【高血压精品英文课件】高心病 hypertensive heart disease

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1、HypertensiveHeartDiseaseGeneBukhmanJanuary12th,2005EpidemiologyINumberofPatientswithHypertensionintheUnitedStates:50millionNumberofPatientswithHeartFailure:5millionPercentofHeartFailurePatientswithHypertension:75%JNC7.2004JessupandBrozena.NEJM.2003Mosterdetal.NEJM.1997MortalityinHypertension50

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

3、unctionIschemiccardiomyopathyLateconsequenceofafterloadArrhythmiasAtrialfibrillationLeftatrialenlargementVentricularArrythmiasKaplaninZipes,Libby,Bonow,andBraunwald.2005LeftVentricularHypertrophyIConcentricincreaseinLVmassCompensatoryresponsetoincreasedafterloadCollagenMyocytehypertrophyLorell

4、andCarabello.Circulation.2000LeftVentricularHypertrophyIIEffectofmechanicalloadingmostclearinrapidregressionfollowingaorticvalvereplacementInsystemichypertensionconfoundedbyroleofangiotensinIIandsympathetichormonesLVHoftendevelopsafterothersignsofdiastolicdysfunctioninHTNLVHalsoseentoprecedede

5、velopmentofsystemicHTNLorellandCarabello.Circulation.2000JessupandBrozena.NEJM.2003ConsequencesofLVHAlthoughinitiallycompensatory,LVHultimatelyassociatedwithriskofcardiovasculareventssimilartohistoryofpriormyocardialinfarctionIschemiaDecreasedcoronaryreservewithincreasedLVmassanginaGreaterrisk

6、ofdeathfollowingmyocardialinfarctionHeartFailureDepressedLVsystolicanddiastolicfunctionArrhythmiaAtrialfibrillationVentriculararrhythmiasNonuniformactionpotentialprolongationAlteredrepolarizationSpecificvulnerabilitytotorsadesIschemicventriculararrhythmiaDunnandPfeffer.NEJM.1999Echocardiograph

7、yFindingsinSystemicHTNLeftatrialenlargementMitralannularcalcificationMildtomoderatemitralregurgitationAorticrootdilatationAorticvalvesclerosisMildaorticregurgitationDiastolicdysfunctionImpairedrelaxationRestrictivepatternReducedejection