D115 Unit 5: Hypertension and Cardiovascular Conditions Review

D115 Unit 5: Hypertension and Cardiovascular Conditions Review

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 Western Governors University

D115 Advanced Pathophysiology for the Advanced Practice Nurse

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D115 Unit 5: Hypertension and Cardiovascular Conditions Review

Hypertension

What is Hypertension?

Hypertension is defined as a chronic condition where the systemic arterial blood pressure remains consistently elevated. According to the 2014 clinical guidelines, hypertension was diagnosed when systolic blood pressure reached 140 mmHg or more, or diastolic pressure was 90 mmHg or higher. However, in 2017, these criteria were updated, lowering the threshold to a systolic pressure of 130 mmHg or above and diastolic pressure of 80 mmHg or above. This change reflects emerging evidence linking lower blood pressure levels to significant cardiovascular risks (American College of Cardiology/American Heart Association Task Force, 2017).

What is the Epidemiology of Hypertension?

Hypertension is the most common primary diagnosis among adults in the United States. It affects a vast segment of the population, with approximately 95% of cases classified as primary (essential) hypertension—where no definitive cause is found. The remaining 5% are categorized as secondary hypertension, typically due to identifiable medical conditions like renal disease or endocrine disorders (James et al., 2014).

What Types of Hypertension Exist?

Type	Characteristics	Causes	Outcomes
Primary (Essential)	No clear etiology; multifactorial	Genetic predisposition and environment	Elevated vascular resistance and blood volume leading to sustained high blood pressure
Secondary	Caused by an underlying medical condition	Diseases such as kidney disorders, endocrine abnormalities	Often reversible if the underlying cause is treated early

What Are the Risk Factors for Primary Hypertension?

Risk factors for primary hypertension can be grouped into three categories:

• Nonmodifiable Factors: Age, ethnicity, family history, and inherited genetic factors.
• Socioeconomic and Behavioral Factors: Lower educational attainment, lower socioeconomic status, tobacco smoking, psychological stress, and conditions like obstructive sleep apnea.
• Dietary and Metabolic Factors: Excessive sodium and fat consumption, obesity, and impaired glucose metabolism.

These risk factors not only contribute to hypertension but also significantly elevate the risk for cardiovascular diseases (Mayo Clinic, 2025).

What is the Pathophysiology of Hypertension?

The development of hypertension stems from increased cardiac output, enhanced total peripheral resistance, or a combination of both. Prolonged elevated blood pressure exerts strain on vital organs such as the heart, kidneys, brain, and eyes, which may result in organ damage over time.

What are the Clinical Manifestations of Hypertension?

Often termed the “silent killer,” hypertension frequently lacks early symptoms. Clinical signs typically emerge only after organ damage occurs, manifesting as coronary artery disease, heart failure, renal impairment, cerebrovascular accidents (strokes), cognitive decline, vision disturbances, edema, or vascular blockages.

How is Hypertension Diagnosed?

Accurate diagnosis requires blood pressure readings taken on at least two separate visits, with an average of two measurements per visit spaced about two minutes apart. Proper technique involves the patient resting comfortably, sitting with the arm supported at heart level, avoiding caffeine, smoking, or exercise immediately before measurement.

How is Hypertension Managed?

Effective management focuses initially on lifestyle modifications such as dietary adjustments (e.g., reduced sodium intake), regular physical activity, weight loss, and stress management. Pharmacological treatments are initiated based on the severity of hypertension and current evidence-based guidelines.

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Metabolic Syndrome

What is Metabolic Syndrome?

Metabolic syndrome comprises a cluster of interrelated metabolic disorders that substantially increase the likelihood of developing type 2 diabetes mellitus and cardiovascular diseases.

What are the Components of Metabolic Syndrome?

Component	Description
Central (Abdominal) Obesity	Excess fat accumulation around the abdomen
Dyslipidemia	Abnormal cholesterol and triglyceride levels
Prehypertension	Elevated blood pressure below hypertension threshold
Elevated Fasting Blood Glucose	Higher than normal blood sugar levels

What is the Epidemiology of Metabolic Syndrome?

This syndrome often begins during childhood or adolescence and is particularly prevalent in sedentary adults and overweight youths. Early detection and intervention are vital to prevent progression to diabetes and cardiovascular diseases (National Heart, Lung, and Blood Institute, 2025).

How is Metabolic Syndrome Managed?

Management revolves around early screening and implementing lifestyle changes aimed at weight reduction, adopting a nutritious diet, and increasing physical activity to improve insulin sensitivity and reduce cardiovascular risks.

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Deep Vein Thrombosis (DVT)

What is Deep Vein Thrombosis?

DVT refers to the formation of a thrombus (blood clot) within a deep vein, most commonly in the legs. The clot remains attached to the vessel wall, posing risks for complications such as pulmonary embolism.

What are the Risk Factors for DVT?

Risk Factor
Hospitalization
Trauma
Orthopedic Surgery
Age over 60 years
Pregnancy
Cancer (Malignancy)
Inherited thrombophilias (e.g., Factor V Leiden mutation)

What is the Pathophysiology of DVT?

DVT pathogenesis is explained by Virchow’s triad, which includes venous stasis, endothelial injury, and a hypercoagulable state. Clot formation commonly starts near venous valves, where blood flow is slower.

What are the Clinical Manifestations of DVT?

While some patients may be asymptomatic, typical signs include unilateral leg pain, swelling, dilated superficial veins, and changes in skin color.

How is DVT Diagnosed?

Initial screening often employs the D-dimer blood test, which is highly sensitive but not specific. Confirmation is achieved through compression Doppler ultrasound imaging.

What are the Prevention and Treatment Strategies for DVT?

Prevention strategies include early mobilization after surgery or hospitalization and the use of compression stockings or devices. Treatment involves anticoagulant medications tailored to individual risk profiles and clinical guidelines (Kahn et al., 2024).

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Angina Pectoris

What is Angina Pectoris?

Angina pectoris is characterized by chest discomfort resulting from myocardial ischemia, typically due to reduced blood flow to the heart muscle.

What Types of Angina Exist?

Type	Description	Clinical Features	Treatment
Stable Angina	Predictable pain on exertion	Relieved by rest; no heart muscle damage	Lifestyle modification, nitrates
Unstable Angina	Occurs unpredictably, including at rest	Associated with plaque rupture; high risk of myocardial infarction	Requires urgent medical intervention
Prinzmetal (Variant) Angina	Caused by coronary artery spasms	Occurs at rest, often at night	Calcium channel blockers, nitrates

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Heart Failure

What is Heart Failure?

Heart failure is a clinical syndrome where the heart is unable to pump sufficient blood to meet the body’s metabolic needs or maintain adequate filling pressures.

What are the Types of Heart Failure?

Type	Features
Left-sided Systolic (HFrEF)	Reduced ejection fraction (<40%), impaired contraction
Left-sided Diastolic (HFpEF)	Preserved ejection fraction; impaired relaxation and filling
Right-sided Heart Failure	Usually follows left-sided failure, causing systemic venous congestion

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Cardiogenic Shock

What is Cardiogenic Shock?

Cardiogenic shock is a life-threatening condition characterized by the heart’s inability to pump enough blood despite normal or elevated filling pressures, resulting in poor tissue perfusion.

What are the Clinical Features of Cardiogenic Shock?

Symptoms include low blood pressure (hypotension), rapid heart rate (tachycardia), shortness of breath (dyspnea), and signs of multiple organ dysfunction due to insufficient blood flow.

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Hypoplastic Left Heart Syndrome (HLHS)

What is HLHS?

HLHS is a severe congenital defect where the left side of the heart is underdeveloped, leading to inadequate systemic circulation.

How Does HLHS Present?

Affected newborns may appear well initially but rapidly deteriorate when the ductus arteriosus closes shortly after birth, compromising systemic blood flow.

How is HLHS Managed?

Management includes continuous prostaglandin infusion to keep the ductus arteriosus open, followed by a series of surgical procedures (Norwood, Glenn, and Fontan) to palliate the condition and improve circulation.

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Hematologic Disorders

What are Some Key Hematologic Disorders?

Disorder	Description	Key Features
Sickle Cell Disease	Genetic hemoglobinopathy causing abnormal RBC shape	Chronic organ damage from vaso-occlusion and hemolysis
Disseminated Intravascular Coagulation (DIC)	Widespread activation of clotting and fibrinolysis	Simultaneous clotting and bleeding
Pernicious Anemia	Vitamin B12 deficiency due to loss of intrinsic factor	Megaloblastic anemia with neurological symptoms
Iron Deficiency Anemia	Most common anemia worldwide; caused by blood loss or poor intake	Microcytic, hypochromic RBCs

What Are Leukemias?

Type	Characteristics	Common Demographics
Acute Leukemias	Rapid proliferation of immature blast cells	ALL common in children; AML in adults
Chronic Leukemias	Involvement of more mature blood cells	CLL marked by smudge cells and immune dysfunction

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Myocardial Infarction

What is a Myocardial Infarction?

Myocardial infarction (MI) results from prolonged ischemia causing irreversible death of heart muscle cells.

What are the Types of MI?

Type	Description
STEMI	Transmural infarction affecting the full thickness of the myocardium
NSTEMI	Subendocardial infarction limited to inner myocardial layers

How is MI Diagnosed?

Diagnosis is based on elevated cardiac biomarkers (troponin) and characteristic electrocardiogram (ECG) changes.

What is the Management of MI?

Prompt reperfusion through percutaneous coronary intervention (PCI) or thrombolytic therapy is crucial. Treatment also includes antiplatelet and anticoagulant medications and long-term management of risk factors.

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Neurologic Disorders

What are Important Concepts in Neurologic Disorders?

Cerebral perfusion pressure (CPP) is the difference between mean arterial pressure (MAP) and intracranial pressure (ICP). Elevated ICP can reduce brain perfusion and cause damage. Injury to the brainstem affects consciousness and vital autonomic functions.

What Are Major Neurologic Conditions?

Critical neurologic conditions include locked-in syndrome, subarachnoid hemorrhage, spinal cord injuries with autonomic dysreflexia, cerebral edema and herniation, seizures, epilepsy, delirium, and dementia.

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References

American College of Cardiology/American Heart Association Task Force. (2017). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127-e248.

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., … & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507-520.

Kahn, S. R., et al. (2024). Deep vein thrombosis and pulmonary embolism. The Lancet, 393(10172), 1839-1852.

Mayo Clinic. (2025). Hypertension (high blood pressure). https://www.mayoclinic.org/diseases-conditions/high-blood-pressure

National Heart, Lung, and Blood Institute. (2025). What is metabolic syndrome? https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome

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