Question

PATH 370 2019 - difference between primary and secondary hypertension CHAPTER 18: ALTERATIONS IN CARDIAC FUNCTION Coronary heart disease (CHD/coronary artery disease (CAD) description, risk factors, arterial changes stable angina pectoris:description, causes, effects on the heart and if they are transitory or permanent, pattern of onset, treatment acute coronary syndrome - stable angina vs myocardial infarction myocardial infarction: - STEMI VS NSTEMI; diagnosis, clinical manifestations including atypical manifestations in women, elderly, and diabetes), serum markers, basic treatment possible sequelae - scar tissue formation and its effects on cardiac muscle effect of Mion CO, compensatory mechanisms - sudden cardiac arrest: description, type of associated arrhythmia - endocardial and valvular diseases:prolapse vs stenosis vs regurgitation-how do these affect blood flow? - pericardial diseases - cardiac tamponade: description, effects of perkardial effusion on heart contraction, why is it life- threatening? congenital heart defects: which direction left to right:right to left) associated with cyanosis? why? - describe abnormal blood flow in: atrial or ventricular septal defect, patent ductus arteriosus, aortic or pulmonary stenosis, transposition of the great arteries, truncus arteriosus, tetralogy of Fallot CHAPTER 19: HEART FAILURE AND DYSRHYTHMIAS: COMMON SEQUELAE OF CARDIAC DISEASES - congestive heart failure descriptions, causes including other diseases, common manifestations, FACES compensatory mechanisms and explain why they eventually cause further heart damage -left and right sided failure: explain backward (where does blood back up) and forward (what areas are affected by impaired blood flow effects - why does biventricular heart failure occur? what further problems does this cause? - cardiac dysrhythmias - role of potassium and calcium in heart rhythms - describe abnormal rhythms: sinus tachycardia and bradycardia, sinus arrest, premature atrial complexes (PACS) and premature ventricular complexes (PVC), atrial flutter and fibrillation ventricular tachycardia, ventricular fibrillation, heart blocks (types Lll, and I) - most severe dysthythmias and why they are life-threatening CHAPTER 20: SHOCK - general description and common factor for all types of shock, general clinical manifestations - causes of cardiopenic, obstructive hypovolemic, and distributive (including anaphylactic, neurogenic, septic) complications of shock: inflammatory process, acute respiratory distress syndrome, disseminated intravascular coagulation, acute renal failure, multiple organ dysfunction syndrome CLASSES OF MEDICATIONS FOR THIS UNT

Answer 1

1Q).

Difference between primary and secondary hypertension:

Hypertension is a consistent rise in blood pressure than the normal. The average adult blood pressure is 120/80 mm Hg (120 is the systolic and 80 is the diastolic pressure) and the pressure exceeding 140/90 is considered as high blood pressure.

Hypertension is of two types:

1. Essential hypertension or primary hypertension
2. Secondary hypertension

In essential hypertension, the etiology is not clearly known, many factors may be responsible for the development of hypertension. The treatment strategy is to be established through trial and error method and the final titer combination of drugs is to be established for therapeutic monitoring.

In secondary hypertension, the reasons are known; it may be due to the defective mechanisms at the level of baroreceptors, renin-angiotensin-aldosterone (RAS) system, habitual factors, and environmental factors such as stress and lifestyle. In these cases, by identifying the reasons behind hypertension, definite classes of drug treatment can be established.

Treatment: For the treatment of hypertension, vasodilators (nitrates), calcium channel blockers (diltiazem), diuretics (losartan), β – adrenergic blockers (atenolol), etc. are used depend upon the patient's history.

Lifestyle modifications (cessation of smoking, reduced salt intake, aerobic exercises, low-fat diet, reduced alcohol intake, and stress reduction) and dietary approaches also help to reduce blood pressure. Consuming a good amount of fruits, vegetables, nuts, fish and whole grain products provide necessary nutrients.

The treatment of stage 1 and stage II hypertension were compared in the below table:

Blood pressure	Treatment
Prehypertension (120 to 139/80 to 89 mmHg)	Lifestyle modifications, drug therapy is recommended for those with diabetes and kidney disease
Stage 1 hypertension (140 -159/ 90-99 mmHg)	Considering the co-existing conditions, thiazide diuretics along with lifestyle modifications
Stage 2 hypertension (160/100 mmHg)	Considering the co-existing conditions, a combination of diuretics and beta-blockers for most of the patients along with lifestyle modifications

2Q).

Coronary artery disease affect the arteries supplying the heart. The two types of coronary heart diseases (CHDs), or the coronary artery disease are,

1. Atherosclerosis
2. Arteriosclerosis

Atherosclerosis occurs because of the accumulation of fatty substances or fatty plaques on the inner lining of the walls of arteries. It makes the artery to become narrow and reduce the flow.

Arteriosclerosis occurs due to the accumulation of calcium in the artery walls. It results in loss of arterial elasticity, thus raise the blood pressure. Blockade of coronary arteries (by atherosclerosis or arteriosclerosis) causes a heart attack. The major and contributory risk factors of CHD are given below:

Primary (major) risk factors	Secondary (contributory) risk factors
Cannot be controlled: Heredity Gender Increasing age Can be controlled: Tobacco use High blood pressure High cholesterol Sedentary lifestyle Overweight and obesity Diabetes	Stress Diet and nutrition Alcohol consumption