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8 June, 2020 Doubts

Overview

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

When to see a cardiologist?

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Causes

There are two types of high blood pressure:

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney problems
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects you’re born with (congenital) in blood vessels
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
    If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.

Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.

Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.

Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.

Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.

Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.


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12 May, 2020 Doubts

What is Ventricular Tachycardia?

Tachycardia is a heart rate higher than 100 beats per minute. A normal resting heart rate is 60 to 100 beats per minute. Ventricular tachycardia starts in the heart’s lower chambers. Most patients who have ventricular tachycardia have a heart rate that is 170 beats per minute or more.

What Causes Ventricular Tachycardia?

Your heart rate is controlled by electrical signals that move across the heart muscle. When something goes wrong and signals are sent too quickly, it can cause tachycardia. Most patients with ventricular tachycardia have another heart problem, such as coronary artery disease, high blood pressure, an enlarged heart (cardiomyopathy) or heart valve disease. The condition can also develop after a heart attack (myocardial infarction) or heart surgery because of scar tissue that forms on the heart. Other, non-heart-related causes of ventricular tachycardia include some medications, an imbalance in electrolytes (the minerals that control heart rhythm), too much caffeine or alcohol, recreational drugs, exercise, and certain genetically transmitted conditions. Sometimes the cause is unknown. You are also more likely to have ventricular tachycardia as you get older or if you have a family history of heart rhythm disorders.

What are the symptoms of ventricular tachycardia?

During an episode of ventricular tachycardia, the heart is beating so fast that the blood pressure drops so the heart cannot pump enough oxygen to every part of the body, and this is what causes symptoms. Although some people with ventricular tachycardia do not experience any symptoms, the most common symptoms are dizziness, lightheadedness, palpitations, shortness of breath or chest pain. When the heart rate is extremely high or the ventricular tachycardia persists for more than a few seconds, it can cause fainting, unconsciousness or cardiac arrest and death. If you experience unexplained fainting, dizziness, lightheadedness, shortness of breath or palpitations, you should be evaluated for possible ventricular tachycardia. Chest pain, difficulty breathing and a rapid pulse are urgent symptoms of a potentially fatal ventricular tachycardia, and you must seek emergency help immediately to avoid the risk of cardiac arrest and death.

How is ventricular tachycardia diagnosed?

You will also have testing to determine if you have ventricular tachycardia. The most common test used to diagnose ventricular tachycardia is an electrocardiogram (ECG/EKG).
An EKG records your heart’s electrical activity. Electrodes are placed on your chest and arms to record the heart’s rhythm, and the pattern prints on graph paper. Your cardiologist may also want to track your heart rhythm at home with a 24 h holter EKG .
Your cardiologist may refer you to a specialist to electrophysiology testing. During the test, catheters are inserted through the veins at the groin and placed directly in the heart. The electrical activity in different parts of the heart is recorded so your doctor can see where the electrical problem starts.

What treatments are available?

These treatments may improve or prevent the abnormal heart rhythm from returning. In emergency situations, CPR, electrical defibrillation and IV medications may be needed to slow the heart rate.

Nonemergency treatment usually includes radiofrequency catheter ablation (RCA) or an implantable cardioverter defibrillator (ICD).

Medications

Medications to slow the heart rate is another treatment option for patients with ventricular tachycardia. These drugs can be effective but are associated with some serious, potentially fatal side effects, and they are not used as much as they were in the past.

Follow-up Care

It is important to keep your appointments for regular follow-up visits. Your cardiologist will want to see how you’re doing, make sure your treatment is working and talk about any symptoms or changes you’ve had.


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24 April, 2020 Doubts

Arrhythmia is a disorder or alteration in the heart rate (pulse) or heart rhythm. The heart may beat too fast (tachycardia), too slow (bradycardia), or irregularly. Arrythmia may be harmless, it might be a sign of other heart problems, or it could be an immediate danger to health.

What is a normal heartbeat like?

Heart rate measures the number of times per minute that the heart contracts or beats, and is an important indicator of health in the human body. Likewise, normal heart rate is a useful reference for identifying different health problems or diseases, although it does not guarantee that a person is totally healthy.

In adults, normal heart at rest should be between 60 and 100 beats per minute at rest.

Types of arrhythmia

To establish suitable treatment, it is crucial to correctly diagnose the type of arrhythmia that the patient has, as there are different types of risk and treatment methods.

Classification of arrhythmia:

  • According to the speed of the heart rate: bradycardia and tachycardia.
  • According to the origin: supraventricular and ventricular arrhythmia.

We distinguish the different types of arrhythmia according to the speed of the heart rate below:

Slow heart beat: bradycardia

A slow heart beat is considered to be a cardiac rate of less than 60 beats per minute at rest. Nevertheless, a low heart rate at rest is not always a symptom of a health problem. For example, it is normal for the heart rate to be slower than usual when sleeping or in moments of deep relaxation.

Bradycardia can cause loss of consciousness, fainting, tiredness or difficulty breathing, as the brain does not receive enough oxygen.

Fast heart beat: tachycardia

Tachycardia is a fast heartbeat. This means a heartbeat of more than 100 beats per minute at rest. Tachycardia may include:

  • Supraventricular tachycardia (SVT)
  • Inappropriate sinus tachycardia
  • Atrial flutter
  • Atrial fibrillation (AF)
  • Ventricular tachycardia (VT)
  • Ventricular fibrillation (VF)

This increase in the heart rate means that the heart cannot correctly pump the blood, which can therefore not take enough oxygen to the rest of the body. Tachycardia can cause chest pains; a very fast, uncomfortable or irregular heartbeat; a state of confusion and a fast pulse. Nevertheless, palpitations do not always indicate a pathology, nor do they mean that there is tachycardia.

We distinguish the different types of arrhythmia according to their origin below:

Supraventricular arrhythmia

This originates in the upper heart chambers. In some cases, it may cause tiredness, embolisms and problems related to cerebral ictus.

This kind of arrhythmia has to be treated using heart rate controllers, so that the heart does not work faster than normal. Anticoagulants can prevent the formation of clots in the upper chambers, which could lead to a cerebral embolism.

People who often experience atrial fibrillation or atrial flutter should be treated with an anticoagulant (such as aspirin or sintrom), depending on the type of arrhythmia and age, as well as other risk factors.

Ventricular arrythmia

Ventricular arrhythmia or tachycardia stems from the lower heart chambers, and means that the cardiac muscle cannot pump blood efficiently. The person may lose consciousness, or experience sudden cardiac death.

Due to the risk of sudden death, this type of arrhythmia should be treated with antiarrhythmics, or an automatic defibrillator should be fitted.

Symptoms of cardiac arrhythmia

The most common symptoms that occur when a patient has arrhythmia include:

  • Chest pain.
  • Loss of consciousness (fainting, dizziness and vertigo).
  • Paleness.
  • Palpitations.
  • Difficulty breathing.
  • Sweating.

Causes of cardiac arrhythmia

Cardiac arrhythmia occurs when there are changes to the cardiac rhythm, the heart’s electric system. This system can fail for various reasons:

  • Abnormal levels of potassium or other substances in the body.
  • Heart attack or damage to the myocardium due to a previous heart attack.
  • Heart disease that was present from birth (congenital).
  • Cardiac insufficiency or enlargement of the heart.
  • Hyperthyroidism.

Prevention of cardiac arrhythmia

To prevent or reduce the formation of cardiac arrhythmia, patients may consider the following measures:

  • Reducing the consumption of sugar and fat to reduce high cholesterol and diabetes.
  • Doing regular sport.
  • Not smoking.
  • Consuming alcohol, tea and coffee in moderation.
  • Managing and reducing stress levels.

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Dr. Luis López - Cardiólogo



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