Hypertension of vsd

High blood pressure in patients with ventricular septal defect (VSD): pathophysiology and clinical implicationsThe ventricular septal defect (VSD) is one of the most common congenital heart defect and can lead to a number of cardiovascular complications, including high blood pressure (arterial hypertension). In this review, the pathophysiological mechanisms and the clinical impact of blood to be examined high pressure in patients with VSD.PathophysiologyIn the case of a VSD, an abnormal Opening in the wall between the two chambers of the heart (Ventricles) is. This leads to a Shunt, i.e., an abnormal blood flow from left-to-right (L‑to‑R Shunt), since the pressure in the left ventricle is usually higher than in the right. The additional volume of blood flow in the right circuit has the following consequences:Increased amount of blood in the pulmonary circulation (pulmonary circulation).Increase in pulmonary blood flow.In the long term, possible pulmonary hypertension, if the Shunt is large and persistent.Pulmonary hypertension, in turn, can lead to an increase in systolic pressure in the right ventricle. In the case of progressive disease can reverse the Shunt (R‑L Shunt, Eisenmenger syndrome), which leads to cyanosis, and other complications.With regard to systemic hypertension (increased blood pressure in the General circulation), this is not caused by VSD directly through the heart defect itself, but can be caused by secondary mechanisms:Renin‑Angiotensin‑aldosterone‑System (RAAS) activation: The changes in hemodynamics and possible renal perfusion limitations can lead to the activation of the RAAS, which in turn increases the blood pressure.Volume retention: The increased blood flow in the pulmonary circulation can lead to fluid accumulation and volume retention in the body, causing the blood pressure to rise further.Vascular resistance: long-Term changes in vascular elasticity and in the systemic vascular resistance can also contribute to the development of arterial hypertension.Clinical symptoms and diagnosisPatients with VSD and associated hypertension may have the following symptoms:Fatigue and power loss.Shortness of breath, especially during physical exertion.Heart palpitations or irregular heartbeat.Headaches that are due to elevated blood pressure.Edema (water retention), and in particular on the legs.For the diagnosis include:Blood pressure measurement (repeatierte measurements for confirmation of hypertension).Echocardiography (ECHO) for the visualization of the VSD, the evaluation of the Shunt size and the function of the heart ventricles.Electrocardiogram (ECG) for the detection of signs of ventricular hypertrophy.Chest x-ray to assess heart size and pulmonary blood flow.Laboratory tests (kidney parameters, electrolytes, RAAS‑Marker).Therapeutic ApproachesThe therapy depends on the size of the defect, the degree of pulmonary hypertension and the degree of systemic high blood pressure:Drug Therapy:Diuretics to reduce volume overload.ACE inhibitors or AT1‑receptor blockers to lower blood pressure and inhibition of the RAAS.Beta-blockers for heart rhythm disorders, or to a reduction in Cardiac output.Calcium channel blockers in pulmonary hypertension.Surgical correction: In the case of large VSD, which lead to significant hemodynamic disorders, is a surgical closure of measure (for example, Patch‑plastic) indicated.Long‑term Monitoring: Regular follow-up with blood pressure control, ECHO and ECG is essential in order to detect complications early and the therapy to adapt.ConclusionHigh blood pressure in patients with VSD is a complex phenomenon that can be caused by the anatomical abnormality, as well as by secondary hemodynamic and neurohumoral mechanisms. Early diagnosis and a multimodal therapeutic approach is crucial to maintain the quality of life of those Affected and to prevent serious complications such as pulmonary hypertension or congestive heart failure.

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Lecture: cardiovascular diseases and their treatment — Interpretation of ECG FindingsIntroductionCardiovascular disease (CVD) is the leading cause of death and require early diagnosis and effective therapy. One of the most important diagnostic methods for the detection of heart problems, the electrocardiogram (ECG) represents the electrical activity of the heart is graphically. In this talk, first of all, the most common cardiac cycle will be introduced to diseases, then the importance of ECG Interpretation for the diagnosis and treatment will be explained.Frequent Cardiovascular DiseasesAmong the most common CVD:Coronary heart disease (CHD): Due to narrowing of the coronary arteries is decreased blood flow to the heart muscle, which can lead to Angina or a myocardial infarction.Hypertension: A permanently elevated blood pressure is damaging in the long term, heart, kidneys and blood vessels and increases the risk for stroke and heart attack.Heart rhythm disorders (arrhythmias): deviations from the normal sinus rhythm, such as atrial fibrillation, tachycardia or bradycardia, can lead to circulatory disorders.Congestive heart failure: The heart loses its Capacity to shortness of breath, Edema, and limitation of physical efficiency.Valve defect: Defects of the heart valves (e.g., aortic stenosis) can affect the blood flow and strain the heart.ECG: principles and InterpretationThe ECG records the electrical impulses, the contraction of the heart is responsible. A normal ECG consists of the following waves and intervals:P‑Wave: Atrial DepolarizationPQ‑interval: time from the beginning of the atrial until the beginning of the chamber of arousalQRS complex: the comb of the earth polarization (discharge)ST Segment: the time between the comb of the earth, polarization and repolarizationT‑Wave: Chamber Of Repolarization (Reverse Polarization)Diagnostic clues in the ECGCertain changes in the ECG indicate specific diseases:Myocardial infarction: ST‑extension, pathological Q‑waves, inverted T wavesIschemia: ST‑cut, flat or negative T‑wavesAtrial fibrillation: an Irregular rhythm, the lack of P‑waves, R‑waves instead of P‑wavesAV Block: prolongation of the PQ interval (1. Degree), failure of the QRS Complex (2. Degrees), the complete decoupling of the P‑waves and QRS (3. Degree)Ventricular tachycardia: a wide QRS Complex, high heart rateTreatment strategies in dependence of ECG FindingsThe recommendations are in accordance with the ECG results:In the case of an acute ST‑lifter infarction (STEMI) is an immediate Revascularization (PCI or thrombolysis) is required.In the case of atrial fibrillation, anticoagulants (e.g., DOAKs) are used for the prevention of Stroke and, if necessary, rhythm‑ or rate-control.At high AV‑blocks, a pacemaker may be necessary.For ventricular arrhythmias, antiarrhythmic drugs, or an Implantable cardioverter‑Defibrillator (ICD) in question.In the case of Ischemia, a coronary angiography to clarify the stenosis location is carried out.ConclusionThe correct Interpretation of the ECG diseases is an indispensable tool in the diagnosis of cardiovascular disease. It provides a rapid and targeted treatment, which can improve the Survival and quality of life of patients significantly. Advances in technology and training of health professionals contribute to increase the accuracy and efficiency of the ECG diagnostics.