BSPS2101 CVS pathophsyiology 2 (1).pptx

BSPS2101 Cardiovascular Pathophysiology 2022-23 Slido Slido.com # 3837250  Hypertension UK Population: 65.65 million Adult Population: 54.56 million Number suffering from hypertension? 13.64 million!! 1:4 of all adults ONS, 2017; NHS, 2018  J...

BSPS2101 Cardiovascular Pathophysiology 2022-23 Slido Slido.com # 3837250  Hypertension UK Population: 65.65 million Adult Population: 54.56 million Number suffering from hypertension? 13.64 million!! 1:4 of all adults ONS, 2017; NHS, 2018  Join: vevox.app ID: XXX-XXX-XXXEnter Text and What is blood pressure? Press Send  Review of SVR and its impact on systemic circulation B = Cardiac X SVR P output Stroke Heart Volume Rate Blood Contractility Volume  Group Exercise 1. What are the causes of hypertension? 2. What other conditions can it lead to? What is 3. What are the S&S you may find/be Hypertensi told? on? Good information source: https://www.nice.org.uk/guidance/cg1 27/chapter/1-guidance Hypertension A sustained Systolic BP (top figure) of 140mmHg or more, or Diastolic BP (bottom figure) of 90mmHg or more = hypertension. It is often caused by loss of elasticity due to hardening and narrowing of the arterial lumen (walls) due to ATHEROSCLEROSIS but there are other factors to consider Patients may be prescribed ACE inhibitors, Beta Blockers, Calcium Channel Blockers, Diuretics among others which we will discuss later A MECC opportunity for us in the prehospital field (what is this?) Hypertension Essential = unknown cause: ? Genetic , develops over years Secondary = results from disease or conditions that affect the normal balance of the body : Pregnancy, kidney disease, illicit drug use Malignant = Extremely high and dangerous BP (180/120 +) that is causing organ damage: visual disturbance, headache, confusion, kidney dysfunction  Sympathetic neurons act up on the arterioles- what chemical and what receptor? Smooth muscle cells contract causing vaso-constriction Mean while…. In the kidneys the juxtaglomerular cells are also affected by the sympathetic nervous system and associate chemicals Renin is increased and converted to angiotensin 2 by the angiotensin converting enzyme (ACE), ultimately this causes vaso- constriction An overview of hypertension  Why is Hyperten sion a problem?  Red Flag Symptoms Symptoms of Severe High Blood Pressure Severe headaches. Nosebleed. Fatigue or confusion. Vision problems. Chest pain. Difficulty breathing. Irregular heartbeat. Blood in the urine. Dangers of Hypertension RENAL HEART VASCULAR DISEASE HYPERTENSI ON CEREBROVASC RETINOPAT ULAR HY Examples of Target Organ Damage  Hypertension Stroke/TIA nti me De An a m eu ri s MI & Angina e d r g Bli l a t nd Fa ney r ne En e a re ss H il u d Ki Information on hypertension: https://www.nice.org.uk/guidance/cg127/chapter/1-guidance How is Hypertension harmful? The pressure of blood can damage the wall of blood vessels leading to atherosclerosis or even dissection of the vessel wall Aneurysms can develop and rupture under pressure causing catastrophic haemorrhages Can result in damage to the nephrons in the kidney (nephropathy) and result in reduced kidney function Heart valves can become damaged The left ventricle thickens because of the extra work load increasing the risk of heart failure (Left ventricular Hypertrophy) The cardiac muscle fibres (myocytes) become enlarged and overstretched leading to possible heart failure  Left Ventricular Hypertrophy This is often seen as an anatomical change in older patients who have chronic hypertension. The heart is often describes as ‘Boot Shaped’ Hypertension is the most common cause but other conditions that make the heart pump harder than it should are also factors in its development eg valvular heart disease. Hypertensive Retinopathy  Aneurysms An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches. As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon. Aneurysms can develop in any blood vessel in the body, but the 2 most common places are: the abdominal aorta (the artery that transports blood away from the heart to the rest of the body) The Thoracic Aorta (the artery that leaves the left ventricle) The brain Aneurysms: Causes Congenital defects Trauma Infections Atherosclerosis Hypertension Any ideas what this could be? Group Task Has anyone been to a patient with a AAA Focus on the variety of ways in which these conditions presented. Atypical presentations would be particularly useful to discuss Abdominal Aortic Aneurysm Thoracic Aortic Aneurysm (TAA) What is a Dissecting TAA  Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear may also occur in the upper aorta (ascending aorta), which may extend into the abdomen. Type B. This type involves a tear in the lower aorta only (descending aorta), which may also extend into the abdomen. How does Atherosclerosis result in a AAA? Most AAAs occur in individuals with advanced atherosclerosis. Atherosclerosis can result in AAA formation by weakening of the aortic wall with loss of elastic recoil due to ‘stiffening’ of the Aorta However not all patients with vascular disease develop a AAA, and some patients with little or no atherosclerosis do develop one  Red flag signs/symptoms AAA? AAA more than 5.5cm (pulsatile mass pre hospital) Known AAA and symptoms suggesting rupture (sudden abdominal/back pain) Hypotensive collapse  AAA – How Reliable is this Classic Triad? Separating fact from fiction Reliable? The classic presentation of a ruptured AAA includes the triad of hypotension, abdominal or back pain, and a pulsatile abdominal mass. In a study of 116 patients with ruptured AAAs, 45 percent were hypotensive, 72 percent had pain, and 83 percent had a pulsatile abdominal mass. https://www.aafp.org/afp/2006/0401/p1198.html#afp200 60401p1198-b25 AAA – Who is at risk? Consider ruptured AAA in people with new abdominal and/or back pain, cardiovascular collapse, or loss of consciousness. Be aware that ruptured AAA is particularly likely if they also have any of the following risk factors: An existing diagnosis of AAA Age over 60 Smoker or used to smoke History of hypertension. https://www.nice.org.uk/guidance/gid-cgwave0769/docu ments/short-version-of-draft-guideline Don’t slip up! AAA’s can be deceptive and are commonly misdiagnosed as: Renal/ureteric colic (24%) Diverticulitis (13%) Gastrointestinal bleed (13%) myocardial infarction (8.7%) MSK back pain (8.7%). AAA diagnosis can be really challenging. This paper discusses an interesting atypical case. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826995/ AAA or kidney stone? Anyone over the age of 55 who appears to be having Renal Colic (kidney stone pain) for the first time. (Think + + pain radiating on one side from loin to groin) This person is having a AAA until proven otherwise  You are sent to a 14 year old patient who has collapsed while playing cricket. He had just run the length of the pitch while fielding and then collapsed. He has no PMH and was perfectly well prior to the Case Study incident. As you arrive you see his teacher is performing CPR. Any thoughts on possible causes? Cardiomyopathy What is Cardiomyopathy? General term relating to diseases of the heart muscle that can cause: Thickening Stretching – sometime called dilation Scarring Most types can have a genetic origin, and are seen in children and young adults – screening occurs if known family history Dilated Most common form Enlargement of chambers - muscle dilates and thins Ability to contract changes Blood flow reduced Can be inherited, develop due to other conditions - common in alcohol-dependant patients and diabetics, or idiopathic Restrictive Protein changes cause muscle of Right ventricle to die and breakdown = amyloidosis Replaced by scar tissue Affects conduction and contraction – ↓ventricular filling, ↑ diastolic pressure, ↓ diastolic volume Progressive disease Hypertrophic cardiomyopathy Cardiac muscle cells enlarge, ventricles thicken Overall size constant, but results in ↓ CO Septum can thicken, and protrude into ventricle further increasing work of the heart Can affect mitral valve causing regurgitation Can cause ventricular arrhythmias Leading cause of unexpected death in childhood and young athletes May be asymptomatic until a critical event occurs or may have SOB, syncope on exertion or chest pain.  Infective Endocarditis Preceded by infection – URTI, tonsillitis, strep throat causing inflammation and, in heart only, scar tissue. Endocarditis – affects valves – Oedema – Verrucae – wart-like growths – Mitral valve affected most commonly – Disruption to blood flow and effectiveness of L ventricle – Can lead to stenosis