PATHOPHYSIOLOGY

In
Hypertension

Predisposing Factors:
Increasing age
Males in >55 years; Females in
<55 years
Family history
Ethnicity
Socioeconomic status

Cerebrovascular
Disease

Coronary Artery Disease

Hypertensive Heart
Disease

Peripheral Vascular
Disease

Left-Sided Failure

Increased pulmonary pressure

Pulmonary
congestion
and edema

CO2 and O2

Increased
pressure in
blood
vessels of
lungs

(+) Crackles
Pulmonary
hypertension

Right-sided
hypertrophy

Causes:
Idiopathic
Viral infection
(most common:
Coxsackie B virus)
Uremia
Bacterial infection
Myocardial
infarction
Cardiac surgery
Tuberculosis
Neoplasm
Radiation to the
chest
Trauma

Dyspnea
Fatigue
Tachycardia
Cold and clammy
skin
Pallor or cyanosis
Chest pain
Restlessness,
confusion,
decreased
attention span,
decreased memory

Low blood pressure

Low cardiac output
Poor renal perfusion
Poor exercise tolerance
Ventricular dysrhythmias

Right-Sided Failure

Impaired CO2 and O2 perfusion to tissues

Fluid extravasation from the

pulmonary capillary bed into the
interstitium and then the alveoli

Precipitating Factors:
Excessive alcohol intake
Cigarette smoking
Diabetes
Elevated serum lipids
Excessive dietary sodium
Obesity
Sedentary lifestyle
Stress

Left Ventricular Hypertrophy

Heart Failure

Ventricular Failure

Blood back up into the left atrium

and into the pulmonary veins

Venous congestion in the

systemic circulation

Jugular venous distention

Hepatomegaly
Splenomegaly
Vascular congestion of
the gastrointestinal tract
Peripheral edema

Increased hydrostatic
pressure

Impaired renal
perfusion
Increasing
pressure in the
pleural
capillaries

Increased fluid
Decreased
urinary
output
during the
day
Increased
urinary
output
during the
night

Leaking of fluid
into the
pericardium

Stretching of the
ventricular and
atrial tissues

Transudation of
fluid from
capillaries into
the pleural
space
Pleural Effusion

Infiltration of
fluid into the
pericardium

Enlargement of the
chambers of the
heart
Alteration in the
normal electrical
pathway, especially
in atria

Muffled
heart
sounds

Pericardial
effusion

Dysrhythmias

Compress nearby structures

Inflammation
of the
pericardial sac
(pericardium)

Pericarditis
Pulmonary tissue
compression

Phrenic nerve
compression

Cough and
tachypnea

Hoarseness

Pericardial effusion
increases in volume

Cardiac Tamponade

Increased pressure in all cardiac chambers

Stretching of pericardial sac

Decreased venous return due to atrial compression

Hardening of the pericardial sac

Impaired diastolic filling of ventricles

Restriction of heart contractions

Decreased heart pumping action

Decreased cardiac output

Decreased O2

Hypotension

Increased venous pressure

Systemic venous
congestion

Pulmonary
venous
congestion

Hypoxia
Crackles
Cyanosis

Syncope
Dyspnea

Jugular venous
distention

Hepatomegaly
ascites

Peripheral
edema