Death Certificate #1
Name of deceased: George Jefferson Walker
Age: 64
Date of Birth: May 4, 1947
Date of Death: December 16, 2011
Cause of death: Hypertensive Heart disease
Etiology:
Poor control of increased blood pressure leads to various changes in the structure of the heart muscle, coronary arteries, and the cardiac conduction system. Clinically, these changes are manifested as angina or myocardial infarction, heart failure, and cardiac arrhythmia. Hypertensive heart disease is a term that exclusively covers heart disease caused by the direct or indirect influence of elevated blood pressure (Jameson et al, 2018). Although these clinical changes often occur with an acute increase in blood pressure, pathological entities related to ischemic heart disease develop in response to chronic increase in blood pressure.
The cause is chronically elevated blood pressure, and the causes of hypertension are various. According to the cause, hypertension is divided into essential and non-essential (secondary) (Jameson et al, 2018).
- Essential hypertension is not known cause of high blood pressure. 90% of all hypertension is essential hypertension.
-In secondary hypertension the cause is known. Based on the cause, secondary hypertension can be caused by:
A. Renal pathology (Renal artery stenosis, renal artery vasculitis polycystic kidney disease, chronic renal failure, nephritic syndrome) (Jameson et al, 2018).
B. Endocrine pathology (Primary hyperaldoseronism, pheochromocytoma, Cushing’s syndrome, Congenital adrenal hyperplasia, acormegaly, hypo and hyperthyroidism, use of sympathomimetics, MAO inhibitors and thiamine-rich foods) (Jameson et al, 2018).
C. Other pathology (Aortic coarctation, increased intracranial pressure, sleep apnea) (Jameson et al, 2018).

Symptoms:
Symptoms that occur in ischemic heart disease are associated with complex pathophysiological effects of hemodynamic, structural, neuroendocrine, cellular and molecular factors (Jameson et al, 2018). The increased blood pressure also increases the afterload. In addition to the increased afterload, the mechanical and neurohumoral stimuli that accompany hypertension can lead to activation of the renin-angiotensin system and through the action of angiotensin on the angiotensin 1 receptors, interstitium and cell matrix of the cardiomyocytes gets increased. Because of that, hypertrophy of the left ventricle occurs. Hypertrophy can also lead to heart failure, the inability of the heart to pump adequate amounts of blood (in proportion to physical activity) and to meet the body's oxygen and energy requirements. The main symptoms of heart failure are dyspnea, edema of lower extremities and ascites, orthopnea, abdominal pain due to enlargement of the liver, fatigue, nausea and so on (Jameson et al, 2018). Also, because of the hypertrophy and heart failure there is a poor blood flow through coronary arteries. This can cause a feeling of pressure and intense chest pain.
Diagnosis:
Physical examination and complete history are needed to confirm the diagnosis of high blood pressure. Body height and weight need to be measured. Blood pressure needs to be measured. Fundoscopic changes can be found on retinal vessels. Proteinuria and retinopathy indicate that hypertension is severe and untreated (or not treated properly). Secondary causes of hypertension should be excluded. Weakened pulse of the femoral artery can be a sign of the coarctation of the aorta. Renal artery stenosis can be seen on arteriography. the presence of stretch marks may indicate that the patient has Cushing's disease
Treatment:
By treating hypertension and heart failure we also treat the hypertensive heart disease. For all non-diabetic patients, blood pressure should be lower than 140/90 (Jameson et al, 2018). In patients with chronic kidney disease, the pressure should be less than 130/90 mmHg (Jameson et al, 2018). Diet control, exercise, weight loss and medications are essential for treating high blood pressure. Reducing sodium intake, increasing your potassium intake, eating fruits and

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