Hypertension
(Internal Disease - Cardiovascular)
Etiology and pathogenesis. There is a neurosis regulating blood pressure points, leading to increased muscle tone of the arterial wall, narrowing of the lumen of small arteries and arterioles and increase blood pressure. Trigger a strain neuro-psychological sphere. For secondary mechanisms include renal ischemic and endocrine factors. Ischemia kidney juxtaglomerular apparatus allocates renin, which ultimately leads to increased blood pressure.
Increased secretion of aldosterone leading to sodium retention and accumulation of fluid in the walls of arterioles, which narrows their lumen and increases the pressure.
Symptoms and flow. Hypertensive heart disease is a chronic disease with different clinical manifestations depending on the stage of disease and predominant vascular lesions of the heart, brain and kidneys. There are three stages.
In the phase A of the I stage, blood pressure increased from time to time under the influence of negative emotions, nerve strain, cold, etc. In phase B are occasionally observed hypertensive crises, intermittent spasms of cerebral and coronary arteries. Subjective feelings can be absent or expressed in complaints of pain in the heart of a stabbing or aching character. Violations of the nervous system results in headaches, dizziness, insomnia, increased irritability, autonomic disorders - in sweat, expressed dermographism, etc.
Stage II of constant increase in blood pressure. It is unstable in the phase A, in the future (Phase B) blood pressure persistently elevated to significant digits. Subjective feelings are growing, declining productivity, were frequent hypertensive crises with strokes and cerebral blood flow due to spasm of blood vessels. Objectively determined left ventricular hypertrophy, accentuation of the second tone of the aorta, systolic noise on top. Reduces renal blood flow. Due to changes in the permeability of the renal vessels in the urine may appear white, red cells, hyaline cylinders. Changes in fundus expressed in narrowing and tortuosity of arteries, venous stasis.
Developing for stage II, mainly coronary atherosclerosis and cerebral vascular compounded stage III disease. It consistently high blood pressure often decreases after emerging myocardial infarction and stroke.
Grave prognostic significance is an isolated reduction in systolic blood pressure ( “decapitated” hypertension), which is due to the weakness of the heart muscle.
Rapidly progressive (malignant) variant of hypertensive disease occurs predominantly in young persons.
One of the first symptoms of the disease is impairment up to complete its loss. In the study of fundus hemorrhage set against the backdrop of papilledema and retina.
The most common form of cerebral expressed in persistent headaches, often accompanied by vomiting. Frequent violations of cerebral circulation and strokes due to bleeding into the brain.
Cardiac form manifests severe coronary insufficiency with attacks of angina, cardiac asthma, recurrent myocardial infarction.
Renal form is characterized by rapidly increasing renal insufficiency with an increase in blood residual nitrogen, oliguria and a clinical picture of uremia.
For the flow of a malignant variant is characterized by frequent crises.
Rapidly emerging weakness of the left ventricle entails bouts: cardiac asthma.
In stage III on the background of naturally developing atherosclerosis of the coronary vessels and vessels of the brain revealed severe functional and organic disorders of the heart and central nervous system. In the terminal stage of frequent crises, occurring with disorders of cerebral circulation (arteries spasm and thrombosis, hemorrhage as a result of atherosclerosis). As a result of scarring revealed renal insufficiency with a decrease in the proportion of urine, an increase in residual nitrogen of blood.
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