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

Decrease blood flow to the arteries of the heart Ischemia ANGINA

Oxidative stress

Disregulation in interaction between MMP & inhibitors (TIMPS) Increase degredation of fibrilar collagen & extracellular matrix

OLIGURIA

A Augmentation of degradation of normal cell type collagen B A Activation of RAAS Myocyte stretch (other humeral stimuli such as angiotensin II, phenylephrine/ endothelin)

Fibrous deposits of poorly cross linked collagens

Increased contraction/pumping of the heart

Intracellular calcium release

PALPITATION Myocyte fibrosis Decrease pumping action of the heart

C

Increase blood pressure

Initiate transcription of genes Aldosterone synthase gene Calcium modulating gene

HYPERTENSION CARDIOMEGALY

Myocyte hypertrophy

LEFT VENTRICULAR HYPERTROPHY

Increase production of fibronectin, laminin, collagen I & II

Proliferation of fibroblast

Myofibroblast configuration

Cardiac fibroblast undergo phenotypic change

Decrease blood flow

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

Uncoordinated beating of both ventricles and atria

Signals travel through the atria in a rapid & disorganized manner

Fast and irregular rhythm

Faulty signals flood the AV node

Arrhythmia

ATRIAL FIBRILLATION