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Cardiovascular Diseases

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Presentation on theme: "Cardiovascular Diseases"— Presentation transcript:

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: YOA, average = 7 YOA Peak incidence : 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% Usual cause of death:
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: 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 Narrow valve opening
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: S/S: may be asymptomatic
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 Veins Aneurysms
Arteriosclerosis/Atherosclerosis Veins Thrombophlebitis Varicose Veins

41 Aneurysms Local dilation of a blood vessel wall Types of aneurym:
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 Thoracic aorta
Severe, tearing abdominal pain, shock Thoracic aorta Severe, tearing thoracic pain, shock, MI-like symptoms and EKG possible Peripheral arteries

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

44 Arteriosclerosis/Atherosclerosis
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

51 Iron Deficiency Anemia
Most common type of anemia RBC are smaller and paler than normal Most common in females (pre-menopausal and adolescents) S/S: pallor, weakness, fatigue Treatment: iron supplements

52 Folic Acid Deficiency Anemia
Deficiency of folic acid (a B vitamin) RBC are large (megaloblasts) Cause: dietary deficiency Most common in pregnant females, children, & adolescents Treatment: folic acid supplements

53 Pernicious Anemia Vitamin B12 deficiency
Megaloblasts also in this type of anemia Common in geriatric & northern European descent populations Due to deficiency of intrinsic factor (IF), a protein made in the stomach mucosa More likely to be autoimmune or inherited

54 Pernicious Anemia Testing: Treatment: Schilling test
Vitamin B12 injection supplements

55 Aplastic Anemia Insufficient or absent RBC, WBC & platelets due to cessation of bone marrow formation Effects: Anemia Coagulation/bleeding problems immunodeficiency

56 Aplastic Anemia Etiology: Treatment:
Idiopathic 50%, rest due to toxins, drugs, infections, pregnancy, radiation Treatment: Avoidance of toxin or drug responsible, transfusions, immunosuppressive therapy

57 Sickle Cell Anemia Hereditary anemia with abnromal shaped RBC that clump together, obstruction capillaries Genetic mutation rendering individual more resistance to malaria Common in African descent, also Mediterranean and Middle Eastern descent

58 SSA Etiology: inherited mutation for hemoblobin S.
Sickle cell trait: heterozygous for HbS Sickle cell disease: homozygous for HbS S/S: episodic severe pain (vasocclusive crises), jaundice, fatigue, dyspnea, pallor Crises may be caused by stress (infections, hypoxia, etc.) Treatment: pain relief, hydration

59 Polycythemia Vera Increased # RBC, WBC, & platelets and increased amount of hemoglobin More common in middle-aged males Etiology: unknown, may be related to altitude or other chronic hypoxic conditions Blood is thicker, more viscous, more prone to clot and move sluggishly

60 Polycythemia Vera S/S: elevated hematocrit, headache, splenomegaly, thrombosis of small vessels Treatment: phlebotomy, myelosuppression

61 Leukemias Malignancy of the blood & blood-forming organs (bone marrow) characterized by numerous abnormal WBC’s Types of leukemia are categorized by their dominant cell type

62 Leukemia: Categories Acute myelogenous leukemia (AML)
Immature WBC precursors (myeloblasts), YOA Acute lymphocytic leukemia (ALL) Lymphocyte precursors (lymphoblasts), children Chronic myelogenous leukemia (CML) Abnormal granulocytes, ages YOA Chronic lymphocytic leukemia (CLL) Immature, ineffective B-cell lymphocytes, geriatric age

63 Leukemias Etiology: exposure to carcinogens, radiation, chemotherapy, genetic predisposition (Down’s) Treatment: varies with leukemia type Chemotherapy, biological therapy, radiation, bone marrow transplantation

64 Lymphatic Diseases Lymphedema
Abnormal collection of lymph, often in extremities Etiology: mechanical or inflammatory obstruction of lymph vessels or nodes S/S: extremity swelling, thickened & fibrotic skin Treatment: elevation, pressure stockings, surgery, diuretics

65 Other Lymphatic Diseases
Hodgkin’s Disease Lymphosarcoma (non-Hodgkin’s lymphoma)

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