TeacherOfMedicine: vascular disease

Showing posts with label vascular disease. Show all posts

Sunday, 25 August 2019

Orthostatic hypotension

Disease class: Hypotension

Hypertension

Disease class: Vascular diseases

Types

Essential hypertension
hypertension, Malignant
hypertension, Pregnancy-induced
hypertension, Renal
Hypertensive retinopathy
Masked hypertension
White coat hypertension

Also known as

Hypertensive diseases
HTN (often written in medical records)
High blood pressure

In brief

Hypertension is a risk factor for many diseases, such as heart failure and renal failure.
Hypertension is a risk factor for many sudden onset events, such as stroke.
Minimising hypertension in the population significantly reduces the number of these diseases.

What is "high"?

European Heart Journal:34;2159–2219

A commonly cited "normal" or "healthy" blood pressure for the average adult is 120/80. This means that the blood pressure is 120 mmHg during systole and 80 mmHg during diastole. The mean arterial pressure would be around 93 mmHg.
Blood pressure varies with age. Children tend to have a lower blood pressure and old adults tend to have a higher blood pressure.
Frequent exercisers tend to have lower blood pressure values.
In an acute situation, it is important to consider what is normal for the patient. Even a blood pressure of 120/80 could be high for them.

Symptoms and signs

Hypertension is usually asymptomatic and detected by routine blood pressure measurement.
Symptoms are more common with hypertensive crises or complications of chronic hypertension.
Headache
Light-headedness
Visual disturbances

Risk factor for:

Stroke
Ischaemic heart disease
Peripheral vascular disease
Heart failure
Dementia

Complications

Hypertensive retinopathy
Hypertensive nephropathy
Hypertensive encephalopathy

Acute severe hypertension (urgency/crisis/emergency)

When hypertension is severe enough it is known as a hypertensive urgency.
The combination of hypertensive urgency, and signs of acute organ damage is a medical emergency. This is known as a hypertensive crisis, hypertensive emergency or malignant hypertension. Within minutes of a hypertensive crisis there is a significant risk of complications such as stroke.
Rapid reduction in blood pressure can precipitate complications such as strokes.

Aetiology and pathophysiology

If successful treatment of another disease causes the hypertension to completely resolve, then it is called secondary hypertension. The hypertension is "secondary" to that disease.
There are many causes of secondary hypertension, particularly kidney dysfunction and endocrine disorders.
Most cases of hypertension are essential hypertension (also called primary hypertension). This means that the body has failed to regulate the blood pressure within healthy limits, usually as a result of ageing. These patients may have no other medical conditions. Even if these patients have another medical condition, and it is completely reversed by treatment, the hypertension will not resolve.

Management

Detect and confirm hypertension.
Establish whether hypertension is primary or secondary. If secondary, what is the cause?
Aim to control blood pressure values, minimising time out of target range.

Reducing blood pressure values to a target level should be done over the course of days. Rapid drops in blood pressure can precipitate strokes.

Lifestyle changes. Dietary changes. Reduction of salt intake.
Medical therapy

Vasodilator therapy

Hypotension

Disease class: Vascular diseases

Types

hypotension, Orthostatic
Post-exercise hypotension
Shy-Drager syndrome

Dyslipidemias

Disease class: Lipid metabolism disorders

Types

Hyperlipidemias
Hypolipoproteinemias
Smith-Lemli-Opitz syndrome

Saturday, 3 August 2019

Arteritis

Disease class: Vasculitis

Types

This refers to inflammation of one or more arteries.

Brain stem infarctions

Disease class: Brain infarction

Subtypes

Lateral medullary syndrome

Lacunar stroke

Disease class: Cerebral small vessel diseases
Disease class: Stroke

Also known as

Lacunar stroke
Lacunar infarct (LACI)

This is a type of ischaemic stroke. It results from the occlusion of small penetrating arteries which provide blood to the brain's deep structures.

Etymology

C. Miller Fisher observed "lacunae" (empty spaces) in the deep brain structures after occlusion of 200–800 μm penetrating arteries and connected them with five classic syndromes.

Types

Pure motor stroke / hemiparesis (occurs in 33–50%)
Ataxic hemiparesis (second most frequent)
Dysarthria / clumsy hand (sometimes considered a variant of ataxic hemiparesis)
Pure sensory stroke
Mixed sensorimotor stroke
Silent lacunar infarction. There are no symptoms despite a loss of brain tissue. This often considered to be a non-stroke syndrome because a diagnosis of stroke can be made clinically. However a diagnosis of silent lacunar infarction must be identified by radiological imaging or post-mortem examination.

Epidemiology

It is estimated that lacunar infarcts account for 25% of all ischaemic strokes.
There is an annual incidence of approximately 15 per 100,000 people.
They may be more frequent in men .
They may be more frequent in people of African, Mexican, and Hong Kong Chinese descent.