高血压英文ppt精品课件hypertensive heart _1

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1、HypertensiveHeartDiseaseGeneBukhmanJanuary12th,2005EpidemiologyINumberofPatientswithHypertensionintheUnitedStates:50millionNumberofPatientswithHeartFailure:5millionPercentofHeartFailurePatientswithHypertension:75%JNC7.2004JessupandBrozena.NEJM.2003Mosterdetal.NEJM.1997MortalityinHypertens

2、ion50%fromischemicheartdiseaseorheartfailure33%fromcerebrovasculardisease10to15%fromrenalfailureKaplaninZipes,Libby,Bonow,andBraunwald.2005HypertensiveHeartDiseaseCoronaryArteryDiseaseHeartFailureDiastolicDysfunctionImpairedrelaxationLeftventricularmyocytehypertrophyInterstitialfibrosisSy

3、stolicDysfunctionIschemiccardiomyopathyLateconsequenceofafterloadArrhythmiasAtrialfibrillationLeftatrialenlargementVentricularArrythmiasKaplaninZipes,Libby,Bonow,andBraunwald.2005LeftVentricularHypertrophyIConcentricincreaseinLVmassCompensatoryresponsetoincreasedafterloadCollagenMyocytehy

4、pertrophyLorellandCarabello.Circulation.2000LeftVentricularHypertrophyIIEffectofmechanicalloadingmostclearinrapidregressionfollowingaorticvalvereplacementInsystemichypertensionconfoundedbyroleofangiotensinIIandsympathetichormonesLVHoftendevelopsafterothersignsofdiastolicdysfunctioninHTNLV

5、HalsoseentoprecededevelopmentofsystemicHTNLorellandCarabello.Circulation.2000JessupandBrozena.NEJM.2003ConsequencesofLVHAlthoughinitiallycompensatory,LVHultimatelyassociatedwithriskofcardiovasculareventssimilartohistoryofpriormyocardialinfarctionIschemiaDecreasedcoronaryreservewithincreas

6、edLVmassanginaGreaterriskofdeathfollowingmyocardialinfarctionHeartFailureDepressedLVsystolicanddiastolicfunctionArrhythmiaAtrialfibrillationVentriculararrhythmiasNonuniformactionpotentialprolongationAlteredrepolarizationSpecificvulnerabilitytotorsadesIschemicventriculararrhythmiaDunnandPf

7、effer.NEJM.1999EchocardiographyFindingsinSystemicHTNLeftatrialenlargementMitralannularcalcificationMildtomoderatemitralregurgitationAorticrootdilatationAorticvalvesclerosisMildaorticregurgitationDiastolicdysfunctionImpairedrelaxationRestrictivepatternReducedejection