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Hypertension:

Normal Blood pressure : < or equal 140 -90 (systolic-diastolic).

Diastolic BP : -some consider 85 as normal Bp

- 90 as a border Line .- 100 Hypertension- 120 Malignant Hypertension.(usually patient survive until 1.5 -2 years )

Etiology:

We have 2 Types:

Essential (primary)- 85%-90% majority ,the Causes (risk factors):

1. with age 30.

2. Obesity

3. High salt Intake

Secondary Causes:

1. Alcohol

2. Pregnancy

3. Vascular causes: 1.coarcationof aorta ( High Blood pressure in the upper half of the body

2. Renal artery stenosis(RAS) : which caused By a. Fibromascular stenosis

(especially in Females). b. Atherosclerosis (which found more in Diabetic patients).

4.Renal diseases :1. Renal failure.

2. Glomerular Nephritic .

you know one of the major functions of kidney is to control Blood pressure byReninAngiotensin

system .

5.endocrine causes.

Presentation of the disease:

-its variable

-Asymptomatic

-Symptomatic: headache, visual distribution chest pain ,lower limb edema, tiredness .

-Complications .

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Physical signs :

Most important : 1.Blood pressure heart S1 and S2 increase.

2.Body examination: -retina (hypertensive damage),-CNS (stroke ,cerebrovascularaccident),-kidney.

lab Examination:

1.Chest x-ray (to detect fluid in the lung ).

2.ECG , helps us in detecting LUH (left ventricle hypertrophy )and IHD( Ischemic heart disease).

3. (ECHO )Echocardiography.

WIKI :- is a sonogram of the heart also known as a cardiac ultrasound, it uses standard ultrasound

techniques to image two-dimensional slices of the heart.

4.Urine analysis(urine ,electrolytes ,kidney function test ).

Management:

1st step in management is lifestyle Modifications .

In case of hypertensive&complication patient needs Emergency.

Aim of treatment is to decrease Hp to normal Blood pressure (

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Ischemic Heart disease:

1st cause of death worldwide

The main cause of IHD is : Atherosclerosis .

Atherosclerosis: Cholesterol(lipid) deposition in Blood vessels -> lead damage to endothelial cells of the vessels which

are very smooth.

We have Modified and Non-modified risk factors of Atherosclerosis :

Unmodified :

1.Age (the risk increase with age )

2.Sex (male>female ) ,BUT after menopause(( it will be equal bw both gender.

3.Family History (sudden death of young age).

Modified :

1.Blood pressure .

2.Diabetes mellitus.

3.High cholesterol level.

4.smoking .

presentation of IHD:

1.Sudden death: - arrhythmia -ventricular fibrillation.

2.Myocardial Infraction(MI): we see if there is Necrosis of the heart muscle .

patient complain of- chest pain ,ECG changes ,Increase of cardiac enzyme (ALT,MB fraction ,LOH

,Troponine).

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3.Anginawithout evidence of MI

We have 2 forms: 1. Angina pectoris (fixed obstruction) which stable.

2. Unstable Angina (chronic Obstruction).

-Note: in MI we have total Occlusion.

4.Heart failure : LVF or RVF or BOTH (CONGESTIVE).

lab Examination:

1. ECG

2. Cardiac enzyme: Not elevated for very long period of time.

3. CXR (chest X-ray): very Important to every patient.

4. ECHO.

5. Stress ECG.

6. Coronary Angiography (): - Brachial artery.

-Femoral Artery.

Treatment :

Best Drug -> Aspirin (Anti platelets Drug).

2. Betablockers .

3. Nitrates (for chest pain)

4. Morphine.