HIPERTENSION

2. Patogenia y Fisiopatologia Pa: GC x RVP y GC: FC x VL lat. 1. >GC: >Precarga (> VL venoso, > abs Na y H2O). 2. > RVP: Estres > catecolaminas > tono simpatico

3. Fisiopatologia

5. HTA Esencial El 95% pactes sin causa identificable Sospechar entre los 25 y 55 años. Etiología multifactorial, rol genético importante. Prevalecía aumenta con la edad. Mayor prevalecía en raza negra. 2,5 veces mas IAM que población general.

6. Factores Geneticos Alteraciones del receptor de glucocorticoides. (> respuesta que estimula produccion de angiotensina). Alteraciones del angiotensinogeno. (50% pactes sal sensibles) Alteraciones de la lipoproteinlipasa participa en la sintesis de INS. lo cual produce resistencia a la INS y > retencion de Na, > precarga y > RVP. Retencion renal de sodio: Alteraciones en la aducina: en cel tubulares, con > actividad. >reabsorcion Na. Alteraciones del transporte ionico. > Na intracel. >salida H, alcalinidad provoca hipertrofia musc liso. Aumento del Ca intracitoplasmatico. por el mecanismo anterior (recambio Na/Ca) esto se inhibe, >Ca intracel provocando contraccion musc liso.

7. HTA Secundaria 5% del total de Hipertensos. Pacientes con inicio temprano (antes de los 20 a) o muy tardia (despues de los 55a). Sin historia familiar. Refractarios al tto.con multiples farmacos.

8. Causas Uso de estrogenos: Aco aumentan VEC el 5% de las mujeres mayores de 35 a, las que han tomado por mas de 5 a, obesas. Enfermedad Renal: cualquier enf. Parenquimatosa, por > VEC,o por actv renina, la HTA agrava las nefropatias, un ejemplo de esto N. Diabetica. Feocromocitoma: episodico o sostenido. HAP y Cushing: < 0,5% causas, por adenoma o hiperplasia en pactes con: ?kalemia, ?kaluria, ? Natremia, ?renina, ?aldosterona. Dg: TAC o RNM.

9. Síntomas y Signos Por lo general, NO HAY síntomas. Muchas personas la tienen, pero no lo sabe. Por eso, la presión arterial se llama “el asesino silencioso”. Y por eso, es importante medirse la presión arterial regularmente. Confusión, Dolor en el pecho, Zumbido o ruido en el oído, Latidos cardíacos irregulares, Hemorragia nasal, Cansancio, Cambios en la visión Signos Presión Alta Hipertrofia ventricular izquierda Proteinuria o elevación leve de creatinina Many people expect a heart attack to be sudden and intense, a crushing chest pain that knocks them to the floor. But often heart attacks begin with vague symptoms that slowly intensify. The pain or discomfort can be relatively mild, and the symptoms may come and go. Because of this, many people aren’t sure if they’re having a heart attack or resist believing it, so they wait. They may think their symptoms are due to another disease or condition. Others are afraid of causing a scene or are afraid of how embarrassed they’d be if it was a false alarm. Still others don’t realize the urgent need to get to a hospital fast. A final mistake that people make is not knowing to call 9-1-1 … or trying to go to the hospital themselves rather than calling 9-1-1.  Don’t you make these mistakes. Many people expect a heart attack to be sudden and intense, a crushing chest pain that knocks them to the floor. But often heart attacks begin with vague symptoms that slowly intensify. The pain or discomfort can be relatively mild, and the symptoms may come and go. Because of this, many people aren’t sure if they’re having a heart attack or resist believing it, so they wait. They may think their symptoms are due to another disease or condition. Others are afraid of causing a scene or are afraid of how embarrassed they’d be if it was a false alarm. Still others don’t realize the urgent need to get to a hospital fast. A final mistake that people make is not knowing to call 9-1-1 … or trying to go to the hospital themselves rather than calling 9-1-1.  Don’t you make these mistakes.

10. Medidas de prevención Para reducir la probabilidad de desarrollar la presión arterial alta, es importante mantener estilos de vida sanos, como: La práctica regular de actividad física (al menos 30 minutos de actividad la mayoría o todos los días de la semana) El mantenimiento de una dieta baja en sal y grasa No fumar Saving the life of a cardiac arrest victim requires a four-step process called the chain of survival. These are the steps. Early access means that people recognize a cardiovascular emergency and immediately call 9-1-1. Early CPR means CPR is given quickly and properly when it’s needed. The mouth-to-mouth breathing and chest compressions keep blood and oxygen circulating, which buys time until defibrillation can occur. Early defibrillation means having immediate access to an automated external defibrillator. This allows trained rescuers to shock a victim’s heart so it can resume a normal rhythm. Early advanced care means having qualified paramedics with up-to-date Advanced Cardiac Life Support training. They can stabilize patients. Saving the life of a cardiac arrest victim requires a four-step process called the chain of survival. These are the steps. Early access means that people recognize a cardiovascular emergency and immediately call 9-1-1. Early CPR means CPR is given quickly and properly when it’s needed. The mouth-to-mouth breathing and chest compressions keep blood and oxygen circulating, which buys time until defibrillation can occur. Early defibrillation means having immediate access to an automated external defibrillator. This allows trained rescuers to shock a victim’s heart so it can resume a normal rhythm. Early advanced care means having qualified paramedics with up-to-date Advanced Cardiac Life Support training. They can stabilize patients.

11. Medidas de prevención Controlar el consumo de sal/sodio (un máximo de 2,3000 miligramos al día, o aproximadamente una cucharadita de sal) Bajar de peso si tiene sobrepeso o es obeso Moderación en el consumo de alcohol Si los cambios en estilo de vida no son suficientes para reducir la presión, podría ser necesario tomar medicamentos.

12. Tratamiento Los antihipertensivos se recetan para controlar la presión arterial (en el caso de que los cambios en estilo de vida no son suficientes). Diuréticos Inhibidores de la enzima convertidora de angiotensina Los antagonistas de los receptores de angiotensina II Los beta bloqueadores Los bloqueadores de los canales de calcio Cardiac arrest is an extreme emergency. Every second counts! With each minute that passes, a victim’s chances of survival drop by 7 to 10 percent. That’s why it’s so important to respond promptly and properly. A moment ago I showed a slide that said that only 5 percent of cardiac arrest victims survived. Experts believe that with a good chain of survival in place, we could save not 5 percent, but 20 percent of victims or more. That’s thousands of lives a year. If you’ve never taken a CPR course, I urge you to do so. If you’ve taken one but it’s been more than two years ago, take one to refresh your skills. The American Heart Association offers CPR courses, including some that teach you how to use an AED. See the handout for information on our courses.   Speaker: Include handout on local course offerings and the numbers to call to sign up. Cardiac arrest is an extreme emergency. Every second counts! With each minute that passes, a victim’s chances of survival drop by 7 to 10 percent. That’s why it’s so important to respond promptly and properly. A moment ago I showed a slide that said that only 5 percent of cardiac arrest victims survived. Experts believe that with a good chain of survival in place, we could save not 5 percent, but 20 percent of victims or more. That’s thousands of lives a year. If you’ve never taken a CPR course, I urge you to do so. If you’ve taken one but it’s been more than two years ago, take one to refresh your skills. The American Heart Association offers CPR courses, including some that teach you how to use an AED. See the handout for information on our courses.   Speaker: Include handout on local course offerings and the numbers to call to sign up.

15. Vasodilatadores

16. Bloqueadores de los canales de calcio

17. Inhib. De la enzima convertidora de angiotensina

18. ANTAGONISTAS DE LOS RECEPTORES DE ANGIOTENSINA II

19. Simpaticoliticos