Pathophysiology of HCVD

Introduction of the Disease Process

Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium
and coronary arteries as a result of chronic blood pressure elevation. Hypertension increases the
workload on the heart inducing structural and functional changes in the myocardium. These
changes include hypertrophy of the left ventricle, which can progress to heart failure. Patients
with left ventricular hypertrophy have significantly increased morbidity and mortality, but
current treatment follows standard hypertension guidelines as the effects of pharmacotherapy on
regression of left ventricular hypertrophy has unclear benefits.
Hypertensive heart disease is sub-classified by the presence or absence of heart failure as the
management of heart failure requires more intensive goal-directed therapy. Hypertensive heart
disease can lead to either diastolic heart failure, systolic failure or a combination of the two. Such
patients are at a higher risk for developing acute complications such as decompensated heart
failure, acute coronary syndrome or sudden cardiac death. Hypertension disrupts the endothelial
system which increases the risk of coronary artery disease and peripheral arterial disease and
thus represents a significant risk factor for the development of atherosclerotic disease. However
hypertensive heart disease ultimately encompasses all of the direct and indirect sequelae of
chronic high blood pressure which include systolic or diastolic heart failure, conduction
arrhythmia especially atrial fibrillation and increased risk of coronary artery disease.
Hypertensive heart disease results from chronic high blood pressure. Current 2017 American
Cardiology Association/American Heart Association guidelines define hypertension as blood
pressure as a systolic blood pressure higher than 120 mm Hg or a diastolic pressure more than
80mm Hg. The risk of cardiovascular mortality doubles for every 20mmHg systolic and
10mmHg diastolic pressure increase over a baseline blood pressure of 115/75.
The vast majority (90 to 95%) of hypertensive patients will classify as having primary or
essential hypertension. The etiology behind primary hypertension is poorly understood.
However, it likely is a complex interplay between genetic and environmental factors. Several
risk factors such as increasing age, family history, obesity, high sodium diets (greater than
3g/day), physical inactivity, excessive alcohol consumption have strong and independent
correlations with the development of hypertension. Hypertension has been found to precede the
development of heart failure by an average of 14.1 years.
Hypertensive heart disease is responsible for roughly one-fourth of all causes of heart failure.
According to the Framingham Heart Study, hypertension has a 2-fold increase in the
development of heart failure in men and a 3-fold increase for women when adjusted for specific
risk factors and age. The 2015 SPRINT trial demonstrated a reduced risk of progression to heart
failure in patients with more intensive blood pressure control with a target systolic blood
pressure of 120mmHg (1.3%) compared with 140mmHg (2.1%). Proper management of
hypertension correlates with a 64% reduction in the development of heart failure.
Name: M.L.H.
Age: 55 years old
Sex: Female
Date: 07/29/19

Hematology

Exam Result Normal Range Significance

Hemoglobin 142 g/L M: 140-175 Within Normal Range

F: 123-153

Hematocrit 0.42 vol. Fr M: 0.41-0.50 Within Normal Range

F: 0.38-0.47

RBC Count 4.67 x1012/L M: 4.5-5.9 Within Normal Range

F: 4.1-5.1

WBC Count 5.44 x109/L 4.4-11.3 Within Normal Range

Differential Count
Segmenters 0.51 % 0.40-0.69 Within Normal Range

Lymphocytes 0.39 % 0.22-0.42 Within Normal Range

Eosinophils 0.06 % 0.00-0.03 May indicate infection

Monocyte 0.04 % 0.00-0.08 Within Normal Range

Platelet Count Adequate x109/L 150-450 x10 Within Normal Range

Name: M.L.H.
Age: 55 years old
Sex: Female
Date: 07/29/19

Blood Chemistry
Exam Result Normal Range Significance
Glucose (FBS) 5.20 mmol/L 3.9-6.1 Within Normal Range
Creatinine 56 umol/L M: 70-115 Within Normal Range
F: 44-80
Uric Acid 331 umol/L M: 208-428 Within Normal Range
F: 155-357
Cholesterol 5.40 mmol/L 3.88-6.47 Within Normal Range
Triglycerides 2.65 mmol/L 0.11-2.15 May indicate risk for
stroke, heart disease
HDL-C 0.60 mmol/L >1.6 May indicate increased
risk of developing
cardiovascular disease
LDL-C 3.59 mmol/L <2.6 May indicate increased
risk for CAD
SGPT 28 u/L 8-33 Within Normal Range
Sodium 135.9 mmol/L 135-148 Within Normal Range
Potassium 4.03 mmol/L 3.5-5.3 Within Normal Range
Name: M.L.H.
Age: 55 years old
Sex: Female
Date: 09/02/19

Electrolytes
Specimen: Serum
Exam Result Normal Range Significance
Sodium 137.7 mmol/L 135.0-145.0 Within normal range
Potassium 3.79 mmol/L 3.50-5.10 Within normal range