PATHOPHYSIOLOGY

Etiology: Risk Factors:

(+) HPN
Unknown Family history
Advancing age
Cigarette smoking
Obesity
Heavy alcohol consumption
Diet
Gender
Stress

Sustained increase in peripheral resistance

Damage to walls of blood vessels

Release of biochemical mediators of inflammation

Increase permeability of vascular endothelium

Calcium enters vessel wall

Smooth muscle contraction

Vasoconstriction

Hypertrophy and hyperplasia of arterial smooth muscles

Narrowing of blood vessel lumen

Increase systemic vascular resistance

Increase force of left ventricular contraction

Hypertrophy of left ventricle

Increase oxygen demand of left ventricle

Hypoxia
 Decrease ATP production for myofibril contraction

Decrease contractility weak and thready pulse

Decrease cardiac output

Increase heart rate tachycardia

Increase cardiac output decrease ventricular filling time

Failure of mechanism decrease preload

Left ventricular dilatation

Increase blood volume accumulation in the left ventricle

Decrease relaxation of the myocardium

Decrease cardiac output Incomplete emptying of the left ventricle

Decrease perfusion to vital organs Overfilling of the left ventricle blood back flows to left atrium

A B Increase intraventricular pressure blood dams back into pulmonary capillary bed
kidney brain
Decrease wall thickness and increase wall tension increase pressure of blood into
pulmonary capillary bed

Cardiomegaly pulmonary capillary filtration pressure exceeds

capillary osmotic pressure

shift of intravascular fluid into the interstitium of the lungs

pulmonary congestion

pulmonary edema impaired gas exchange

cough with frothy sputum pallor

orthopnea cyanosis
 paroxysmal nocturnal dyspnea shortness of breath

crackles dyspnea
wheezes cheyne-stokes respiration
pulmonary hypertension

increased pressure in the R side of the heart

R side hypertrophy

R side dilatation

overfilling of the right ventricle

blood dams back to the right atrium

blood backflows to systemic circulation

congestion of peripheral tissues and organs

liver congestion GIT decrease venous return

hepatomegaly congestion of the abdominal distention edema

portal circulation
right upper abdominal discomfort nocturia
quadrant pain spleenomegaly feeling of fullness
acsitis
jugular vein distention anorexia
nausea and vomiting

left upper quadrant pain hypersplenism weight loss

anemia
leukopenia
thrombocytopenia increase bleeding tendencies
 A
Kidneys

Activation of renin-angiotensin aldosterone system hypoxia

Release of renin ischemia

Angiotensin I sloughing off of the tubular epithelial layer

ACE
Angiotensin II arteriolar vasoconstriction tubular obstruction

Adrenal cortex stimulation increase peripheral vascular resistance matrix theory urinary stasis

Aldosterone nidus formation increase in blood and

urinary levels of stone
Water and sodium reabsorption components and interactions
among the components
Increase plasma volume
Stone formation
Increase BP
Decrease GFR Obstruction

Accumulation of nitrogenous oliguria

substances
Proximal dilatation of the tubules
azotemia
Cyst formation
Increase BUN
Increase CREA Pain (dull, deep, ache in flank or back)
Impaired ability to concentrate urine
Signs of UTI

B
 Brain
Restlessness
Confusion
Disorientation