1. Hypertension
    Patients with sustained blood pressure higher than 140/90 are considered to have hypertension and are candidates for drug therapy

    Diagnosis based on elevated readings at least 3 times over a period of a week or longer
  2. Hypertensive Crisis
    Severe & abrupt BP elevation


    Rises quickly

    Can be due to noncompliance, crack cocaine use, tumor of the adrenal medulla, etc
  3. Significance of HTN
    Increased BP places heart & blood vessels under strain & is considered a risk factor for:

    • CVA (#1)
    • MI (major)
    • Renal Failure
  4. Blood Pressure
    Force exerted by blood against walls of blood vessels

    C.O. x SVR= BP
  5. Cardiac Output
    amount of blood pumped out of the heart each minute
  6. Systemic vascular resistance (SVR)
    arteries’ resistance to blood flow
  7. Sympathetic Nervous System.
    System that regulates BP

    • Increases heart rate (chronotropic)and cardiac
    • contractility (inotropic)

    Net effect is increase in arterial pressure by increasing CO and SVR

    Under influence of epinephrine and norepinephrine
  8. Arterial Baroreceptors
    System that regulates BP

    Found in carotid, aorta and walls of left ventricle

    monitors the level of arterial pressure
  9. Renal system
    system that regulates BP

    controls sodium excretion & extracellular volume

    Renin -angiotensin-aldosterone system
  10. Endocrine System
    regulates BP

    release of epinephrine & norepinephrine

    release of aldosterone

    Release of ADH

    Think Increases fluid retention
  11. Types of Hypertension
    • Primary
    • Secondary
  12. Primary Hypertension
    (essential - idiopathic) 95% of all cases. Usual >60 years. Unknown cause. Examine contributing factors.
  13. Secondary Hypertension
    • (non-essential) 5% of all cases. Elevated BP with a specific cause that can be identified and corrected.
    • Suspected in persons <20 or >50 with sudden onset

    If pt comes in high bp sudden onset and maybe 50 think secondary
  14. Diagnostic Studies
    Check BP both arms then use arm that is higher

    Follow-up for high BP is to take it twice, 5 minutes apart

    Basic serum metabolic panel with creatinine

    Cardiac work-up

    Urine tests to assess secondary causes
  15. BP elevation should be assessed carefully before
    linitiating Rx.
  16. Lifestyle modifications should provide foundation for
    for Rx.
  17. First line Drugs:

    Beta blockers

    Adrenergic Inhibitors

    Direct Vasodilators

    Ace Inhibitors

    Ca Channel Blockers

    Angiotensin Receptor Antagonists
  18. What are some Management advise for some side effects from medications
    Gum & hard candy for dry mouth

    Slow position changes for orthostatic hypotension

    Discussion R/T sexual dysfunction

    Schedule diuretics to avoid nocturia
  19. Congestive Heart Failure
    CHF is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

    Congestive: Fluid is building up
  20. Impairment of the contractile properties of the heart, which leads to
    a lower-than normal cardiac output.
  21. When cardiac output fails, compensation to attempt to improve CO...
    Sympathetic nervous system

    Ventricular Dilation

    Ventricular Hypertrophy

    Renin-angiotensin System
  22. Clinical Manifestations
    • The dominant feature in cardiac failure is increased
    • intravascular volume

    Manifestations depend on extent of failure, and which ventricle is affected

    Result of fluid build up think circulation and o2 plus the fluid
  23. Left- and Right-Sided Cardiac Failure
    The left and right ventricles can fail separately.

    Left ventricular failure most often precedes right ventricular failure.

    Pure left ventricular failure is synonymous with acute pulmonary edema.

    Generally HF is left sided. Left sided usually procedes right sided
  24. Systolic Dysfunction
    Left sided

    Impaired ventricular contraction

    Result is decreased cardiac output
  25. Diastolic Dysfunction
    Right Sided

    • Ventricles become non-complaint and unable to
    • accommodate the preload or afterload changes

    HF due to increased volume
  26. ACC/AHA Heart Failure Stage*:
  27. Stage A
    At high risk for HF without structural disease or symptoms of HF (i.e. patient with hypertension)
  28. Stage B
    structural disease without s/s HF
  29. Stage C
    structural disease with s/s HF
  30. Stage D
    Refractory HF requiring specialized interventions/end of life care
  31. Left-Sided Cardiac Failure Signs and Symptoms
    • Dyspnea
    • Orthopnea
    • Paroxysmal nocturnal dyspnea (PND)
    • Dry Hacking Cough
    • Fatigue
    • Restlessness and anxiety
    • Chest Pain
    • Nocturia
  32. Right-Sided Cardiac Failure Signs and Symptoms
    • Edema
    • Hepatomegaly
    • Jugular vein distention
    • Ascites
    • Anorexia and nausea
    • Weakness
  33. Management for pt
    Diet - Sodium restriction

    Fluid management – weigh daily (1kg. = 1 liter of fluid)

    • Medications
    • - Diuretic
    • - ACE or ARB’s
    • - Inotropic Drugs
    • - Beta blockers

    Reduce Anxiety

    Activity - energy-efficient behavior, and rest
  34. Low sodium diet restrict sodium, it will prevent
    further accumulation of fluid. Depending upon degree of CHF they may b on a fluid restriction
  35. Inotropic drug
    digoxin , for CHF bc increases cardiac output by actions of the drug negative pronotropic(decreases HR), positive inotropic (increases force of contraction)
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