Thursday, July 8, 2010

HYPERTENSION/ HEART FAILURE http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm

Hypertension

Hypertension is the term used to describe high blood pressure.
Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body.
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.
The top number is your systolic pressure.
  • It is considered high if it is over 140 most of the time.
  • It is considered normal if it is below 120 most of the time.
The bottom number is your diastolic pressure.
  • It is considered high if it is over 90 most of the time.
  • It is considered normal if it is below 80 most of the time.
Blood pressure
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Blood pressure
Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure.
If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.
See also: Blood pressure

Causes

Many factors can affect blood pressure, including:
  • How much water and salt you have in your body
  • The condition of your kidneys, nervous system, or blood vessels
  • The levels of different body hormones
You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.
You have a higher risk of high blood pressure if you:
  • Are African American
  • Are obese
  • Are often stressed or anxious
  • Eat too much salt in your diet
  • Have a family history of high blood pressure
  • Have diabetes
  • Smoke
Most of the time, no cause is identified. This is called essential hypertension.
High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:

Symptoms

Most of the time, there are no symptoms. Symptoms that may occur include:
  • Confusion
  • Ear noise or buzzing
  • Fatigue
  • Headache
  • Irregular heartbeat
  • Nosebleed
  • Vision changes
If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension.

Exams and Tests

Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your health care provider may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed.
If you monitor your blood pressure at home, you may be asked the following questions:
  • What was your most recent blood pressure reading?
  • What was the previous blood pressure reading?
  • What is the average systolic (top number) and diastolic (bottom number) reading?
  • Has your blood pressure increased recently?
Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications in your heart, kidneys, eyes, and other organs in your body.
These tests may include:

Treatment

The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.
There are many different medicines that can be used to treat high blood pressure, including:
  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers
  • Central alpha agonists
  • Diuretics
  • Renin inhibitors, including aliskiren (Tekturna)
  • Vasodilators
Your health care provider may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range.
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.
In addition to taking medicine, you can do many things to help control your blood pressure, including:
  • Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water.
  • Exercise regularly -- at least 30 minutes a day.
  • If you smoke, quit -- find a program that will help you stop.
  • Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
  • Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day.
  • Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga.
  • Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.
Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you.
Your health care provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly.

Outlook (Prognosis)

Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Possible Complications

Hypertension - overview
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Hypertension - overview

When to Contact a Medical Professional

If you have high blood pressure, you will have regularly scheduled appointments with your doctor.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.
Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:
  • Chest pain
  • Confusion
  • Excessive tiredness
  • Headache
  • Nausea and vomiting
  • Shortness of breath
  • Significant sweating
  • Vision changes

Prevention

Adults over 18 should have their blood pressure checked routinely.
Lifestyle changes may help control your blood pressure:
  • Avoid smoking. (See: Nicotine withdrawal)
  • Do not consume more than 1 drink a day for women, 2 a day for men.
  • Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet)
  • Exercise regularly. If possible, exercise for 30 minutes on most days.
  • If you have diabetes, keep your blood sugar under control.
  • Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
  • Try to manage your stress.
Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

Alternative Names

High blood pressure; HBP; Blood pressure - high




Heart failure

Heart failure, also called congestive heart failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.

Causes

Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.
The condition may affect the right side, the left side, or both sides of the heart.
  • Right-sided heart failure means the right ventricle of the heart loses its pumping function.
  • Left-sided heart failure means the heart's ability to pump blood forward from the left side of the heart is decreased. The left side of the heart normally receives blood rich in oxygen from the lungs and pumps it to the remainder of the body.
Heart failure is often classified as either systolic or diastolic.
  • Systolic heart failure means that your heart muscle cannot pump, or eject, the blood out of the heart very well.
  • Diastolic heart failure means that your heart's pumping chamber does not fill up with blood.
Both of these problems mean the heart is no longer able to pump enough blood out to the rest of your body, especially when you exercise or are active.
As the heart's pumping action is lost, blood may back up in other areas of the body, producing congestion in the lungs, the liver, the gastrointestinal tract, and the arms and legs. As a result, there is a lack of oxygen and nutrition to organs, which damages them and reduces their ability to work properly.
Perhaps the most common cause of heart failure is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart. For information on this condition and its risk factors, see: Coronary artery disease.
Heart failure can also occur when an illness or toxin weakens the heart muscle or changes the heart muscle structure. Such events are called cardiomyopathies. There are many different types of cardiomyopathy. For information, see: Cardiomyopathy
Other heart problems that may cause heart failure are:
  • Congenital heart disease
  • Heart valve disease
  • Some types of abnormal heart rhythms (arrhythmias)
Diseases such as emphysema, severe anemia, hyperthyroidism, or hypothyroidism, may cause or contribute to heart failure

Symptoms

Common symptoms are:
Other symptoms may include:
Infants may sweat during feeding (or other activity).
Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions:

Exams and Tests

A physical examination may reveal the following:
  • Fluid around the lungs (pleural effusion)
  • Irregular heartbeat
  • Leg swelling (edema)
  • Neck veins that stick out (are distended)
  • Swelling of the liver
Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds.
The following tests may reveal heart swelling,decreased heart function, or lung congestion:
This disease may also alter the following test results:

Treatment

If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.
You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that your heart failure is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.
Other important measures include:
  • Take your medications as directed. Carry a list of medications with you wherever you go.
  • Limit salt intake.
  • Don’t smoke.
  • Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
  • Lose weight if you are overweight.
  • Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.
Here are some tips to lower your salt and sodium intake:
  • Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.
  • Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).
  • Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
  • Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
  • Use oil and vinegar, rather than bottled dressings, on salads.
  • Eat fresh fruit or sorbet when having dessert.
Your doctor may consider prescribing the following medications:
  • ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart
  • Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)
  • Digitalis glycosides to increase the ability of the heart muscle to contract properly and help treat some heart rhythm disturbances
  • Angiotensin receptor blockers (ARBs) such as losartan and candesartan to reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
  • Beta-blockers such as such as carvedilol and metoprolol, which are particularly useful for those with a history of coronary artery disease
Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms.
Valve replacements or repair coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.
The following devices may be recommended for certain patients:
  • A single or dual chamber pacemaker to help with slow heart rates or certain other heart signaling problems
  • A biventricular pacemaker to help the left and right side of your heart contract at the same time.
  • An implantable cardioverter-defibrillator to correct or prevent severe arrhythmias (abnormal heart rhythms)
Severe heart failure may require the following treatments:
  • Intra-aortic balloon pump (IABP), a temporary device placed into the aorta
  • Left ventricular assist device (LVAD), which takes over the role of the heart by pumping blood from the heart into the aorta; it's most often used by those who are waiting for a heart transplant.
Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.
Heart failure symptoms may be improved with biventricular pacemaker or cardiac resynchronization therapy. Ask your provider if you are a candidate for this type of treatment.

Outlook (Prognosis)

Heart failure is a serious disorder. It is usually a chronic illness, which may get worse with infection or other physical stress.
Many forms of heart failure can be controlled with medication, lifestyle changes, and treatment of any underlying disorder.

Possible Complications

  • Irregular heart rhythms (can be deadly)
  • Pulmonary edema
  • Total heart failure (circulatory collapse)
Possible side effects of medications include:

When to Contact a Medical Professional

Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling, or other new or unexplained symptoms develop.
Go to the emergency room or call the local emergency number (such as 911) if you experience severe crushing chest pain, fainting, or rapid and irregular heartbeat (particularly if other symptoms accompany a rapid and irregular heartbeat).

Prevention

Follow your health care provider's treatment recommendations and take all medications as directed.
Keep your blood pressure , heart rate, and cholesterol under control as recommended by your doctor. This may involve exercise, a special diet, and medications.
Other important treatment measures:
  • Do not smoke.
  • Do not drink alcohol.
  • Reduce salt intake.
  • Exercise as recommended by your health care provider.

Alternative Names

CHF; Congestive heart failure; Left-sided heart failure; Right-sided heart failure

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