Cardiovascular System Diseases and Disorders Chapter 8 Cardiovascular System Diseases and Disorders 1

Anatomy and Physiology Cardiovascular system Heart, arteries, and veins with blood Heart Size of man’s fist Located slightly left of the middle of the chest Composed of cardiac muscle, 4 chambers, 4 valves 2

The Heart 3

Anatomy and Physiology Heart: Wall of heart has three layers Epicardium Myocardium Endocardium 4

Common Signs and Symptoms Chest pain Shortness of breath Tachycardia Cardiac palpitations 5

Diagnostic Tests Noninvasive procedures: Auscultation Doppler Arterial blood pressure Electrocardiogram Echocardiography PET scan 6

http://www.bcbsks.com/customerservice/providers/MedicalPolicies/policies/policies/PositronEmissionTomographyScanning_CardiacApplications_2013-10-30.pdf DESCRIPTION Cardiac positron emission tomography (PET) scanning is used in 2 key clinical situations: 1) myocardial perfusion scanning as a technique of identifying perfusion defects, which in turn reflect coronary artery disease (CAD); and 2) assessment of myocardial viability in patients with left ventricular (LV) dysfunction as a technique to determine candidacy for a revascularization procedure. A third potential clinical use related to CAD is being evaluated, use of cardiac PET in the measurement of myocardial blood flow and blood flow reserve. Cardiac PET is also being studied in the evaluation of coronary artery inflammation.

Diagnostic Tests Cardiac catheterization X-rays Invasive procedure to determine oxygen content and blood pressure X-rays To determine normal function of heart and vessels 8

The following is a video of a cardiac catherization http://www.youtube.com/watch?v=cUIbLRO2pnU

Diagnostic Tests Common X-rays: Blood tests Angiocardiography Angiography Venogram Blood tests Enzymes Creatine phosphokinase (CPK) muscle damage ( CKMB) specific for heart muscle damage Troponin 1 Lactate dehydrogenase (LDH) 10

Diseases of the Cardiovascular System Cardiovascular disease CVD (coronary artery disease) Leading cause of death in the United States High blood pressure is common cause(= to or > than 140/90) 11

Diseases of Arteries Hypertension Indicator of development of cerebrovascular, cardiovascular, and kidney disease Chronic disease Leading cause of stroke and heart failure 12

Diseases of Arteries Hypertension Normal blood pressure 119/79 or less Top number (systolic) Measures highest pressure in artery when ventricles contract Bottom number (diastolic) Measures pressure in artery when ventricles relax High blood pressure Equal to or Greater than 140/90 13

Diseases of Arteries Hypertension Primary Risk factors: Idiopathic with gradual onset Also known as essential hypertension Risk factors: Heredity Diet Age Obesity Smoking Stress 14

Diseases of Arteries Hypertension Treatment: Antihypertensive medications—second or third Lifestyle changes—first Low-salt diet—also first Stress-reducing exercise—also first Smoking cessation—also first Diuretics--second 15

Diseases of Arteries Arteriosclerosis and atherosclerosis Loss of elasticity and thickening of artery wall Also known as hardening of arteries Plaque Deposits of fatty or lipid material in wall of artery 16

Diseases of Arteries Atherosclerosis Major areas affected: Coronary arteries Cerebral arteries Aorta Peripheral arteries 17

Diseases of Arteries Atherosclerosis Risk factors: Noncontrollable factors Heredity Age Sex Diabetes 18

Diseases of Arteries Atherosclerosis Risk factors: Controllable factors Diet Sedentary lifestyle Cigarette smoking Stress Hypertension—even if medication is necessary 19

Diseases of Arteries Atherosclerosis Diagnosis by blood pressure, arteriograms, X-rays, and Doppler Symptomatic treatment: Bypass surgery of occluded arteries and plaque removal 20

Diseases of Arteries Peripheral vascular disease (PVD) Caused by atherosclerotic plaque in arteries supplying blood to legs Intermittent claudication Muscle cramps relieved with rest and increased with activity 21

Diseases of Arteries Peripheral vascular disease (PVD) Treatment: Endarterectomy If necrosis occurs, amputation or resection may be necessary 22

Physicians use endarterectomy to treat many arteries; however, the most common use is for treating blockages in the carotid arteries. Your carotid arteries are in your neck and deliver blood to your brain. Your physician may recommend endarterectomy to treat one or more of the following: Carotid artery disease Peripheral arterial disease, such as leg or arm artery disease Renal (kidney) artery disease Aortic arch conditions Aortoiliac occlusive disease Visceral (intestines, spleen, and liver) artery disease

Diseases of Arteries Aneurysm Weakening in wall of artery leading to bulge or rupture Usually asymptomatic and discovered accidentally Aorta Most common location Treatment: Repairing aneurysm before rupture through resection and grafting 25

Types of Aneurysms 26

Diseases of Arteries Coronary artery disease Narrowing of arteries that supply blood to myocardium Single leading cause of death in United States Commonly due to atherosclerosis 29

Diseases of Arteries Coronary artery disease Progressive narrowing of vessels may lead to ischemia of heart muscle and symptoms Scar tissue replaces muscle Occlusion may progress slowly or suddenly as result of thrombus or embolus 30

Diseases of Arteries Coronary artery disease Myocardial infarction Death of heart muscle caused by ischemia Diagnosis by history, electrocardiogram (ECG), and angiograms Treatment: Aimed at increasing blood flow or decreasing oxygen needs 32

Grossly, a remote myocardial infarction is evidenced by white collagenous scar.

Diseases of Arteries Coronary artery disease Treatment: Angina treated with vasodilators—most common is Nitroglycerine Angioplasty—ballooning of occlusion Coronary artery bypass graft (CABG) Reduction of atherosclerotic risk factors Diet Exercise Smoking 34

CABG 35

saphenous vein is harvested from the leg

Diseases of the Heart Angina pectoris Chest pain Lack of oxygen to heart--ischemia Sign of impending myocardial infarction Treatment: Decrease workload of heart Use nitroglycerin 37

Diseases of the Heart Myocardial infarction Heart attack Occurs when heart does not get enough oxygen--ischemia Symptoms: Severe chest pain with diaphoresis and nausea Referred pain to neck, arm, and jaw with discomfort similar to bad or unrelieved indigestion 38

Diseases of the Heart Myocardial infarction Treatment: Give immediate attention to prevent shock Relieve respiratory distress Decrease workload If cardiac arrest, cardiopulmonary resuscitation (CPR) must be performed 39

Diseases of the Heart Myocardial infarction Treatment: Oxygen and pain medication—nitroglycerine for chest pain and opening up arteries—morphine for pain Medications to treat arrhythmias—beta blockers, calcium channel blockers Clot-busting medications---to open vessels To keep blood from clotting--aspirin-----heparin---plavix Education on prevention by lifestyle changes Smoking cessation Diet Exercise 40

Diseases of the Heart Hypertensive heart disease Result of long-term hypertension Causes: Disease or disorder causing chronic elevation in blood pressure Treatment: Treat cause of hypertension Can only be controlled No cure 41

Diseases of the Heart Rheumatic heart disease Autoimmune disorder caused by streptococcal throat infection All layers of heart and valves can be affected Treatment: Prevention/treatment of streptococcal infections Rest during acute stage Valve replacement to correct deformity 42

Diseases of the Heart Congestive heart failure (CHF) Heart fails to pump adequate blood supply Develops slowly and increases workload of heart Symptoms: Gradual increase in dyspnea Tachycardia Tachypnea 43

Diseases of the Heart CHF Symptoms: Neck vein distention—right side Edema in ankles and lower legs—right side Right-sided leads to congestion of liver and spleen Left-sided leads to congestion of lungs 44

Diseases of the Heart CHF Diagnosis by history and physical, chest X-ray, and ECG Treatment: Decrease workload Diuretics Salt and fluid restrictions Medications to strengthen and slow heart E.g., digitalis 45

Diseases of the Heart Cardiomyopathy Disease of heart muscle Characterized by dilated, enlarged, thin, flabby heart muscle No cure Leads to CHF, myocardial infarction, and death 46

Cardiomyopathy Opened left ventricle of heart shows a thickened, dilated left ventricle with subendocardial fibrosis manifested as increased whiteness of endocardium.

normal heart (left) and a patient with hypertrophic cardiomyopathy (right). There is a marked increase in the thickness of the walls of the heart in the patient with hypertrophic cardiomyopathy.

Diseases of the Heart Carditis Inflammation of heart E.g., pericarditis, myocarditis, endocarditis Often secondary to respiratory, urinary tract, or skin infection Treatment: Rest Antibiotics Analgesics Antipyretics 49

Diseases of the Heart Valvular heart disease Malfunction of heart valves Murmurs or abnormal heart sound Causes: Congenital abnormalities or malformations Rheumatic fever Endocarditis 50

Surgical Repair Of Mitral Valve Stenosis Due to Rheumatic Fever

Diseases of the Heart Arrhythmias Abnormal heart rhythm Sinus rhythm is normal heart rhythm 60 to 100 beats per minute Flutter Unusually fast heart rate Fibrillation Wild and uncoordinated Heart block Interruption in conduction system 52

From top to bottom: normal sinus rhythm, atrial flutter, atrial fibrillation, complete heart block

Diseases of the Heart Arrhythmias ---atrial fibrillation, atrial flutter, atrial tack, and pacs -- Junctional—escape, accelerated junctional, junctional tack and pjcs Blocks are Divided into first-, second degree (mobitz 1 or Mobitz 2), or third-degree(complete heart block) ---mature or early contractions may affect atria (PACs) or ventricles (PVCs) ---Ventricular Rhythms—PVCs, ventricular tack, torsodes, idioventricular, ventricular fibrillation Treatment: Ranging from unnecessary if asymptomatic to meds to defibrillation 54

From top to bottom: PVC, Ventricular tack, ventricular fibrillation, accelerated idioventricular

Diseases of the Veins Phlebitis Inflammation of superficial veins Symptoms: Pain Swelling Red, cord-like hardening along vein toward heart 56

Diseases of the Veins Phlebitis Treatment: Analgesics Warm compresses Elevation of area above heart level Elastic stockings Exercise 58

Diseases of the Veins Thrombophlebitis Clotting in vessels of legs, thighs, and pelvis Asymptomatic until embolization occurs Risk factors: Immobility Dehydration Varicose veins Leg/pelvic surgery, obesity, pregnancy 59

Phlebitis and Thrombus 60

Diseases of the Veins Deep vein thrombosis (DVT) Treatment: Reduce clot Prevent embolization Use anticoagulants 61

Diseases of the Veins Varicose veins Dilated, tortuous, and elongated veins in legs Causes: Prolonged sitting or standing Pregnancy Obesity 62

Diseases of the Veins Varicose veins Symptoms: Treatment: Leg fatigue and cramps Thickening veins Edema Fluid Treatment: Elevate legs Walk Use support or elastic hose Strip vein 63

http://www.veinexperts.org/bvl-blog-archive/content.asp?id=3116

What is ligation and stripping for venous disease? Ligation means the surgical tying of veins through a small incision in the skin to prevent pooling of blood. Ligation may be used in conjunction with vein stripping, or removal of the vein. In many instances, the vein is removed using a minimally invasive surgical procedure called venous ablation.

Trauma Hemorrhage Abnormal loss of blood May be acute or chronic Exsanguination Loss of circulating blood Internal bleeding can lead to anemia or shock due to blood loss 67

Trauma Hemorrhage Low-pressure vessels lead to petechiae or ecchymosis of purpura High-pressure vessels lead to squirting of bright red blood 68

Trauma Shock Extremely low blood pressure that leads to decreased tissue perfusion Types: Cardiogenic Septic Hypovolemic Neurogenic Anaphylactic 69

Trauma Shock Symptoms: Facial pallor Cool and clammy skin Cyanosis Tachycardia Tachypnea Altered mental status Syncope Unconsciousness Oliguria or anuria hypotension 70

Trauma Shock Treatment: Rest in supine position Move to warm, quiet environment Elevate feet and legs above heart 71

Rare Diseases Malignant hypertension Cor pulmonale Raynaud’s disease Buerger’s disease Polyarteritis nodosa 72

DOWNLOAD ALL SIZES USE THIS FILE ON THE WEB USE THIS FILE ON A WIKI EMAIL A LINK TO THIS FILE INFORMATION ABOUT REUSING Cor pulmonale is a condition that most commonly arises out of complications from pulmonary hypertension (high blood pressure). It is also known as right-sided heart failure because it occurs within the right ventricle of your heart. Cor pulmonale causes the right ventricle to enlarge and pump blood less effectively than it should. Subsequently, the ventricle is then pushed to its limit and ultimately fails

In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in the hands and feet and may eventually affect larger areas of your arms and legs.

Polyarteritis nodosa is a serious blood vessel disease. The small and medium-sized arteries become swollen and damaged. Symptoms include: Abdominal pain Decreased appetite Fatigue Fever Joint aches Muscle aches Unintentional weight loss Weakness

Effects of Aging Decreased contractility of heart muscle Decreased elasticity of vessels Thickening of valves Becoming sclerotic 76