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Cardiovascular Diseases

Cardiovascular Diseases. Introduction to Human Diseases Chapter 12. Review of Cardiovascular Anatomy. Atria (right and left) Ventricles (right and left) Valves Tricuspid, pulmonic, mitral, aortic Regurgitation or insufficiency, stenosis Systole Diastole. Review of CV Anatomy.

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Cardiovascular Diseases

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  1. Cardiovascular Diseases Introduction to Human Diseases Chapter 12

  2. Review of Cardiovascular Anatomy • Atria (right and left) • Ventricles (right and left) • Valves • Tricuspid, pulmonic, mitral, aortic • Regurgitation or insufficiency, stenosis • Systole • Diastole

  3. Review of CV Anatomy • Myocardium • Epicardium & endocardium • Coronary arteries • Left mainstem • Left anterior descending • Left circumflex • Right coronary artery

  4. Review of CV Anatomy • Aorta • Arteries, arterioles • Capillaries • Venules, veins • Vena cava (inferior and superior)

  5. Reye’s Syndrome • Non-inflammatory encephalitis & hepatic failure associated with: • Mitochondrial dysfunction, often due to mitochondrial toxin (aspirin most commonly) • First described in Australia in 1963 • Peak ages: 5-14 YOA, average = 7 YOA • Peak incidence 1979-80: 555 cases • 2 or fewer cases/year since 1994

  6. Reye’s Syndrome • Develops within 3 weeks after viral illness • Strong association with aspirin use • S/S: altered consciousness & mood, abnormal liver tests, high serum ammonia level, cerebral edema, abnormal CSF (lymphocytes)

  7. Reye’s Syndrome • Mortality: 20% • Down from 50% • Usual cause of death: • Cerebral edema • Common neurological impairment in survivors

  8. Acute Rheumatic Fever (ARF) & Rheumatic Heart Disease (RHD) • Disease caused by recent Group A streptococcal infection (usually URI) • Well-known and described since 1800’s and earlier • Decreased incidence & mortality over last few decades, due to: • Antibiotic Rx of strep infections • Changes in subtypes & virulence of strep

  9. ARF & RHD • Some genetic susceptibility involved also • Sore throat is commonest URI • Average age: 5-15 YOA • 60% with ARF eventually develop RHD • Usually cause of morbidity is cardiac disease • Diagnosis via: • Known strep infection previously • Plus two major criteria

  10. ARF & RHD • Major criteria • Carditis (40%) • Murmur, CHF, valvular disease, pericarditis, cardiomegaly • Migratory polyarthritis (75%): large joints • Subcutaneous nodules (10%) • Erythema marginatum rash (5%) • Chorea (Syndenham’s chorea) (5-10%) • Abnormal purposeless movements of face and upper extremities

  11. ARF & RHD • Treatment: • Antibiotics for strep, anti-inflammatories, steroids

  12. Carditis • Pericarditis • Myocarditis • Endocarditis

  13. Pericarditis • Inflammation of pericardium • Acute or chronic • Etiologies: • Infection (most common), metastases, ARF, uremia, trauma, idiopathic, associated with autoimmune diseases

  14. Pericarditis • S/S: atypical chest pain, effusion, abnormal pulse & BP, dysrhythmias and EKG changes • Treatment: • Pericardiocentesis, possibly surgery • Antiinflammatories, antibiotics, etc.

  15. Myocarditis • Inflammation of the myocardium & conducting system • Acute or chronic • S/S: fever, fatigue, pain, less specific • Etiology: viral infection, alcohol, toxins, drugs or radiation therapy • Treatment: variable

  16. Endocarditis • Inflammation of endocardial membrane lining the valves and chambers • Typically infectious (bacterial) • Group A nonhemolytic strept • During bacteremic episodes (surgery, IVDA) • Structurally abnormal valves are most susceptible • Causes vegetations • These may embolize to other areas

  17. Endocarditis • S/S: highly variable, often long-standing illness with fever, fatigue, new murmur • Testing: echocardiogram & blood cultures • Treatment: • Long-term antibiotics • Occasional valve surgery

  18. Valvular Disease • Types • Improper valve closure • Incompetance, regurgitation, insufficiency • Allows backward flow of blood into previous chamber • Narrow valve opening • Stenosis • Blood is more slowly pumped out of the chamber prior to the stenotic valve, higher pressure there

  19. Valvular Disease • Any valve may be involved • S/S: murmurs (grades I through VI), dilation of various cardiac chambers • Most commonly affected valves: • Mitral and Aortic

  20. Mitral Valve Disease • Mitral insufficiency & mitral stenosis • Left atrial enlargement • Etiology: ARF, mitral valve prolapse (MVP), left heart failure • Testing: Echocardiography • S/S: murmur, CHF, fatigue, dyspnea • Treatment: medical or surgical

  21. Aortic Valve Disease • Aortic insufficiency or aortic stenosis • Both can cause left ventricular dilation, hypertrophy, or failure • Etiology: ARF, syphilis, endocarditis, HTN, congenital malformations • S/S: murmur, syncope, angina, fatigue, CHF • Testing: echocardiogram • Treatment: medical or surgical

  22. Hypertensive Heart Disease • Hypertension: over 140/90 on at least 3 separate occasions • Hypertensive Cardiac Disease: • Type of heart disease that is due to the longterm effect on the heart of pumping against higher than normal pressure in the systemic circulation • Types of hypertension: • Essential • renovascular

  23. Hypertension • Higher risk of HTN: • Sedentary, obese, African-Americans, high salt and fat diet, genetics, older age, smokers, oral contraceptive users • S/S: may be asymptomatic • Dizziness, headaches, fatigue, shortness of breath, tinnitus • Treatment: medications • Diuretics, beta-blockers, vasodilators, calcium channel blockers, also low salt diet

  24. Hypertension • Common disease of middle-aged and older people • Only about 1/3rd of hypertensive patients have well-controlled BP on treatment • Those with good BP control are almost always on multiple meds, usually 3.

  25. Coronary Artery Disease (CAD) • Narrowing of coronary arterial lumens by plaque, causing myocardial ischemia due to decreased blood flow • Increased plaque risk: • Older age, heredity, hyperlipidemias, DM, HTN, smoking • More common in males, in post menopausal females and geriatrics

  26. CAD • S/S: chest pain (angina), shortness of breath, fatigue • Testing: EKG, stress tests, cardiac catheterization • Treatment: medical (nitroglycerin, other vasodilators, lipid-lowering meds) or surgical (angioplasty or CABG-bypass grafting)

  27. Angina Pectoris • Chronic or recurrent chest pain due to myocardial ischemia • Substernal pressure, squeezing, tightness • Associated symptoms: • Nausea, diaphoresis, radiation of pain to shoulder or jaw • Worsened by exertion or activity • Improved with rest, oxygen, nitroglycerin

  28. Myocardial Infarction (MI) • Emergency condition of major/total coronary artery occlusion leading to severe myocardial ischemia or necrosis (cell death) • Almost always due to lumen occlusion by clot forming on a ruptured plaque • Cardiovascular disease is the #1 cause of death in the US

  29. MI • S/S: same as for plaque formation • HTN • DM • Hyperlipidemias • Smoking • Obesity • Sedentarism • Past history of CAD or family hx of CAD

  30. MI • S/S: Chest pain most commonly (like angina) • Dyspnea, fatigue, nausea, diaphoresis • Right or left shoulder or arm pain • Jaw pain • Epigastric pain, indigestion • Syncope (fainting), palpitations, sudden death

  31. MI • Testing: EKG, cardiac enzymes (blood tests) • Treatment: • Angioplasty, cardiac catheterization • Coronary artery bypass grafting (CABG) • Medical treatment • Nitroglycerin, beta-blockers, lipid-lowering meds, aspirin and other anticoagulants • Fibrinolytics (thrombolytics) “clot buster” meds

  32. MI • Complications: • Ventricular fibrillation: fatal dysrhythmia, most common cause of sudden death • Congestive heart failure • Cardiogenic shock • Ventricular septal rupture • Papillary muscle rupture

  33. Congestive Heart Failure • Impaired cardiac ability to pump leads to backing up of blood in the pulmonary circulation and fluid in the alveoli • Right and left-sided heart failure • Acute or chronic • Left-sided heart failure may eventually lead to right sided heart failure

  34. Congestive Heart Failure (CHF) • Left-sided failure: • Left ventricle fails to pump efficiently • Blood backs up into the left atrium and then the pulmonary circulation, eventually filling the alveoli • S/S: rales in lungs, dyspnea, orthopnea

  35. Heart Failure • Right-sided Heart Failure: • Failure of the right ventricle to pump effectively • Blood backs up into the right atrium, then the vena cava, and systemic veins • Extra fluid in the liver and spleen • hepatosplenomegaly • Fluid in the feet and distal legs • Pedal edema

  36. Heart Failure • Treatments: • Diuretics, control of HTN, oxygen, meds to enhance contractility (digitalis, etc), beta-blockers, etc.

  37. Cardiac Arrest • Cessation of all cardiac activity • Pulseless • Apneic • No other signs of life • No movement, cough, attempts at breathing, pupillary activity

  38. Cardiac Arrest • Numerous causes • Everyone will eventually have a cardiac arrest • Most common arrythmias involved: • Ventricular fibrillation • Ventricular tachycardia • Asystole (flatline)

  39. Cardiac Arrest • Treatment: • CPR*** • Oxygen administration • Defibrillation or pacemaker (varies with the dysrhythmia)*** • Antiarhythmic medicines • ***these are most likely to be lifesaving

  40. Blood Vessel Diseases • Arteries • Aneurysms • Arteriosclerosis/Atherosclerosis • Veins • Thrombophlebitis • Varicose Veins

  41. Aneurysms • Local dilation of a blood vessel wall • Usually arteries • May also occur in ventricular walls • Types of aneurym: • Saccular (like a sac off one side of vessel) • Fusiform (symmetric dilation of vessel) • Dissecting (separation of layers of the vessel by leaking blood under pressure)

  42. Aneurysm • Types (according to location) • Abdominal aorta • Severe, tearing abdominal pain, shock • Thoracic aorta • Severe, tearing thoracic pain, shock, MI-like symptoms and EKG possible • Peripheral arteries

  43. Aneurysms • Complications: • Leaking or rupture • Thrombus formation in aneurysm, possible embolism • Treatment: various surgeries

  44. Arteriosclerosis/Atherosclerosis • Arteriosclerosis • Diffuse thickening of walls of small arteries & arterioles with loss of elasticity • Atherosclerosis • Lipid, cholesterol, & other debris formation as plaques on endothelial layers of arteries • Begins in 20’s in some places • Commonly affect cerebral & coronary arteries and aorta • Often asymptomatic for decades

  45. Atherosclerosis • Treatment: • Vasodilators • Lipid-lowering meds and diet changes • Endarterectomy (removal of plaque and part of endothelium) • Most commonly done in internal carotid and large peripheral arteries of leg.

  46. Thrombophlebitis • Vein inflammation with clot formation • Partial or complete vein obstruction • Usually in an extremity • Usually leg • May be superficial or deep • Superficial: conservative treatment • Deep: anticoagulants

  47. Thrombophlebitis • Risk factors: • Trauma, turbulent blood flow (endothelial injury), infection, chemical irritation, prolonged immobility, oral contraceptive or other hormone treatment, smoking

  48. Varicose Veins • Dilated, superficial veins • Most commonly in legs • Etiology: • usually conditions that cause venous stasis • Populations affected: • Females, over age 50, obese

  49. Varicose Veins • Treatment: • Pressure stockings • Variation of exercise • Avoidance of prolonged standing, etc • Sclerosing agents (injection) • Stripping and ligation (surgical)

  50. Anemias • Condition of abnormal RBC or hemoglobin deficiency • Types: • Iron deficiency • Folic acid (folate) deficiency • Pernicious anemia (vitamin B12 deficiency) • Aplastic anemia • Sickle cell anemia

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