D115 Unit 5: Hypertension and Cardiovascular Conditions Review

D115 Unit 5: Hypertension and Cardiovascular Conditions Review

Student Name

Western Governors University

D115 Advanced Pathophysiology for the Advanced Practice Nurse

Prof. Name:

Date

Hypertension

Definition

Hypertension is a sustained elevation of systemic arterial blood pressure.

• 2014 Guidelines:

  • Systolic ≥ 140 mmHg or Diastolic ≥ 90 mmHg

• 2017 Guidelines:

  • Systolic ≥ 130 mmHg or Diastolic ≥ 80 mmHg

Epidemiology

• Most common primary diagnosis in the United States

• Primary (Essential) Hypertension: ~95%

• Secondary Hypertension: ~5%

Types

Primary Hypertension

• No identifiable cause

• Results from genetic and environmental interactions

• Increased vascular tone and/or blood volume

• Leads to sustained elevation in blood pressure

Secondary Hypertension

• Caused by identifiable disease (e.g., renal disease)

• Due to increased peripheral resistance or cardiac output

• Potentially reversible if treated early

Risk Factors for Primary Hypertension

• Nonmodifiable: Age, ethnicity, family history, genetics

• Socioeconomic/Behavioral: Low education, low socioeconomic status, smoking, stress, obstructive sleep apnea

• Dietary/Metabolic: High sodium/fat intake, obesity, glucose intolerance

• These are also major cardiovascular disease risk factors

Pathophysiology

• Increased cardiac output (CO), increased total peripheral resistance (TPR), or both

• Chronic elevation leads to target organ damage

Clinical Manifestations

• Often asymptomatic early (“silent disease”)

• Symptoms occur with target organ damage:

  • Heart: Coronary disease, heart failure

  • Kidneys: Renal insufficiency

  • CNS: Stroke, confusion

  • Eyes: Visual impairment

  • Vasculature: Edema, occlusion

Diagnosis

• Blood pressure measured on two separate occasions

• Average of two readings taken two minutes apart

• Proper technique required (seated, arm at heart level, rested, no caffeine/smoking beforehand)

Management

• Lifestyle modification

• Pharmacologic therapy based on severity and guidelines

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Metabolic Syndrome

Definition

A cluster of metabolic abnormalities that significantly increase the risk of type 2 diabetes and cardiovascular disease.

Components

1. Central (abdominal) obesity

2. Dyslipidemia

3. Prehypertension

4. Elevated fasting blood glucose

Epidemiology

• May begin in childhood

• Common in sedentary adults and overweight youth

Management

• Routine screening and early identification

• Aggressive lifestyle modification

• Focus on weight loss, diet, and physical activity

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Deep Vein Thrombosis (DVT)

Definition

A venous thrombus that remains attached to the vessel wall, most commonly in one lower extremity.

Risk Factors

• Hospitalization, trauma, orthopedic surgery

• Age > 60

• Pregnancy, malignancy

• Inherited thrombophilias (Factor V Leiden, prothrombin mutation)

Pathophysiology

• Venous stasis, endothelial injury, hypercoagulability (Virchow’s triad)

• Progressive clot formation near venous valves

Clinical Manifestations

• Often asymptomatic

• Pain, unilateral swelling, dilated superficial veins, skin discoloration

Diagnosis

• D-dimer (high sensitivity)

• Compression Doppler ultrasound (confirmatory test)

Prevention and Treatment

• Early mobilization

• Compression devices

• Anticoagulation based on risk

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Angina Pectoris

Definition

Chest pain caused by myocardial ischemia.

Types

Stable Angina

• Predictable, exertional

• Relieved by rest

• No myocardial necrosis

Unstable Angina

• Occurs at rest or with increasing frequency

• Associated with plaque rupture

• Precursor to myocardial infarction

Prinzmetal (Variant) Angina

• Caused by coronary vasospasm

• Occurs at rest, often at night

• Treated with calcium channel blockers or nitrates

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Heart Failure

Definition

Inability of the heart to maintain adequate cardiac output and/or filling pressures.

Left-Sided Heart Failure

Systolic (HFrEF): EF < 40%, impaired contractility
Diastolic (HFpEF): Normal EF, impaired relaxation

Right-Sided Heart Failure

• Most often secondary to left-sided failure

• Causes systemic venous congestion

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Cardiogenic Shock

Definition

Failure of the heart to pump sufficient blood despite adequate filling pressures.

Clinical Features

• Hypotension, tachycardia, dyspnea

• Reduced cardiac output and organ perfusion

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Hypoplastic Left Heart Syndrome (HLHS)

Definition

Congenital underdevelopment of left heart structures resulting in inadequate systemic circulation.

Presentation

• Appears normal at birth

• Rapid deterioration as ductus arteriosus closes

Management

• Prostaglandin infusion to maintain ductal patency

• Staged surgical palliation (Norwood, Glenn, Fontan procedures)

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Hematologic Disorders

Sickle Cell Disease

• Autosomal recessive hemoglobinopathy

• Causes vaso-occlusion, hemolysis, and chronic organ damage

Disseminated Intravascular Coagulation (DIC)

• Systemic activation of coagulation and fibrinolysis

• Leads to thrombosis and bleeding

• Requires treatment of underlying cause

Pernicious Anemia

• Vitamin B12 deficiency due to intrinsic factor loss

• Causes megaloblastic anemia and neurologic deficits

Iron Deficiency Anemia

• Most common anemia worldwide

• Caused by blood loss, malabsorption, or poor intake

• Characterized by microcytic, hypochromic RBCs

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Leukemias

Acute Leukemias

• Immature blast proliferation

• ALL common in children; AML common in adults

Chronic Leukemias

• More mature cell types

• Chronic lymphocytic leukemia (CLL) characterized by smudge cells and immune dysfunction

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Myocardial Infarction

Definition

Myocyte necrosis due to prolonged coronary ischemia.

Types

• STEMI: Transmural infarction

• NSTEMI: Subendocardial infarction

Diagnosis

• Elevated troponin levels

• ECG changes

Management

• Rapid reperfusion (PCI or thrombolytics)

• Antiplatelet and anticoagulant therapy

• Long-term risk reduction

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Neurologic Disorders

Key Concepts

• Cerebral perfusion pressure (CPP) = MAP − ICP

• Increased ICP reduces brain perfusion

• Brainstem injury affects consciousness and vital functions

D115 Unit 5: Hypertension and Cardiovascular Conditions Review

Major Conditions

• Locked-in syndrome

• Subarachnoid hemorrhage

• Spinal cord injury and autonomic dysreflexia

• Cerebral edema and herniation

• Seizures and epilepsy

• Delirium vs. dementia