarction or heart failure.
b) a transient cerebral ischemia, cerebral thrombosis and hypertensive encephalopathy.
c) exudates and retinal hemorrhages, papilledema.
Chronic renal d) impairment.
e) aortic aneurysm or atherosclerosis obliterans of lower limbs.

The thickening of the arterial wall and arteriolosclerosis are signs of hypertension slight

Hypertension benign vascular changes occur gradually in response to a stable and sustained hypertension. These changes degenerative in the walls of small vessels such as arterioles effectively reduces the light. ischemia resulting in tissue and increase the vascular fragility in the brain, with the risk of bleeding.

In case of malignant hypertension is a destruction of the walls of small vessels

When blood pressure increases both sudden and acute destructive occur in the walls of small blood vessels, with the resumption of the response proliferative
walls of small arteries. The disturbance caused by the lack of flow of small blood vessels, with the formation of multiple foci of necrosis, eg in renal glomeruli.

High blood pressure affects mainly the heart, brain, kidneys and aorta

The pathological consequences of hypertension occurs mainly in four tissues:
• Heart. With increasing pressure, ventricular hypertrophy left. Because hypertension is often associated with a greater intensity of atherosclerotic coronary flow in May is insufficient, and produced a
ischemic heart disease. Left ventricular failure is a normal consequence of hypertensive heart disease.
• Brain. Hypertensive patients are particularly prone to intracerebral hemorrhage from ruptured blood vessels in the brain. Damage to small vessels microinfarctions cerebral hemispheres occurs as small areas of destruction in the brain filled with fluid ( "gaps hypertensives).
• kidney. Ischemia arteriolosclerosis progressive nephron, which eventually destroys the glomeruli, and atrophy of the tubular system. The disease progresses slowly, as the nephron wounded at a time. When the number of functional nephrons by ischemia is not high enough, the patient developed renal chronic renal slowly
progressive. If hypertension was a significant ischemia of the nephron, the kidney is said to have suffered nephrosclerosis mild hypertension. It is a major cause of renal failure
Chronicle East and age.
• Aorta. Hypertension predisposes to the development of large aneurysms of the abdominal aorta and dissection of the mean.

Secondary hypertension is less than 10% of cases

In a minority of cases, it is considered that there is no structural alteration responsible for the development of hypertension. For example, stenosis
renal artery (usually the root) may cause atherosclerosis by hypertension, with possible surgical treatment. Hypertension is associated with high levels of renin and angiotensin II in the circulation of kidney ischemic, and can cure in the early stages to
removal of kidney disease. Hypertension is also a symptom of diffuse nephropathies such as glomerulonephritis and pyelonephritis. Hypertension is transitional in the early acute phase of illness glomerular (p, ex.,
Nephritic syndrome), but standing diffuse chronic kidney disease.
Pheochromocytoma, a tumor that secretes norepinephrine, epinephrine usually occurs in the adrenal medulla, produces hypertension that
first outbreak.

Coarctation aorta is a congenital malformation increased peripheral resistance due to structural narrowing of the aorta. In these cases, hypertension Not really as it only affects the blood system before coarctation, usually to the arms, head and neck.

Hypertension is a symptom of a disease of the adrenal cortex associated with excessive production of glucocorticoid and mineralocorticoid (síndromede syndrome Cushing's and Conn).

It is also a symptom of pre-eclampsia, and may be associated with endocrinopathies such as hyperthyroidism, acromegaly, hypothyroidism, and, sometimes, or neurogenic causes such as intracranial hypertension.

treatment

a) In patients with hypertension grade I or II, we recommend you start treatment with medication alone. If the patient suffers from hypertension hyperkinetic syndrome, the best option is a beta-blocker, is impractical and the use of vasodilators such as alpha-blockers or antagonists blockers exacerbate circulatory hyperkinesis. In patients suspected that the expansion of the extracellular space (especially women) the best option is the diuretic as mono, are less effective than beta-blockers and vasodilators are against the deterioration of water retention and expansion intravascular space. ACE inhibitors may be equally effective. In elderly patients with systolic hypertension is preferable to use calcium antagonists as drugs of first choice.

b) Patients with essential hypertension Grade III, require the use multiple drugs for effective control of hypertension. It is best to start treatment with beta-blockers and diuretics (thiazide and potassium-sparing). In the absence of effective control of blood pressure can add an ACE inhibitor. When not achieved normalization of blood pressure can be used vasodilators (hydralazine, minoxidil, prazosin), which reduce vascular resistance. The calcium antagonists can be used in these patients are not able to control hypertension with drugs and / or because are two states that stop unwanted side effects such as drop (thiazide), asthma or heart failure (beta-blockers) or persistent cough (ACE inhibitors). Gonistas Anta calcium can also produce undesirable side effects (swelling, redness face) can bind to suspension or change to another drug in a different family.
As a general conclusion one can say that the treatment of hypertensive patients should be individualized, taking into account age, clinical conditions and hemodynamic effects of drugs.

c) The patient with hypertension Grade IV is a hypertensive emergency or urgency, so that your treatment requires immediate hospitalization and therapy.

Hypertensive crisis

a) The patient was asymptomatic, but with numbers of diastolic blood pressure 140 mm Hg or more should be hospitalized for observation and bed rest, under the administration of nifedipine 10 mg sublingually.

b) The patient hypertensive crisis, with a blood pressure of 180/140 and acute pulmonary edema should be treated with Fowler's position, sitting on the edge of the bed, rotating tourniquets, by IV furosemide at a rate between 20 and 60 mg IV and sodium nitroprusside dissolved in glucose solution at a rate of 0.3 to 8 mg / kg / min, and in some cases, these measures reached the area jugular but others also must examine the patient in time (or lanata Ouabain C). When the patient is already in clinical conditions will be acceptable to begin Oral antihypertensive.

c) The patient in hypertensive crisis associated with hypertensive encephalopathy presents the physician with a very luxurious product headache, nausea, projectile vomiting, blurred vision and a progressive state of mental lethargy, all this coincides with elevations figures exaggerated blood pressure (> 180/140). The appropriate procedure will also be treated with sodium nitropusiato also mentioned in the preceding paragraph, although such cases can also be used diazoxide with an initial dose of 300 mg IV, which may be repeated w / 4 or 6 hours depending on response. Remember that prolonged administration of this drug causes sodium and water retention, so when it is widely used for more than 24 hours must fall within the administration of diuretics. As soon as possible to initiate oral therapy.

d) Hypertensive crisis that is complicated by aortic dissection exaggerated figures is presented as an acute illness that the patient may have chest pain or back pain accompanied by feelings of death, paleness, sweating, mind and high (> 180/140 mmHg). This table should be treated with Sodium nitroprusside, another alternative is the drug alpha-methyldopa at a rate of 250 to 500 mg IV with 4 to 6 hours and was shown to start Oral antihypertensive therapy.

e) If a hypertensive crisis due to a pheochromocytoma patient referred headache, palpitations and found with pallor and diaphoresis, sinus tachycardia and the number too high (> 180 / 140 mmHg), in which case the ideal treatment should be done with phentolamine, an initial bolus injection 5 to 15 mg IV followed by a continuous infusion to maintain the level of blood pressure to an acceptable level. If the frequency exageradeamente heart is high (> 150 per minute) or paroxysmal tachycardia appear as atrial fibrillation by propranolol should be administered intravenously at 1 mg / min up to 3 to 5 mg total dose.

Patients with essential hypertension grade III requires multiple medications to achieve the desired control. In summary, the treatment must be individualized according to age, clinical conditions and hemodynamic drug susceptibility.

Prevention Methods

* Leave smoking reduces mortality in half those who continue to smoke.
* Control of hypertension.
* Reduction of body weight.
* Increase physical activity.
* Controlling Diabetes
* Changes in eating habits.

The beginning of May can be abrupt, such as myocardial infarction or May a chronic disorder with an increased loss of heart function. In turn, this may be offset from a disease where the activity remains normal or decompensated in that the patient has dyspnea and chest pain in this case should rest and receive medication and diuretics.
From a nutritionally is the application of a diet low salt diet (containing less than 5grs. salt).

In coronary disease should avoid Foods rich and abundant that it places an undue burden on the heart and circulation.

When you make a food choice for these patients should be processed to replace the salt and no bloating, constipation and flatulence.

Bibliography:
• Pathology Roobins 2007
• Pathology Rubin
• Web Journal of Cardiology hypertensive crisis
• Institute of Cardiology http://www.drscope.com/cardiologia/pac/arterial.htm
• Goodman and Gilman, pharmacology.
• National Institute of Cardiology – Ignacio Chavez, Hypertension Articles
• National Association of Cardiologists of Mexico
• Society of Interventional Cardiology of Mexico
• National Society of Echocardiography in Mexico
Nutrition zonadiet.com 2004 • Hypertension
• vascular health. is
• Book of Physiology Guyton
• Stevens Pathology

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

[mage lang="en|es|fr|en" source="answers"]ischemic heart disease myocardial infarction[/mage]