Examination of patients with hypertension.
Newly diagnosed patients with hypertension, in addition to blood pressure, there are some physical indicators need to be clear. Because hypertension is often combined with other chronic diseases, and blood pressure on the body’s harm is systemic, through a number of tests can determine whether the high blood pressure has caused damage to the body. The following examination is needed to be done in newly diagnosed patients with hypertension.
Abnormal blood routine, suggesting increased disease secondary hypertension, hyperthyroidism can also indicate the real red blood cell; hypertension is very serious, has caused renal failure, leading to renal anemia.
Urine routine. Abnormal urine routine, secondary hypertension suggests the presence of glomerulonephritis, chronic pyelonephritis caused by. If the urine of the patients with proteinuria, suggesting that the high blood pressure combined with early renal damage, the treatment of key in addition to blood pressure, should improve renal function.
Fasting blood glucose. The significance of the examination lies in the timely detection of diabetes, if the patient has diabetic nephropathy, newly diagnosed hypertension may be caused by diabetes. Hypertension combined with diabetes is a dangerous combination, the occurrence of cardiovascular risk is the general population of 4 to 8 times, the total mortality increased by 4 ~ 5 times.
Lipids. If the exception, it is suggested that hypertension may be combined with coronary heart disease, cerebral infarction, easy to induce cardiovascular and cerebrovascular events, it is recommended that this part of the patient detailed examination, even after the examination did not find cardiovascular and cerebrovascular disease, should also be given antihypertensive treatment, coronary heart disease, stroke will be high.
Blood potassium. Hypertension and hypokalemia prompt primary aldosteronism, and with hyperkalemia prompted abnormal renal function, can according to the diagnosis, selection of special treatment.
Serum uric acid. Hypertension associated with high blood uric acid may be caused by gout nephropathy. It should be noted that high blood uric acid may increase the risk of cardiovascular disease. At the time of treatment, do not use double hydrogen chlorothiazide increased uric acid drugs.
Serum creatinine. Hypertension associated with creatinine abnormalities suggest that patients with abnormal renal function, showing that high blood pressure at high risk or high risk. If the patients with uremia, the effect is poor, the need to help dialysis treatment.
Homocysteine levels. Hypertension with high homocysteine also known as H type hypertension, suggesting that the risk of stroke is high, at the same time, can take folic acid, combined treatment can achieve good results.
Electrocardiogram. This examination can be found in the early detection of high blood pressure on heart injury, and through the observation of myocardial ischemia, arrhythmia, evaluation of risk.
Read out accurate blood pressure reading skills
Lead to mispronounce the readings from one of the most important reasons is to neglect the cuff size. Size does not fit the cuff back causing false readings. Cuff air bags should be wide enough to cover the whole area from the armpit to the elbow. Sleeve length with air bags a week to fully wrap around your arm, to allow room for a few centimeters. When you buy a home blood pressure monitor, to determine whether there is a suitable for your arm cuff air bags. Cuff air bags are listed in the following table of standard size, it will help you pick out the sphygmomanometer cuff with air bags is most suitable.
Cuff size airbags standard
Distance between shoulder and elbow cuff air bag size
< 33.0 cm 13.0~23.0 cm 33.0~40.0 cm 15.0~33.0 cm >40.0 cm 18.0~35.5 cm
Blood pressure readings you need to think about what to wear. Wear short sleeves or sleeves f-sudden easy to roll up the clothes best. Measurements under the sleeve must be rolled up, otherwise it may affect blood pressure readings.
Normally, blood pressure readings, stand, sit or lie down Park row is nothing. Elderly, diabetic or taking certain medications (such as antihypertensives and drugs for the treatment of Parkinson’s disease) who stand measuring blood pressure blood pressure readings may be lower. This is called orthostatic hypotension. Doctors often measure the blood pressure of patients in different postures to determine whether this is a causal factors. However, the blood pressure is measured in the calmness when sitting.
High blood pressure in the morning than the afternoon or evening. Talk will elevate blood pressure and tension can elevate blood pressure before the measurement. If you’re in a hurry to a meeting, Han it immediately when you get there to measure blood pressure readings may be increased.
Smoking and drinking of caffeinated beverages (coffee, tea, and Cola) can affect blood pressure in 2-3 hours. Intake a lot of salt in the blood pressure will not change in the short term, but over time may affect blood pressure (http://healthy-girl.net/). In the elder’s blood pressure drops after meals.
Measuring blood pressure at home may be slightly lower than the blood pressure measured at a clinic. When you measure blood pressure at home (especially if you’re at home for the first time have detected blood pressure), there is a good way is to do 2 or 3 measurements. Doctor may pick out the ‘ told you at a different time of day (morning and evening) to measure their own blood pressure, to judge the impact of the drugs you use. When you were diagnosed with high blood pressure for the first time, or when you start your treatment options (especially drug treatment program) when you make any changes, or if you are receiving the treatment of another disease, you’d better always measure your blood pressure. In normal circumstances f, when after your blood pressure is well controlled, you need only checks the blood pressure every 1 week or each month.
In supermarkets, drugstores and other public areas and electronic blood pressure monitoring device is very convenient to operate, but they did not completely replace the old-style blood pressure monitor, because these instruments too sensitive on f the hand or arm movement, they measure the accuracy of blood pressure readings is not very high. But these instruments the yin to raise public awareness about blood-pressure monitor is still very useful. If you use this instrument measured i0i I sell is high, you should go to the doctor to check your blood pressure.
For some seniors, with any instrument measure blood pressure accurately is very difficult, because as they grow older, the artery will slowly harden, so that there will be false high blood pressure, not the arteries by the pressure standard blood pressure monitor and accurately measured. The arterial pulse faint (accurate reading difficult), lift the arms up (flush with the shoulders) before measuring the blood pressure may help.
To the arterial blood supply to the brain will because of chronic hypertension and suffered, and above the similar hurt Q vascular wall thickening and narrowing of the blood vessels, or the formation of a blood clot, prevent certain parts of the blood flow to the brain. The formation of blood clots in the brain called cerebral thrombosis, and can cause stroke. Depending on the different blood vessels, stroke patients may lose their ability to talk, walk or move up the body. Such as carotid artery off the blood clot with blood flow to the brain blood vessel blockage on the formation of the cerebral embolism from anywhere in the blood vessels in the body.
In addition, one or more projections are produced in the middle cerebral artery. These are cerebral aneurysms, which may eventually rupture, causing cerebral hemorrhage, and thus causing another type of stroke, which is usually caused by a more damage than the cerebral thrombosis. Stroke caused by cerebral hemorrhage is more likely to die from a stroke caused by a clot.
It is estimated that the United States has 50 stroke patients annually, of which about 25% -30% of people die, and in the United States, which makes the stroke has become the third common diseases caused by death. Even if there is no death after a stroke, the patient is usually very weak, stroke is the first cause of disability of the elderly in the United states. A stroke can cause paralysis, blindness, deafness, aphonia. Forgetful and a lot of other destructive effects.
80% a 70% of stroke patients with hypertension at the same time. The evidence suggests that a person with a blood pressure and untreated treatment, the probability of a stroke is almost 7 times those of a person who has a normal or high blood pressure. Even normal blood pressure and high blood pressure in patients with mild hypertension risk of stroke is also high. Controlling blood pressure is the best preventive measure to reduce the risk of stroke. Other preventive measures include not smoking, eating less fatty foods, more exercise and taking a small dose of aspirin.
A less common warning sign of a stroke is the so-called small stroke, which is a transient ischemic attack (TIA). Transient ischemic attack unlike explosive stroke that would cause permanent brain damage, small stroke stroke like symptoms lasts only a few minutes to several hours, and go away within 24 hours. Symptoms may include sudden weakness, clumsy, or upper hand. Feet or half face numbness. May also occur in visual impairment, visual acuity and can not speak or speak not coherent. If you have a transient ischemic attack, you should talk with their doctors about how to take preventive measures to prevent another attack, more important is how to prevent the outbreak of stroke onset.
As age increases, many people are worried that they may have to get Alzheimer’s disease, which mainly affects memory and other more advanced brain function, and that the blood supply to the brain may be reduced in older people with a memory disorder or a sudden onset of dementia (a mental decline). Multiple cerebral infarction dementia and Alzheimer’s disease, which can be stable by taking a small dose of aspirin and careful control of blood pressure.
No control of the development of severe hypertension in the course of the development of fiber protein like necrosis, and rapid rupture of blood vessels. This makes the blood and body fluid to leak into the brain, the intracranial pressure increased. Elevated intracranial pressure can cause symptoms such as headache and fatigue, if the pressure has not been reduced, the brain itself will be injured. However, with the great development of blood pressure control technology, this situation is now very rare.
Also, if the extremely dangerous to raised blood pressure, hypertension is a direct result of a called hypertensive encephalopathy of brain diseases. The symptoms of the disease include severe hypertension and disturbance of consciousness, intracranial (skull) with, damage to the retina and more lame attack.
Eyes are not involved in blood pressure regulation, but there are a lot of blood supply arteries in the eyes. These arteries can be seen in the Department of Ophthalmology when the doctor is examining the retina. If doctors find that these blood vessels rupture or shrink, then other arteries in the body may have similar damage. High blood pressure can lead to retinal (responsible for the reception of images from the lens) degradation, resulting in retinal diseases. The lesions of these ocular arteries showed a similar occurrence of the kidney.
Because the kidneys have to filter all the blood in the body, they are very susceptible to damage from untreated hypertension. The effects of hypertension on blood vessels, as discussed above, may occur in the renal arteries (arteries that supply blood to the kidneys). As discussed in the second chapter, renal artery constriction may cause a blood pressure, which can be treated by surgery.
Kidney tissue itself is also affected by severe hypertension. The ability to filter out the waste product will gradually weaken until the kidney is completely dead. Waste will be gathered in the blood, forming a toxic cord, which lead to uremia. Early symptoms of renal failure include fatigue, mental focus, and muscle cramps. If there is no early treatment of renal failure, there will be nausea, vomiting, gastrointestinal bleeding, bad breath and loss of appetite symptoms. Renal failure patients must be treated by dialysis, and the waste in the blood is filtered through dialysis. Some people may worry that drugs that control blood pressure may damage the kidneys, which actually protect the kidney.
Renal sclerosis occurs when small arteries and arteries become stiff and occluded in the kidney. Benign renal sclerosis is a process of gradual development of these vessels in the kidney and a long-term deterioration of the wall of the inner wall of the small artery wall will be gradually thickened. Then the fat will pile up on the wall of the degenerated tissue, and the sterile line is blocked. The rapid development of malignant kidney disease can cause bleeding (blood flow into the tissue), rupture and tissue swelling. Symptoms of kidney sclerosis include vision loss, hematuria, weight loss, and uremia. Treatment methods include the use of antihypertensive drugs, elimination of infection and obstruction, and other measures to mitigate chronic renal failure, such as dialysis. Progressive renal failure and all stages of hypertension are related, but more common in patients with grade 3, grade 2 and grade 4 hypertension.
Blood vessels in the body will be destroyed by high blood pressure, and the pressure of the blood to push the human artery can strain or tear the cell wall of the artery. The injured arteries can repair itself, but when the damage is too large or too frequent, the repair process will produce a bulge of the fat, cholesterol, and dead cells (also known as fat plaques). For people with elevated blood cholesterol levels, especially those with low density lipoprotein cholesterol, the risk of the fatty plaques is the most dangerous. High blood pressure will speed up the process, and the fat spot will continue to grow until it is long enough to block the flow of blood. This process is the process of atherosclerosis, which may occur from childhood and has been sustained for several years 1-. Do the same in the hypertension, atherosclerosis caused enough damage to cause obvious symptoms before is soundless and stirless. In nearly 1/5 of patients with atherosclerosis, fatal heart attack is the only symptom.
In addition to accelerate artery plugging, hypertension can accelerate atherosclerosis (hardening of the arteries) process. Arterial blood is thick and stiff, and it will cause the arteries to narrow and make the arteries lose their elasticity, so that the process of atherosclerosis is accelerated. The results are less and less blood in the blood vessels through the blood vessels.
Hypertension accelerates the process of atherosclerosis by causing tissue damage to the arterial wall. When blood pressure is too high, excessive blood pressure can be struck on the fragile artery wall, which can cause damage to blood vessels. Other arteries are also hurt by the harmful chemical substances in cigarettes and the low density lipoprotein cholesterol (chemical change). Foods rich in antioxidant vitamins (especially vitamin A, vitamin C, and vitamin E) can reduce the amount of oxidized LDL cholesterol in the blood, which is contained in foods such as citrus fruits, leafy vegetables, Cereals, and low fat dairy products.
Attract impaired movement in the event a called white Xirun mononuclear cells, they are inflammatory attack the blood of bacteria and other foreign substances of white blood cells, these mononuclear cell attachment in the damaged area to complete their work, and eventually drilling in the inner lining of the arteries of the internal.
Once in the human arterial union internal, mononuclear cells will into another cell, called macrophages, macrophages in vivo play or doffer. Garbage collection. The role of macrophages in the phagocytosis of dead cells, so that they no longer block blood flow channel, but also to absorb low density lipoprotein cholesterol. Dolphin alliance of macrophages are not and animals by blood circulation, and so they will stay forever in the Ministry when low density lipoprotein in the blood of the finding in human atherosclerotic lesions of the pathway in macrophages will its absorption and expansion become foam cells. If low density lipoprotein cholesterol levels are elevated in the blood, LDL may be more prone to impaired blood vessel regions. So as to promote the formation of foam cells in the formation of macrophages. When the foam cells gathered together, a fat (i.e. fatty plaques) formed in animal dolphin house.
As the foam cells continue to grow, they begin to crush the arteries, making the injured area expand and prevent blood flow. This additional damage to the artery to attract other blood platelets — Tian Yu one. Platelets remain in the damaged site to release a chemical, which promotes the reverse growth of the fragile arteries. Smooth muscle in the arterial wall can also react to the chemical and begin to reverse its growth. By the accumulation of stem cells and the abnormal growth of tissue, the arteries will become narrower and eventually become completely blocked.
In the damaged site, the clot aggregates the calcium, fibrous tissue, and other debris in the blood that increases the risk of arterial blockage. Blood clots may be from the artery (especially in additional pressure exerted by hypertension) can clog arteries and cause stroke or myocardial infarction.
Coronary artery disease occurs when the arteries that supply blood to the heart are narrowed (usually due to the accumulation of plaques). Ischemic heart disease (ischemia) is the result of the occurrence of coronary artery atherosclerosis, or coronary artery spasm (due to the involuntary contraction of the arterial wall muscles) and the results of contraction. Sometimes, such a narrow narrow will not cause any discomfort, this situation is called asymptomatic ischemia. However, most people in the tissue ischemia and hypoxia will occur angina (chest pain). The position of angina occurs in the chest, but may spread to the neck, shoulders, arms, or jaw. Angina attack does not cause permanent damage, but the attack of angina pectoris is an important warning signal.
The condition of the arterial obstruction can occur in any part of the body. The leg artery coarctation can cause pain or cramps when you walk, this is called intermittent claudication. Like angina, the pain disappears after a break. However, severe untreated leg artery occlusion may eventually result in tissue necrosis of the toe (and leg). This is called gangrene, especially in some diabetic patients.
The arteries that supply blood to the arteries are narrowed, which can cause stomach and stomach cramps. This is abdominal pain, usually in the meal after the pain. The blood vessel that leads to the intestinal tract is completely blocked can cause blood in the stool, and eventually the blockage of the intestinal tract may be necrotic. If the bowel perforation occurs, the bacteria can enter the abdomen, causing abdominal infection (Fu Moyan) or death.
There is another danger, that is, that some of the blocks may fall off and into the blood. If such obstruction is attached to blood vessels and blocks the flow of blood, the tissue of the distal end may begin to necrosis by ischemia. If this occurs in the heart, it is likely to cause myocardial infarction $if the brain occurs in the brain, it will have a stroke.
If blood pressure rises sharply, the risk will be even greater. Extremely high blood pressure can cause the fragile blood vessels to rupture, and the blood flow out of the blood vessel can be seriously damaged by the blood. In the case of the brain, a fatal stroke occurs. The largest artery in the human body, the aorta, is swollen with a high blood pressure. This swelling is the aneurysm, which may rupture. However, the potentially fatal effects of these are caused by a rapid rise in blood pressure that are generally associated with symptoms such as headache, dizziness, nasal bleeding, blurred vision, occasional chest pain or abdominal pain.
Xiang Xin’s syndrome
The adrenal glands also secrete a hormone, cortisol, and. The disease is called Cushing’s syndrome (i.e., an increase in cortisol). It is mainly treated by the Department of Endocrinology doctor (who is a specialist in the treatment of the disease). Cushing’s syndrome in addition to cause a rise in blood pressure, too much cortisol also caused by moon face, centripetal obesity (limbs thin, weak, ecchymosis, abdominal purple longitudinal lines) and menstrual disorders. The tumor on the pituitary gland may also trigger the Cushing’s syndrome. Sometimes the abnormal increase in the volume of the adrenal gland (Zeng Sheng) or a small adenoma is a factor in Cushing’s syndrome. The treatment of Cushing’s syndrome depends on the cause of the disease, which usually involves surgery, radiation therapy, or medical treatment, and the goal is to get the cortisol levels (and blood pressure) to return to normal.
Congenital adrenal hyperplasia
Cortisol is a hormone produced by the adrenal glands. If the developing fetus can not produce cortisol, the adrenal glands secrete a large amount of sexual stimulation and other chemicals. This can cause a variety of diseases, these diseases are collectively referred to as the congenital adrenal hyperplasia (hyperplasia is the organization of the abnormal increase, here is an abnormal adrenal gland enlargement). Congenital adrenal hyperplasia, the specific impact on the baby depends on the occurrence of the disease in pregnancy, baby girls have the possibility of abnormal development of the sexual organs, some of the newborn in the birth, the adrenal glands will immediately lose function. Fortunately, the treatment with the adrenal cortex hormone, can prevent the occurrence of this disease, and can make the baby normal growth and development.
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Severe hypothyroidism is also known as mucinous. When the thyroid (located in the neck) stop play the function which lead to slower metabolism occurs thyroid function hypothyroidism, after suffering from hypothyroidism, the patient’s body will change slowly, including facial puffiness, hoarseness, speed slow, hair and skin becomes rough, dry, scaly. Other emerging symptoms include weight gain, memory decline, constipation, menstrual disorders and hypothermia. Although radiation therapy, surgery, certain drugs, and pituitary disease may affect thyroid function, it is not the main cause of the disease. Primary hypothyroidism (unexplained) is the most common type of disease, but no matter what the cause of hypothyroidism, should be treated with an alternative therapy.
Thyroid function hyperthyroidism
Hyperthyroidism is caused by excessive thyroid gland secretion of thyroid function hyperthyroidism. Thyroid goiter, thyroid goiter, and some other diseases are associated with hyperthyroidism. Thyroid function hyperfunction caused by a consequence is caused by adrenal excitement. This means that adrenaline and noradrenaline activity was increased, resulting in increased blood pressure. The symptoms of hyperthyroidism include weight loss, increased appetite, sweating and cold. In addition, the heart rate, such as 1 fast and tremor, may occur. The treatment of hyperthyroidism is mainly based on the cause of hyperthyroidism, the treatment method includes the use of radioactive iodine, drug treatment (including P a receptor blocker) and surgical treatment.
Because the kidney plays a very important role in the regulation of blood pressure, some diseases of the kidney can lead to hypertension. In fact, 3% of the 4% hypertension is associated with kidney, especially in young patients and those with diabetes. The urine is often used for the diagnosis of kidney disease caused by hypertension.
Renal vascular hypertension
Renal vascular hypertension is the most common secondary hypertension. Renal vascular hypertension occurs when most of the arteries (kidneys) are supplied to the kidney (more than half) or completely blocked. If the blood supply to the kidney is reduced, it is affected by the release of the renin to respond to the kidney. Renin is not only an elevated blood pressure in the renal arteries, but rather an elevated blood pressure in the whole body.
In most people with renal vascular hypertension, the arteries are clogged with plaques. In some cases, the renal arteries can be completely removed by surgery, and it can also be removed by vascular reconstruction. Once the artery is open, blood pressure will return to normal. Renal vascular hypertension patients for the elderly (over 55 years of age), and systolic blood pressure tends to be higher. Other arteries in the body, such as the coronary artery, are prone to clogging.
Renovascular hypertension can also be caused by fibromuscular hyperplasia. In this patient, the muscular and fibrous tissue of the renal arteries (arteries) in the renal arteries increases and becomes ring. Like common atherosclerotic plaques, these fibrous tissue rings interfere with the flow of blood in the renal arteries. Fibromuscular hyperplasia occurs mainly in young white women (usually less than 30 years old), and when they get pregnant, is likely to get worse. Can be used for dredging or widening reconstruction of renal artery by surgical operation, so that the blood pressure returned to normal.
The kidney is responsible for removing the body’s waste products and excess sodium and other substances. Small filter material in the kidney is called the glomerular. Glomerulonephritis is the inflammation of these filters. Inflammation of the kidney can not play a role, and may eventually become permanent damage and make functional recession T results is a significant rise in blood pressure. If the glomerular nephritis is a sudden attack, such as a result of infectious diseases, urine will be black (usually with blood), and a sharp rise in blood pressure can cause headaches and vision problems. Acute (sudden) episodes of glomerulonephritis in children and young people. Chronic glomerulonephritis is gradually developing, and will continue for many years. Unless the kidney is seriously hurt by the disease, the symptoms of chronic glomerulonephritis are not very obvious. According to the disease and the disease, a lot of mild acute glomerulonephritis may be better. If it is an acute attack, the first need to treat the underlying cause of disease.
Polycystic kidney disease
Polycystic kidney disease is a genetic disease, patients with two kidneys have a lot of cyst (charge to shout Zhu Zhu Xia Han Bu production bases rare into kidney volume increased and functional decline. In the body such as a cyst in pregnancy can be detected by B ultrasound or genetic examination, otherwise the disease will not occur until the time of childhood multiple urinary tract infection and hematuria, etc.. This kind of cyst can destroy normal kidney function, cause uric road infection and high blood pressure, both of them should be treated, if need, still need to take medicaments appropriately. Polycystic kidney disease can only be treated by renal transplantation.
When a part of the kidney is inflamed and the urethra is blocked, it will occur. The acute attack of the kidney or the slow production, or in the middle of the kidney may occur in the middle of the kidney, the kidney may be due to congenital (born when there is) the cause of urinary tract obstruction. Because of its damage to kidney tissue can cause blood pressure rise, must rely on surgery to remove excess water wells to solve the problem of blockage. Once the renal function returned to normal, blood pressure will generally return to normal levels.
The heart is controlled by the brain, which allows blood to flow at a steady rate of 5.5 liters per minute. If the fluid overload, blood will be increased, cardiac output and blood pressure were all increased. The greater the amount of fluid, the more difficult the heart and blood vessels to make the blood flow. Diuretic is a common drug for treating hypertension, which works by reducing the amount of fluid in the body.
Kidney (two in the back of the waist of the bean shaped organs) to control the amount of fluid circulation in the body. They control the amount of fluid in a person’s urine, either by keeping them in a salt or by keeping them in water. Usually if you eat too much salt, the kidney will emit an excess of sodium and the relative amount of water. However, if your kidneys are unable to rule out the excess sodium, your body will keep the moisture, which will increase the amount of blood and elevated blood pressure.
There are two important chemical substances and maintain the balance of water and sodium in the body. An enzyme called renin (which is secreted by the kidneys, which can accelerate the rate of chemical reaction in the body). The amount of the kidney in the body fluid (which is based on the amount of salt consumed) and the blood pressure applied to the kidney to determine when to release the renin. The lower the pressure, the more the ridge is released. Renin can speed up the rate of angiotensin (a protein in the blood) to a blood vessel. In the next chapter, the reaction and the results are presented.
The side product of the renin can also stimulate the adrenal gland, the right side of the kidney, to produce a chemical that is related to the level of sodium in the body. This chemical is a hormone called aldosterone. And the enzyme is not the same, the hormone will enter a single cell and to serve as a chemical messenger to their target tissues. Aldosterone enters the blood from the adrenal gland and then enters the kidney. The chemical information that aldosterone gives to the kidneys is to retain more sodium and water. The holding capacity of sodium and water increased blood pressure.
Other hormones that affect cardiac output and blood pressure. When you are in any stressful situation, your brain is in the middle of a sudden condition. One way is to send the information to an organ through the sympathetic nervous system. The sympathetic nervous system is a part of the vegetative nervous system, while the vegetative nervous system belongs to the nervous system. The system is responsible for controlling involuntary movements such as breathing, digesting food and controlling blood pressure.
When the adrenal gland is received from the sympathetic nervous system, they secrete epinephrine and norepinephrine, which have different effects on the body. Adrenaline makes the heart beat faster, and that’s what’s going on in the next chapter. As you would like to be the heart of the heart of the sudden rise in heart rate will increase the output of the heart, so high blood pressure.