Pathophysiology Of Hypertensive Cardiovascular Disease

PATHOPHYSIOLOGY OF HYPERTENSIVE CARDIOVASCULAR DISEASE

PREDISPOSING FACTORS  Age: 73Y/O  History of Hypertension

ETIOLOGY  Unknown

PRECIPITATING FACTORS  Sedentary lifestyle  Diet(fatty foods)  BMI=30.5(Obese, Grade I)

Increase intake of fats

Decrease blood flow to the arteries of the heart Ischemia

Oxidative stress

Disregulation in interaction between MMP & inhibitors (TIMPS)

ANGINA

A

Increase degredation of fibrilar collagen & extracellular matrix

Fats clogs on arteries (arteriosclerosis) Narrowing of blood vessels (arteries) Increase vascular resistance Decrease blood flow to organs (kidneys) B A

OLIGURIA

A Augmentation of degradation of normal cell type collagen

Fibrous deposits of poorly cross linked collagens

B A

Myocyte stretch (other humeral stimuli such as angiotensin II, phenylephrine/ endothelin)

Activation of RAAS

Increased contraction/pumping of the heart

Intracellular calcium release

PALPITATION

Initiate transcription of genes  Aldosterone synthase gene  Calcium modulating gene

Myocyte fibrosis Decrease pumping action of the heart

Increase blood pressure

C

HYPERTENSION

Myocyte hypertrophy

CARDIOMEGALY

LEFT VENTRICULAR HYPERTROPHY

Increase production of fibronectin, laminin, collagen I & II

Proliferation of fibroblast

Myofibroblast configuration

Cardiac fibroblast undergo phenotypic change

C

Decrease blood flow

Atria beat very fast Blood pools in the atria Ventricles beat very fast Electrical signals originate from around the atria

Signals travel through the atria in a rapid & disorganized manner

Faulty signals flood the AV node

Uncoordinated beating of both ventricles and atria

Fast and irregular rhythm

Arrhythmia

ATRIAL FIBRILLATION