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Cardiovascular Disease: Hypertension , Congestive Heart Failure and Angina

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Cardiovascular Disease: Hypertension , Congestive Heart Failure and Angina Toni Benton MD ---------------------------------------------------------- High Blood Pressure (Hypertension) Definition Blood pressure is a measurement of the pressure your blood exerts against the artery walls. Introduction High blood pressure occurs when the pressure of your blood against the artery walls is higher than normal. As your heart pumps out oxygen rich blood, the pressure in your arteries rises. Between heartbeats, the pressure drops back down. The pressure when the heart contracts is called the systolic pressure; this is the first number in the blood pressure reading. The pressure between beats, when the heart relaxes, is called the diastolic pressure. This is the second number in the blood pressure reading. If your blood pressure is consistently 140/90 or higher, you have high blood pressure. Most people with high blood pressure have no symptoms. Despite what a lot of people think, high blood pressure does not make you dizzy, nervous, or tense. Untreated high blood pressure can lead to stroke, heart disease or heart attack, or kidney failure. High blood pressure is very common; more than half of all older people have high blood pressure. Other persons who may be at increased risk include people who smoke, African Americans, those who are overweight, and people with a family history of high blood pressure. Diagnosis The blood pressure is measured by putting a blood pressure cuff around the arm, inflating the cuff, and listening for the flow of blood as the cuff is deflated. The normal blood pressure readings are 135/ 85 or lower. If the blood pressure is over 140/90, the diagnosis of high blood pressure, or hypertension can be made. The healthcare provider usually will make the diagnosis of high blood pressure when the blood pressure readings are consistently over 140/90; usually the criteria are high readings on three separate occasions. Your doctor may do lab tests to rule out treatable causes of high blood pressure. Essential hypertension (or primary hypertension) refers to high blood pressure in which the physician is unable to identify a specific cause. This is the most common type of high blood pressure, occurring in up to 95% of patients. Secondary hypertension has a recognizable cause-usually treatable or reversible, but these are rare causes, and your doctor will consider these in appropriate circumstances. These causes include kidney disease, thyroid problems, pregnancy, Cushing’s syndrome(a rare problem in which the body has too much of a hormone called cortisol), coarctation of the aorta( a narrowing of the large blood vessel that carries blood out of the heart to the body), cirrhosis (liver disease), sleep apnea (Link to sleep apnea), and pheochromocytoma (a rare type of tumor the produces a chemical similar to adrenaline, causing high blood pressure). Certain medications, including birth control pills, decongestants and nonsteroidal anti-inflammatory pain medications can cause or contribute to hypertension. Continuum of Care 2350 Alamo Avenue SE, Suite 155 Albuquerque, NM 87106 505.925.2350 Fax 505.925.2389 hsc.unm.edu/som/coc Treatment Many types of medicines are available to treat high blood pressure; these are called antihypertensive medications. The ideal situation is to lower the blood pressure to less than 135/85 with medicine that is easy to take and with as few side effects as possible. There are other things you can do to help lower your blood pressure besides medicines. Don’t smoke; nicotine constricts the arteries and raises the blood pressure. Avoid cocaine and other drugs that can affect your heart. If you are overweight, losing weight will help lower your blood pressure; regular exercise is a good way to bring down the blood pressure, and exercise is beneficial in helping to lower the blood pressure on its own. Limit your alcohol consumption to no more than 1-2 drinks per day. In some people, alcohol can raise blood pressure; these people should avoid alcohol altogether. Not everyone is affected by sodium (salt), but sodium can increase blood pressure in some people. Most people who have high blood pressure should limit the sodium they eat each day to less than 2,300 mg. Don't add salt to your food. Check food labels for sodium. If your blood pressure can only be controlled with medicine, you'll most likely need to take the medicine for the rest of your life. Don't stop taking the medicine without talking with your family doctor. If you do, you raise your risk of having a stroke or heart attack. Types of antihypertensive drugs: - Diuretics- help your body to get rid of extra sodium and fluid so your blood vessels don’t have to hold so much fluid. - Vasodilators-expand the blood vessels. - Beta blockers- these drugs block the effects of adrenaline, which eases the force of the heart’s pumping action, slows the pulse (heart) rate and decreases the tension in the arterial walls. - Alpha blockers-relax the blood vessels to help them stay open. - Calcium channel blockers-prevent the blood vessels from constricting by blocking calcium from entering your cells. - ACE inhibitors-decrease the production of angiotensin II, a chemical produced in the body that causes the blood vessels to constrict. - Angiotensin receptor blockers-These drugs prevent the action of angiotensin II by blocking the angiotensin II from entering the cells. Emergency Situations – What can go wrong? Hypertensive Crisis High blood pressure becomes an emergency when it is causing damage to the affected organs of the body. (i.e., brain, heart, kidneys). A person who has a severely elevated blood pressure (more than 200/120) whether they have signs of organ damage or not, requires urgent treatment of their high blood pressure, but not usually admission to the hospital. The decision to admit a patient to the hospital is not always based on the blood pressure reading, but the body’s response to the elevated blood pressure. A person who has a sudden increase in blood pressure may not tolerate the rise, whereas a person with chronically high blood pressure may be able to tolerate a very high blood pressure. Symptoms of hypertensive crisis can include headache, dizziness, blurred vision, chest pain, heart palpitations (a feeling of fluttering or rapid heart beat), or shortness of breath. The health care provider will evaluate a patient with very high blood pressure reading or symptoms of hypertensive crisis for any signs of damage to the brain, heart or kidneys. Continuum of Care 2350 Alamo Avenue SE, Suite 155 Albuquerque, NM 87106 505.925.2350 Fax 505.925.2389 hsc.unm.edu/som/coc Emergencies Caused by the Long Term Effects of High Blood Pressure Aneurysm/ stroke If hypertension is not detected and treated, life- threatening complications can develop over a course of years. High pressure, over time can make the arteries more vulnerable to build up of fatty deposits, and cause a condition called atherosclerosis. This condition in an artery in the brain can cause a stroke. Weakened portions of an artery wall can balloon out, and form an aneurysm. If an aneurysm ruptures, internal bleeding will occur. If this happens to an artery in the brain, stroke can occur. (link to stroke) Aneurysms and atherosclerosis can affect other parts of the body as well. Aortic Aneurysm An aneurysm that develops in the large artery that carries blood out of the heart, the aorta, can rupture, or pop, causing severe internal bleeding, and death. Symptoms of aortic aneurysm rupture depend on the part of the aorta that is bleeding. Excruciating pain in the front part of the chest if the upper part of the aorta is bleeding, or pain in the abdomen that migrates to the back if the lower part of the aorta is bleeding. If the top portion of the aorta is affected, pain can be in the neck, jaw or teeth. Sometimes the pain is described as much worse with each heartbeat. Heart Failure The heart has to work harder to pump against high pressure, causing the heart to become enlarged. An enlarged heart is not very good at pumping blood around the body, and this can lead to heart failure. Conclusion High blood pressure is a serious disease, usually with no symptoms. It is called the silent killer. If high blood pressure is not detected and treated, long-term damage can result, leading to deadly complications. High blood pressure can cause heart disease, eye disease, aneurysms, stroke, and kidney failure. With proper treatment, these complications can be prevented. Congestive Heart Failure Definition Blood pressure is a measurement of the pressure your blood exerts against the artery walls. Introduction Congestive Heart Failure does not mean that the heart has completely failed, but that the heart is not able to pump as strongly as it needs to, in order to keep up with the body’s need for oxygen and nutrients. When the heart has been damaged by heart disease, long standing high blood pressure, complications of diabetes, disease of the heart valves or heart attack, it no longer pumps effectively. The reduction in the ability to pump blood to the body has a predictable effect on the body. There are three types of heart failure, depending on which side of the heart is weak: left-sided heart failure, right –sided heart failure, and biventricular failure (both left and right sides are weak.) The left side of the heart pumps blood containing oxygen taken from the lungs to the cells of the body. When the body has used the oxygen in the blood, it returns to the heart. The right side of the heart then pumps the oxygen poor blood to the lungs to get a fresh load of oxygen.
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