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Heart disease, hypertension and diabetes are major silent killer diseases
'Silent killer disease' are diseases that produces minimum or no symptoms and are capable of causing death if not treated.
SYSTEMIC HYPERTENSION
Definitions of hypertension: Elevated arterial blood pressure is a major cause of premature vascular disease leading to cerebrovascular events, ischaemic heart disease and peripheral vascular disease.
Hypertension - Introduction
Silent Killer painless complications It is the leading risk factor MI, HF, CRF Stroke Responsible for the majority of office visits, Number one reason for drug prescription. 25% of population Complications bring to diagnosis but late
Regulation of BP:
BP = Cardiac Output x Peripheral Resistance Endocrine Factors
Renin, Angiotensin, ANP, ADH, Aldosterone.
Neural Factors
Sympathetic & Parasympathetic
Blood Volume
Sodium, Mineralocorticoids, ANP
Cardiac Factors
Heart rate & Contractility.
BP
Cardiac Factors Rate & Contract..
Cardiac Output
Peripheral Resistance
Local Factors pH, Hypoxia
Etiology
1- Essential: In more than 95% of cases, an underlying cause cannot be found. Proposed mechanisms include: Excess renal sodium retention Over activity of sympathetic nervous system Exess of Renin angiotensin Hyperinsulinemia Alterations in vascular endothelium
2- Secondary hypertension
Renal:
These account for over 80% of the cases of secondary hypertension. The common causes are diabetic nephropathy, chronic glomerulonephritis, adult polycystic disease, chronic tubulointerstitial nephritis.
Endocrinal:
These include Conn's syndrome, adrenal hyperplasia, acromegaly, Cushing's syndrome.
Complications
Cerebrovascular disease and coronary artery disease are the most common causes of death, although hypertensive patients are also prone to renal failure and peripheral vascular disease.
HYPERTENSION
Classification of blood pressure levels:
(according to the British Hypertension Society) Category Systolic blood pressure pressure Optimal < 120 Normal < 130 High normal 130-139 Hypertension Grade I (mild) Grade 2 (moderate) Grade 3 (severe) 140-159 160-179 180 Diastolic blood < 80 < 85 85-89 90-99 100-109 110 < 90 < 90
HISTORY
The patient with mild hypertension is usually asymptomatic. Attacks of sweating, headaches and palpitations may point towards the diagnosis of phaeochromocytoma. Higher levels of blood pressure may be associated with headaches, epistaxis or nocturia. Breathlessness may be present owing to left ventricular hypertrophy or cardiac failure. Malignant hypertension may present with severe headaches, visual disturbances, fits, transient loss of consciousness or symptoms of heart failure.
Hypertensive Retinopathy:
Grade I Thickening of arterioles. Grade II Focal Arteriolar spasms. Vein constriction. Grade III Hemorrhages (Flame shape), dot-blot and Cotton wool and hard waxy exudates. Grade IV - Papilloedema
INVESTIGATIONS
Routine investigation of the hypertensive patient should include: ECG Urine stix test for protein and blood Fasting blood for lipids (total and highdensity lipoprotein cholesterol) and glucose Serum urea, creatinine and electrolytes.
Non-pharmcological treatment
Weight reduction - BMI should be < 25 kg/m2 Low-fat and saturated fat diet Low-sodium diet - < 6 g sodium chloride per day Limited alcohol consumption - 21 units/week for men and 14 units/week for women Dynamic exercise - at least 30 minutes' brisk walk per day Increased fruit and vegetable consumption Reduce cardiovascular risk by stopping smoking and increasing oily fish consumption.
Amyloidosis
Amyloidosis
is a group of diseases that result from the abnormal deposition of a particular protein, called amyloid, in various tissues of the body.
Amyloid protein
can be deposited in a localized area and may not be harmful or only affect a single tissue of the body.
Pathogenesis
native cell creates a protein which regress into the protein fragments fragments or actual proteins could missfold along the way and make a bad protein
Oligomers and amyloid fibrils can go and cause cell toxicity and organ disfunction
Proteolysis, which is a mechanism for protein digestion, to come and digest the miss-folded fragments and proteins
When the fragments do not dissolve they get spit out of Proteolysis and they aggregate to form Oligomers