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With prolonged poorly controlled hypertension, end-stage renal disease (ESRD) can occur. The fundus serves as a mirror to brain circulation. Changes there may range from minor atherosclerosis to papilledema. The heart is also evaluated for presence of LVH with increased LV mass. This can be seen on ECG or echocardiogram, but the echo is more speciﬁc. In some patients it may be appropriate to look for an underlying cause. However, most cases of hypertension are primary, and only around 5% of patients will have a secondary form of hypertension.
Mitral Stenosis In mitral stenosis, the thickened leaﬂets become noncompliant and partially fused, resulting in obstruction of blood ﬂow from the left atrium to the left ventricle. The left atrial pressure and pulmonary pressures can become elevated. Atrial ﬁbrillation occurs as the left atrium dilates. In atrial ﬁbrillation, blood ﬂow is less brisk and clots can form, and systemic emboli including stroke can occur. The murmur of mitral stenosis is heard as a diastolic rumble and is best heard directly over the LV apex.
The CO is typically normalized for body size (CI = CO/m2 BSA). 2 L/min/m2. of the His–Purkinje system. The system divides into right and left bundles and on into smaller branches that carry the impulse throughout the right and left ventricle (see Figure 2–2). 4. Cardiac Cycle The cardiac cycle is pictured in Figure 2–3. During systole, the ventricular pressure starts to rise rapidly almost immediately after the QRS complex is inscribed. The increase in ventricular pressure creates a pressure gradient between the ventricle and atrium that causes the mitral valve to close.