【高血压英文ppt课件】高心病 Hypertensive Heart Disease.pptVIP

Harvard Medical School 代理报关委托书委托报关协议关于审理城镇房屋租赁合同纠纷案件司法解释有关劳务派遣制度设计及对劳务派遣行业的影响分析糖皮质激素在呼吸系统疾病中的合理应用严重脓毒症导致急性肺损伤病人自发利尿现象的观察分析 Harvard Medical School Harvard Medical School Hypertensive Heart Disease Gene Bukhman January 12th, 2005 Epidemiology I Number of Patients with Hypertension in the United States: 50 million Number of Patients with Heart Failure: 5 million Percent of Heart Failure Patients with Hypertension: 75% JNC 7. 2004 Jessup and Brozena. NEJM. 2003 Mosterd et al. NEJM. 1997 Mortality in Hypertension 50% from ischemic heart disease or heart failure 33% from cerebrovascular disease 10 to 15% from renal failure Kaplan in Zipes, Libby, Bonow, and Braunwald. 2005 Hypertensive Heart Disease Coronary Artery Disease Heart Failure Diastolic Dysfunction Impaired relaxation Left ventricular myocyte hypertrophy Interstitial fibrosis Systolic Dysfunction Ischemic cardiomyopathy Late consequence of afterload Arrhythmias Atrial fibrillation Left atrial enlargement Ventricular Arrythmias Kaplan in Zipes, Libby, Bonow, and Braunwald. 2005 Left Ventricular Hypertrophy I Concentric increase in LV mass Compensatory response to increased afterload Collagen Myocyte hypertrophy Lorell and Carabello. Circulation. 2000 Left Ventricular Hypertrophy II Effect of mechanical loading most clear in rapid regression following aortic valve replacement In systemic hypertension confounded by role of angiotensin II and sympathetic hormones LVH often develops after other signs of diastolic dysfunction in HTN LVH also seen to precede development of systemic HTN Lorell and Carabello. Circulation. 2000 Jessup and Brozena. NEJM. 2003 Consequences of LVH Although initially compensatory, LVH ultimately associated with risk of cardiovascular events similar to history of prior myocardial infarction Ischemia Decreased coronary reserve with increased LV mass angina Greater risk of death following myocardial infarction Heart Failure Depressed LV systolic and diastolic function Arrhythmia Atrial fibrill