SILENT KILLER DISEASESSILENT KILLER DISEASESHypertensionAmyloidosisSleep Apnea

By IFFAT FATIMA (08)

SILENT KILLER DISEASESSILENT KILLER DISEASES

Many diseases are silent killers in that they are silent (no symptoms or only vague symptoms) killer that they are deadly.

There are a number of diseases that are known as "silent killers" because they gradually consume you without causing any serious symptoms in the early stages.

Facts of silent killersFacts of silent killers

SYSTEMIC HYPERTENSIONSYSTEMIC HYPERTENSION Definitions of hypertension:

Elevated arterial blood pressure is a major cause of premature vascular disease leading to cerebrovascular events, ischaemic heart disease and peripheral vascular disease.

Hypertension - IntroductionHypertension - Introduction

Silent Killer – painless complications It is the leading risk factor –MI, HF, CRF

Stroke Responsible for the majority of office visits, Number one reason for drug prescription. 25% of population Complications bring to diagnosis but late…

Regulation of BP:Regulation of BP:

BP = Cardiac Output x Peripheral ResistanceEndocrine Factors

– Renin, Angiotensin, ANP, ADH, Aldosterone.Neural Factors

– Sympathetic & ParasympatheticBlood Volume

– Sodium, Mineralocorticoids, ANPCardiac Factors

– Heart rate & Contractility.

Control of Blood Pressure:Control of Blood Pressure:

BPCardiac Output

PeripheralResistance

Blood VolumeNa+, Aldosterone

VasoconstrictorsAngiotensin II

CatecholaminesVasodilatorsPg & Kinins

Local FactorspH, Hypoxia

Neural FactorsAdrenergic – Consß Adrenergic - Dil

Cardiac FactorsRate & Contract..

Humoral Factors

EtiologyEtiology 1- Essential:In more than 95% of cases, an underlyingcause cannot be found. Proposed

mechanismsinclude:Excess renal sodium retentionOver activity of sympathetic nervous

systemExess of Renin angiotensinHyperinsulinemiaAlterations in vascular endothelium

Factors contributing to the development of Essential hypertension

•Genetic Factors: hypertension is more common in some families and in some ethnic groups like African Americans

•Environmental factors include obesity, alcohol, lack of exercise and excess salt intake

2- Secondary hypertension2- Secondary hypertension Renal:

These account for over 80% of the cases of secondary hypertension. The

common causes are diabetic nephropathy, chronic glomerulonephritis, adult

polycystic disease, chronic tubulointerstitial nephritis. Endocrinal:

These include Conn's syndrome, adrenal hyperplasia, acromegaly, Cushing's

syndrome. Drugs and toxins Pregnancy-induced hypertension Vascular:

coarctation of aorta, vasculitis

ComplicationsComplicationsCerebrovascular

disease and coronary artery disease are the most common causes of death, although hypertensive patients are also prone to renal failure and peripheral vascular disease.

HYPERTENSIONHYPERTENSIONClassification of blood pressure levels:(according to the British Hypertension Society)

Category Systolic blood pressure Diastolic blood pressure

Optimal < 120 < 80Normal < 130 < 85High normal 130-139 85-89

HypertensionGrade I (mild) 140-159 90-99Grade 2 (moderate) 160-179 100-109Grade 3 (severe) ≥180 ≥110

Isolated systolic hypertensionGrade 1 140-149 < 90Grade 2 ≥160 < 90

HISTORYHISTORY The patient with mild hypertension is usually

asymptomatic. Attacks of sweating, headaches and palpitations

may point towards the diagnosis of phaeochromocytoma.

Higher levels of blood pressure may be associated with headaches, epistaxis or nocturia.

Breathlessness may be present owing to left ventricular hypertrophy or cardiac failure.

Malignant hypertension may present with severe headaches, visual disturbances, fits, transient loss of consciousness or symptoms of heart failure.

Hypertensive Retinopathy:Hypertensive Retinopathy:

Grade I – Thickening of arterioles.

Grade II – Focal Arteriolar spasms. Vein constriction.

Grade III – Hemorrhages (Flame shape), dot-blot and Cotton wool and hard waxy exudates.

Grade IV - Papilloedema

INVESTIGATIONSINVESTIGATIONSRoutine investigation of the hypertensive

patient should include: ECG Urine stix test for protein and blood Fasting blood for lipids (total and high-

density lipoprotein cholesterol) and glucose

Serum urea, creatinine and electrolytes.

Investigation of selected casesInvestigation of selected casesChest X-ray Ambulatory BP recordingEchocardiogram Renal ultrasoundRenal angiographyUrinary catecholaminesUrinary cortisol and dexamethasone

suppression testPlasma renin activity and aldosterone

Non-pharmcological treatmentNon-pharmcological treatment Weight reduction - BMI should be < 25 kg/m2 Low-fat and saturated fat diet Low-sodium diet - < 6 g sodium chloride per day Limited alcohol consumption - ≤ 21 units/week

for men and ≤ 14 units/week for women Dynamic exercise - at least 30 minutes' brisk walk

per day Increased fruit and vegetable consumption Reduce cardiovascular risk by stopping smoking

and increasing oily fish consumption.

AmyloidosisAmyloidosisAmyloidosis

is a group of diseases that result from the abnormal

deposition of a particular protein, called amyloid, in various

tissues of the body.

Amyloid protein

can be deposited in a localized area and may not be

harmful or only affect a single tissue of the body.

– Localized amyloidosis– Systemic amyloidosis

PathogenesisPathogenesis