Hypertension & Heart Failure

I had to do this assignment for class and I thought I would share the information I researched.

1. What risk factors could have possibly led to the development of hypertension?
   • Non-modifiable risk factors include family history, age, and race. To elaborate, high blood pressure (HBP) increases as you age; through early middle age or about 45 (Mayoclinic, 2016). High blood pressure is more common in men, but women usually develop HBP after 65 (Mayoclinic, 2016). HBP is more common in African Americans and usually developing earlier in age than for whites. Stroke, heart attack and kidney failure are also more common in African Americans (Mayoclinic, 2016). Also, HBP tends be seen more in families. Some modifiable risk factors can include: being overweight or obese, using tobacco, or drinking too much alcohol. Being overweight or obese means that you will need more blood to supply oxygen and nutrients to all of the tissues; once the volume of blood increases so does the pressure on the arterial walls (Mayoclinic, 2016). Using tobacco immediately increases your blood pressure, but the chemicals from the tobacco damage the arterial walls causing arteries to narrow, thus increasing blood pressure (Mayoclinic, 2016). Fun fact, secondhand smoking can increase someone’s blood pressure too. Lastly, drinking too much alcohol damages the heart. Drinking multiple times a day affects blood pressure, thus should be consumed in moderation. Other risk factors include: not being active, too much salt intake, too little potassium intake, too little vitamin D intake, stress, and certain chronic conditions (Mayoclinic, 2016).

2. Describe the pathophysiology of essential hypertension
   • Essential hypertension progresses from occasional to established hypertension (Hamrahian, 2017). During a long asymptomatic period, persistent hypertension develops into complicated hypertension and this targets organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system (Hamrahian, 2017). Essential hypertension starts with prehypertension from the ages of 10-30 years old with increased cardiac output. Basically, volume regulation and the blood pressure vs. sodium excretion are abnormal. Resetting pressure natriuresis can be seen from a decreased slope of pressure natriuresis and salt-sensitive hypertension or a parallel shift of higher blood pressure and salt-insensitive hypertension.

3. Explain the possible long term consequences if one does not comply with treatment for hypertension
   • According to KevinMD, untreated hypertension can result in congestive heart failure, sick sinus syndrome, open heart surgery to repair an aortic aneurysm which could have ruptured on the OR table, aortic valve insufficient, arterial fibrillation, and vascular dementia (Bayrich, 2015). Without taking the one pill a day necessary for the disease, you will find yourself in a secure nursing unit sooner than later.

4. What are the symptoms and signs of congestive heart failure?
   • Signs and symptoms from left-sided failure include: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, hemoptysis, and cyanosis. For right-sided failure signs and symptoms include: fatigue, ascites, dependent anemia, anorexia and gastrointestinal distress, distended jugular veins, liver and spleen enlargement, and hemorrhoids and esophageal varices. According to the American Heart Association, shortness of breath, chronic wheezing, edema, feeling lightheaded, nausea, confusion, and high heart rate are also signs of heart failure (Heart.org, 2017).

5. Describe the pathophysiology of congestive heart failure.
   • The primary cardiac defect is that the intrinsic contractibility of the myocardium has decreased, usually because of pressure or volume overload. Multiple compensatory mechanisms occur to maintain proper function; some include: increasing cardiac output via the Frank-Starling mechanism, increasing ventricular volume and wall thickness through ventricular remodeling, and maintaining tissue perfusion with augmented mean arterial pressure through activation of neurohormonal symptoms (Kemp, 2012). Usually, all of the compensatory mechanisms lead to even worse heart failure. Release of norepinephrine by adrenergic cardiac nerves augments myocardial contractibility and includes activation of renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS) (Dumitru, 2017). The primary response to increased wall stress is myocyte hypertrophy, death, and regeneration (Dumitru, 2017).
   • The pathophysiology of left sided failure includes: decreased emptying of LV, increased volume/pressure of LV and LA, increased volume/pressure of pulmonary veins and capillaries, fluid transudation from capillaries to alveoli, and pulmonary edema. For right sided failure, pathophysiology includes: decreased emptying of RV, increased volume/pressure of RV and RA, increased volume/pressure of systemic veins and capillaries, fluid transudation from capillaries to tissue, and peripheral edema and serous effusion.