HTN and CHF

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

Severe & abrupt BP elevation

BP>180/120

Rises quickly

Can be due to noncompliance, crack cocaine use, tumor of the adrenal medulla, etc

Increased BP places heart & blood vessels under strain & is considered a risk factor for:

• CVA (#1)
• MI (major)
• Renal Failure

Force exerted by blood against walls of blood vessels

C.O. x SVR= BP

amount of blood pumped out of the heart each minute

arteries’ resistance to blood flow

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

System that regulates BP

Found in carotid, aorta and walls of left ventricle

monitors the level of arterial pressure

system that regulates BP

controls sodium excretion & extracellular volume

Renin -angiotensin-aldosterone system

regulates BP

release of epinephrine & norepinephrine

release of aldosterone

Release of ADH

Think Increases fluid retention

• Primary
• Secondary

(essential - idiopathic) 95% of all cases. Usual >60 years. Unknown cause. Examine contributing factors.

• (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

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

linitiating Rx.

for Rx.

Diuretics

Beta blockers

Adrenergic Inhibitors

Direct Vasodilators

Ace Inhibitors

Ca Channel Blockers

Angiotensin Receptor Antagonists

Gum & hard candy for dry mouth

Slow position changes for orthostatic hypotension

Discussion R/T sexual dysfunction

Schedule diuretics to avoid nocturia

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

a lower-than normal cardiac output.

Sympathetic nervous system

Ventricular Dilation

Ventricular Hypertrophy

Renin-angiotensin System

• 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

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

Left sided

Impaired ventricular contraction

Result is decreased cardiac output

Right Sided

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

HF due to increased volume

ABCD

At high risk for HF without structural disease or symptoms of HF (i.e. patient with hypertension)

structural disease without s/s HF

structural disease with s/s HF

Refractory HF requiring specialized interventions/end of life care

• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea (PND)
• Dry Hacking Cough
• Fatigue
• Restlessness and anxiety
• Chest Pain
• Nocturia

• Edema
• Hepatomegaly
• Jugular vein distention
• Ascites
• Anorexia and nausea
• Weakness

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

further accumulation of fluid. Depending upon degree of CHF they may b on a fluid restriction

digoxin , for CHF bc increases cardiac output by actions of the drug negative pronotropic(decreases HR), positive inotropic (increases force of contraction)