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Transcript of Hypertension & Stroke
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HYPERTENSION
& STROKE
Prepared by:
Sharinah Ainee S. Pasandalan BSN-III, Group 4
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What is Hypertension?
Hypertension or high bloodpressure is a condition in which
the blood pressure in the arteries is
chronically elevated. With everyheart beat, the heart pumps blood
through the arteries to the rest of
the body.
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Blood pressure is the force of
blood that is pushing up againstthe walls of the blood vessels. If
the pressure is too high, the heart
has to work harder to pump, and
this could lead to organ damage
and several illnesses such asheart attack, stroke, heart failure,
aneursym, or renal failure.
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The normal level for blood
pressure is below 120/80,where 120 represents the
systolic measurement (peakpressure in the arteries) and
80 represents the diastolic
measurement (minimum
pressure in the arteries).
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Blood pressure between120/80 and 139/89 is called
prehypertension (to denote
increased risk of hypertension), and a blood
pressure of 140/90 or above isconsidered hypertension.
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Hypertension may be classified as
essential or secondary. Essentialhypertension is the term for high
blood pressure with unknown cause.
It accounts for about 95% of cases.Secondary hypertension is the term
for high blood pressure with a known
direct cause, such as kidney disease,tumors, or birth control pills.
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What causes hypertension?
SMOKING
Smoking injures blood vessel walls andspeeds up the process of hardening of the
arteries (Atherosclerosis). So even though it
does not cause high blood pressure,smoking is bad for anyone, especially those
with high blood pressure. If you smoke, quit.
If you don't smoke, don't start. Once you quit,your risk of having a heart attack is reduced
after the first year. So you have a lot to gain
by quitting.
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Moreover, The nicotine in cigarettes
and other tobacco products causesyour blood vessels to constrict andyour heart to beat faster, whichtemporarily raises your bloodpressure. If you quit smoking orusing other tobacco products, youcan significantly lower your risk of
heart disease and heart attack, aswell as help lower your bloodpressure.
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OBESITY (OVERWEIGHT)
If you are overweight, your body requires
extra blood to pass to the bigger areas of flesh; otherwise they would not receive
enough oxygen and vital nutrients that are
required for the growth and repair of allbody cells. This means that the blood
pressure raises and puts unnecessary
stress on the blood vessels, which willeventually lead to heart disease, heart
attack and ultimately, death.
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DIABETES
Hypertension occurs because of anarrowing in the arteries. In
diabetics, this can be caused by
continued and consistently highblood glucose levels (a good
reason to keep blood sugar levels
under control). When the blood flowis restricted, the blood pressure
increases.
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High levels of salt intake
A general rule in biology is that water will
flow towards higher concentrations of salt.
In the case of blood vessels, water moves
in and out towards higher sodium
concentrations, primarily through adiffusion process termed osmosis. Sodium
chloride concentration in blood is highly
regulated in the body to remain between136-145 mEq/L. This range is slightly
larger at 132-146 mEq/L for persons over
the age of 90.
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As more sodium is found in the blood,
water follows to maintain a balance
between the sodium concentration
found in tissue cells, body
compartments and blood vessels. Asa result, increasing salt intake may
increase the volume of fluid contained
in the bloodstream
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Vitamin D deficiency
Recent research suggests that adequate
levels of vitamin D in the body can help toprotect against hypertension working as a
natural blood pressure regulator. A
cardiovascular researcher from the EmoryUniversity School of Medicine concluded
that a lack of vitamin D can impair
vascular health leading to high bloodpressure. Supplementation given to study
participants to increase vitamin D levels
resulted in lowered blood pressure.
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Chronic kidney disease
The relationship between CKD and hypertension
can be explained by several factors. CKD canlead to salt retention and subsequent volume
overload. This may or may not be accompanied
by swelling (edema) along with increased blood
pressure. In addition, failing kidneys appear totrigger increased activity of the sympathetic
nervous system, causing something like an
adrenaline surge. More advanced CKD can also
lead to low blood count or anemia. The
treatment may help to produce hypertension,
depending on the resultant rise in the blood
count.
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Other factors include:
- Stress
- Aging
-Medicines such as birth control pills
- Genetics and a family history of hypertension
- Adrenal and thyroid problems or tumors
- Sedentary lifestyle- Lack of physical activity
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Signs & Symptoms:
Extremely high blood pressure may lead to some
symptoms, however, and these include:- Severe headache
- Fatigue or confusion
- Dizziness- Nausea
- Problems with vision
- Chest pains- Breathing problems
- Irregular heartbeat
- Blood in the urine
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Diagnosing Hypertension
Measuring Blood Pressure
Blood pressure is most often measuredwith a device known as a
sphygmomanometer, which consists of a
stethoscope, arm cuff, dial, pump, and
valve
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Blood pressure is measured in two
ways: systolic and diastolic.
- Systolic blood pressure is the
maximum pressure during aheartbeat.
- Diastolic blood pressure is the lowest
pressure between heartbeats.
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If you're diagnosed with high blood
pressure, your doctor may
recommend other tests, such as:
Electrocardiogram (EKG or ECG):
A test that measures the electrical
activity, rate, and rhythm of your
heartbeat via electrodes attached toyour arms, legs, and chest. The
results are recorded on graph paper.
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Echocardiogram:
This is a test that uses ultrasoundwaves to provide pictures of the
heart's valves and chambers so
the pumping action of the heartcan be studied and measurement
of the chambers and wallthickness of the heart can be
made.
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How is hypertension treated?
High blood pressure may be treatedmedically, by changing lifestyle
factors, or a combination of the two.
Important lifestyle changes includelosing weight, quitting smoking, eating
a healthful diet, reducing sodium
intake, exercising regularly, andlimiting alcohol consumption.
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How is hypertension treated?
Medical options to treat hypertension include
several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium
channel blockers, alpha-blockers, and
peripheral vasodilators are the primary drugsused in treatment. These medications may
be used alone or in combination, and some
are only used in combination. In addition,some of these drugs are preferred to others
depending on the characteristics of the
patient (diabetic, pregnant, etc.).
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STROKE
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What is a Stroke?
A stroke is a condition where a blood
clot or ruptured artery or blood vessel
interrupts blood flow to an area of thebrain. A lack of oxygen and glucose
(sugar) flowing to the brain leads to the
death of brain cells and brain damage,often resulting in an impairment in
speech, movement, and memory.
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TYPES OF STROKE
Ischemic strokeIschemic stroke occurs when an
artery to the brain is blocked. The
brain depends on its arteries to bringfresh blood from the heart and lungs.
The blood carries oxygen andnutrients to the brain, and takes away
carbon dioxide and cellular waste.
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If an artery is blocked, the brain
cells (neurons) cannot make enoughenergy and will eventually stop
working. If the artery remains
blocked for more than a fewminutes, the brain cells may die.
This is why immediate medical
treatment is critical.
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What causes it?
Ischemic stroke can be caused by
several different kinds of diseases.
The most common problem is
narrowing of the arteries in the neck or head. This is most often caused by
atherosclerosis, or gradual cholesterol
deposition. If the arteries become toonarrow, blood cells may collect and
form blood clots.
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Another cause of stroke is blood
clots in the heart, which can occur as a result of irregular heartbeat (for
example, atrial fibrillation), heart
attack, or abnormalities of the heartvalves. While these are the most
common causes of ischemic stroke,
there are many other possiblecauses.
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Types of ischemic stroke
A thrombotic stroke occurs when
diseased or damaged cerebral
arteries become blocked by the
formation of a blood clot within thebrain. Clinically referred to as
cerebral thrombosis or cerebral
infarction, this type of event isresponsible for almost 50 percent of
all strokes.
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Cerebral thrombosis can also be divided
into an additional two categories that
correlate to the location of the blockagewithin the brain: large-vessel thrombosis and
small-vessel thrombosis. Large-vessel
thrombosis is the term used when the
blockage is in one of the brain’s larger blood-
supplying arteries such as the carotid or
middle cerebral, while small-vessel
thrombosis involves one (or more) of thebrain’s smaller, yet deeper, penetrating
arteries. This latter type of stroke is also
called a lacuner stroke.
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Thrombotic Stroke
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Embolic stroke is also caused by a clot
within an artery, but in this case the clot(or emboli) forms somewhere other than
in the brain itself. Often from the heart,
these emboli will travel in thebloodstream until they become lodged
and cannot travel any farther. This
naturally restricts the flow of blood to thebrain and results in near-immediate
physical and neurological deficits.
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Embolic Stroke
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Transient ischemic attack (TIA)
A transient ischemic attack (TIA) — also
called a ministroke — is a brief episode of symptoms similar to those you'd have in a
stroke. A transient ischemic attack is
caused by a temporary decrease in bloodsupply to part of your brain. TIAs often last
less than five minutes. Like an ischemic
stroke, a TIA occurs when a clot or debrisblocks blood flow to part of your brain. A TIA
doesn't leave lasting symptoms because the
blockage is temporary.
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Hemorrhagic Stroke
Hemorrhagic stroke occurs when a blood
vessel in your brain leaks or ruptures. Brainhemorrhages can result from many
conditions that affect your blood vessels,
including uncontrolled high blood pressure(hypertension) and weak spots in your blood
vessel walls (aneurysms). A less common
cause of hemorrhage is the rupture of anarteriovenous malformation (AVM) — an
abnormal tangle of thin-walled blood vessels,
present at birth.
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The types of hemorrhagic stroke include:
Intracerebral hemorrhage. In an
intracerebral hemorrhage, a blood vesselin the brain bursts and spills into the
surrounding brain tissue, damaging brain
cells. Brain cells beyond the leak aredeprived of blood and damaged. High
blood pressure, trauma, vascular
malformations, use of blood-thinningmedications and other conditions may
cause intracerebral hemorrhage.
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Intracerebral Hemorrhage
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Subarachnoid hemorrhage
In a subarachnoid hemorrhage, an artery on or
near the surface of your brain bursts and spills intothe space between the surface of your brain and
your skull. This bleeding is often signaled by a
sudden, severe headache. A subarachnoid
hemorrhage is commonly caused by the rupture of an aneurysm, a small sack-shaped or berry-shaped
outpouching on an artery in the brain.After the
hemorrhage, the blood vessels in your brain maywiden and narrow erratically (vasospasm), causing
brain cell damage by further limiting blood flow to
parts of your brain.
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Subarachnoid Hemorrhage
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Who gets stroke?
Risk factors for stroke include the following:
High blood pressure. High blood pressurecauses significant damage to the arteries when
it goes untreated for a long period. When the
force, or pressure, of the blood flowing throughthe arteries is greater than normal, those
arteries weaken over time. Weakened arteries
are more susceptible to burst, or rupture,leading to a hemorrhagic stroke. Chronic high
blood pressure is one of the primary reasons
why hemorrhagic stroke occurs.
Hi h h l t l Ch l t l i
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High cholesterol. Cholesterol is a waxy
substance that contributes to the buildup of
deposits, known as plaques, within blood
vessels. Plaques can accumulate in the
coronary arteries, which supply oxygen to the
heart, and in the carotid arteries, which
supply oxygen to the brain. LDL is the "badcholesterol" in terms of its potential for
harming the heart and brain and is a major
contributor to arterial plaque development.Levels of LDL cholesterol greater than 130
milligrams per deciliter (mg/dL) are linked to
an increased risk for ischemic stroke.
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Smoking cigarettes
Smoking can cause a stroke bythickening or narrowing the blood
vessels that lead to the brain, mostly
by increasing the likelihood of ablood clot. The nicotine and carbon
monoxide in cigarette smoke
damage the endothelium, which
sets the stage for the build-up of
plaque.
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Diabetes
The second scenario is actually theone that leads to stroke--ischemic
stroke, to be exact. The excess glucose
or blood sugar in the blood adds toplaque that sticks to the walls of
arteries, which in turn may cause blood
clots that trigger stroke. Having highglucose levels also leads to high blood
pressure, which is another stroke risk.
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Obesity
Obesity is one of many causes of
stroke. Obesity can lead to fat deposits
in the arteries. These may form blood
clots that travel to the brain blocking
blood and oxygen flow causing stroke.
The health effects of obesity cannot be
disputed. Obesity significantly raises the
risk factor for these and other diseases
like sleep apnea and colon, breast,
gallbladder cancer.
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Heavy use of alcohol
Chronic excessive alcohol intake can
precipitate hemorrhagic stroke. This is inmany cases the result of harmful effects of
alcohol on the liver, as this organ makes
proteins which are necessary to preventspontaneous bleeding. However, most of
the risk of stroke with excess alcohol
intake appears to be due to a combinationof high blood pressure, and impaired blood
clotting mechanisms.
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What are the symptoms of stroke?
Within a few minutes of having a
stroke, brain cells begin to die and
symptoms can become present. It isimportant to recognize symptoms, as
prompt treatment is crucial to recovery.
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Common symptoms include:
- Dizziness, trouble walking, loss of
balance and coordination
- Speech problems
- Numbness, weakness, or paralysis onone side of the body
- Blurred, blackened, or double vision
- Sudden severe headache
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- A possible sign that a stroke is about
to occur is called a transient ischemicattack (TIA) - a temporary interruption in
blood flow to part of the brain.
Symptoms of TIA are similar to strokebut last for a shorter time period and do
not leave noticeable permanent
damage.
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How is stroke diagnosed?
- Physical assessment - blood pressure tests
and blood tests to see cholesterol levels,blood sugar levels, and amino acid levels
- Ultrasound- a wand waved over the carotid
arteries in the neck can provide a picture that
indicates any narrowing or clotting
- Arteriography - a catheter is inserted into
the arteries to inject a dye that can be picked
up by X-rays
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- Computerized tomography (CT) scan - ascanning device that creates a 3-D image
that can show aneurysms, bleeding, or
abnormal vessels within the brain- Magnetic resonance imaging (MRI) - a
magnetic field generates a 3-D view of the
brain to see tissue damaged by stroke
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- CT and MRI with angiography - scans
that are aided by a dye that is injectedinto the blood vessels in order to provide
clearer and more detailed images
- Echocardiography - an ultrasound that
makes images of the heart to check for
embolus
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How is stroke treated?
The primary goal in treatingischemic stroke is to restore blood
flow to the brain. This will be
attempted using blood clot-bustingdrugs such as aspirin, heparin, or
tissue plasminogen activators thatmust be administered within three
hours of the stroke.
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In addition, surgical procedures
may be performed that can open upor widen arteries. These include
carotid endarterectomy (removal of
plaque and widening of the carotidartery) and angioplasty (a balloon
that widens the cartoid artery and is
held open with a metallic mesh tube
called a stent).
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Hemorrhagic stroke is treated differently
than ischemic stroke. Surgical methods
used to treat this stroke variant include
aneurysm clipping, aneurysm embolisation,
and arteriovenous malformation (AVM)
removal.
Aneurysm clipping consists of a small
clamp placed at the base of the aneurysm
that isolates it from the circulation of it's
attached artery and keeps the aneurysm
from bursting or re-bleeding.
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Aneurysm embolisation (coiling) uses
a catheter inserted into the aneurysm todeposit a tiny coil that coil fills the
aneurysm, causing clotting and sealing
off the aneurysm off from arteries. AVM removal is a surgical procedure
to remove usually smaller AVMs or
AMVs that are in more accessibleportion of the brain in order to eliminate
the risk of rupture.
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