D115 Unit 5: Hypertension and Cardiovascular Conditions Review

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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

Metabolic Syndrome

Definition

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

Components

Central (abdominal) obesity
Dyslipidemia
Prehypertension
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

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

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

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

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

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)

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

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

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

Neurologic Disorders

Key Concepts

Cerebral perfusion pressure (CPP) = MAP − ICP
Increased ICP reduces brain perfusion
Brainstem injury affects consciousness and vital functions