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Pulmonary Hypertension - Coggle Diagram
Pulmonary Hypertension
Pathogenesis
Secondary hypertension is caused by underlying disease that raise cardiac output such as renal disease, tumors, and drugs such as corticosteroids and antihistamines.
Increased SNS activity will cause systemic vasoconstriction, which elevates cardiac output and peripheral vascular resistance that leads to high blood pressure
Overactivitty of the renin-angiotensin aldosterone system leads to retention of sodium and water and increased vascular resistance (high BP).
Increased peripheral vascular disease results into increased preload that causes decreases ventricular emptying and increased workload on the ventricles that leads to Hypertension.
Elevated levels of renin, angiotensin, and aldosterone cause arteriolar remodeling which is the structural change in blood vessels. This remodeling causes permanent peripheral vascular resistance.
Prevalence
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The median age at the time of diagnosis of pulmonary arterial hypertension was 60 years and 29% of the patients were 70 years or older.
Individuals who reach the age of 40 might have a lifetime risk of one in ten of developing pulmonary hypertension.
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Up to 50–70 million individuals, almost 1% of all people, are affected by pulmonary hypertension worldwide.
Treatments
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Surgery: surgery may be necessary to treat underlying conditions that contribute to pulmonary hypertension, such as congenital heart defects
Anti-platelet therapy: may be used in the treatment of pulmonary hypertension to prevent blood clots from forming in the lungs ex. Aspirin, clopidogrel
Antiplatelet therapy: decrease bloods ability to clot and can be used in the treatment of hypertension ex. rivaroxaban, apixaban, and dabigatran
Calcium Channel Blockers: Inhibits calcium ion influx across cardiac and smooth-muscle cells, dilates coronary arteries and arterioles, and decrease BP and myocardial oxygen demand. Ex. Nifedipine, Verapamil, diltiazem
Lifestyle changes: maintaining a healthy weight, staying physically active, avoiding smoking and exposure to secondhand smoke, and limiting alcohol consumption
Pathogensis
Conditions such as COPD and cystic fibrosis causes higher blood pressure in the arteries and chronic hypoxemia that causes hypertension
Emphysema is characterized by the destruction of the alveolar destruction causes loss of lung elasticity with hyperinflation of lung tissues that lead to pulmonary arterial hypertension.
Pulmonary arterial hypertension is a mean pulmonary artery pressure greater than 25 mm Hg at rest with a normal range of 15 to 18 mm Hg.
Aortic stenosis causes resistance of blood flow from the left ventricle to the aorta which leads to an increased end-diastolic pressure resulting into HTN.
Symptoms
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Shortness of breath, especially during physical activity
Risk Factors
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Exposure to certain drugs, such as methamphetamines, cocaine, or amphetamines
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Clinal Manefestations
Manefestations of tachypnea, dyspnea, fatigue, and discomfort in the chest.
A head to toe assessment will show peripheral edema, jugular venous distention, palpable pulsations of the chest wall, accentuated of the second heart sound.
Indication of hypertension can be an enlarged right heart or an ECG that reveals right ventricular hypertrophy.
A tricuspid valve or pulmonic valve murmur may be heard with due to hypertrophy of the heart that indicates HTN.
Diagnostics
Measuring of blood pressure on two seperate occasions. During measurment, the individual must be seated, with arm at heart level, at rest for at least 5 minutes, and person shouldn't have had smoked or drank caffeine.
24 hour blood pressure monitoring in suspected indidivduals. Also monitoring electrolytes, glucose, lipids, and an electrocardiogram (ECG).
People who have sustained elevated high blood pressure are assumed to have primary hypertension unless patient history and physical exam states secondary hypertension.