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)