1. Alterations of Cardiovascular Function

2. Aneurysm
Local dilation or outpouching of a vessel wall or cardiac chamber
True aneurysms
Involvement of all three layers of the arterial wall
Fusiform saccular and/or circumferential
False aneurysms
Leak between a vascular graft and a natural artery

4. Aneurysm Clinical manifestations Heart Aorta Thoracic Abdomen
Include dysrhythmias, heart failure, and embolism of clots to the brain or other vital organs.
Aorta
Is asymptomatic until it ruptures, then it becomes painful.
Thoracic
Dysphagia and dyspnea are caused by the pressure.
Abdomen
Flow to an extremity is impaired, causing ischemia.

5. Aneurysm
Treatment
Maintenance of low blood volume and low blood pressure to decrease the mechanical forces
Smoking cessation
β-adrenergic blockage
Surgery

6. Aneurysm Complication Aortic dissection
Is a devastating complication that involves the aorta (ascending, arch, or descending); can disrupt the flow through the arterial branches.
Is a surgical emergency.

7. Disorders of the Endocardium
Valvular dysfunction
Stimulates chamber dilation and/or myocardial hypertrophy.
Treatment
Careful fluid management
Valvular repair or valve replacement with a prosthetic valve, followed by long-term anticoagulation therapy and life-long antibiotic prophylaxis before invasive procedures

8. Disorders of the Endocardium
Valvular stenosis
Aortic
Mitral
Valvular regurgitation
Tricuspid
Characteristic heart sounds, cardiac murmurs, and systemic complaints: Assist in determining which valve is abnormal
Mitral valve prolapse syndrome

10. Disorders of the Endocardium
Aortic stenosis
Orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta
Clinical manifestations: Angina, syncope, and heart failure
Treatment
Most require valve repair or replacement with a prosthetic valve, followed by long-term anticoagulation therapy
Transcatheter aortic valve implantation

11. Disorders of the Endocardium
Aortic stenosis

12. Disorders of the Endocardium
Mitral stenosis
Impairment of blood flow from the left atrium to the left ventricle
Most common cause: Acute rheumatic fever
Clinical manifestation: Opening snap
Treatment: Surgical repair; may require valve replacement

14. Disorders of the Endocardium
Aortic regurgitation
Inability of the aortic valve leaflets to close properly during diastole
Clinical manifestations: Widened pulse pressure as a result of increased stroke volume and diastolic backflow
Treatment: Valve replacement may be delayed for many years with the use of vasodilators and inotropic agents

15. Disorders of the Endocardium
Mitral regurgitation
Most common causes: Mitral valve prolapse and rheumatic heart disease
Permits backflow of blood from the left ventricle into the left atrium
Treatment: Surgical repair or valve replacement

16. Disorders of the Endocardium
Tricuspid regurgitation
Leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure
Mitral valve prolapse syndrome
Anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole
Clinical manifestations: Asymptomatic
Treatment: None needed or beta blockers

17. Acute Rheumatic Fever and Rheumatic Heart Disease
Is a diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic streptococci.
Is a febrile illness.
Inflammation of the joints, skin, nervous system, and heart
If left untreated, rheumatic fever causes rheumatic heart disease. (It may have a genetic component.)

18. Acute Rheumatic Fever and Rheumatic Heart Disease
Abnormal immune response to the M proteins that cross react with normal tissues
Fibrinoid necrotic deposits: Aschoff bodies
Clinical manifestations
Carditis: Murmur
Polyarthritis: Large joints mainly affected
Chorea: Sudden, irregular, involuntary movements
Erythema marginatum: Truncal rash
Treatment: 10-day regimen of antibiotics, NSAIDs, may need antibiotics for 5 years

20. Infective Endocarditis
Inflammation of the endocardium from infectious agents
Most common: Bacteria, especially streptococci, staphylococci, and enterococci
Pathogenesis
Endocardial damage
Bloodborne microorganism adherence
Formation of infective endocardial vegetations

22. Infective Endocarditis
Clinical manifestations
Fever
New or changed cardiac murmur
Petechial lesions of the skin, conjunctiva, and oral mucosa
Osler nodes: Painful erythematous nodules on the pads of the fingers and toes
Janeway lesions: Nonpainful hemorrhagic lesions on the palms and soles

23. Infective Endocarditis
Treatment
Was once a lethal disease, but morbidity and mortality have significantly diminished with antibiotics and improved diagnostic techniques.
Antimicrobial therapy is generally administered for 4 to 6 weeks.
Begin with intravenous and end with oral administration.
May use a combination.
Other drugs are administered to treat left heart failure, secondary to valvular dysfunction.
Surgery to repair or replace the valve, as prescribed.

25. Cardiomyopathies Causes: Remodeling due to Neurohormonal changes
Ischemia
Hypertension
Infectious Diseases
Exposure to toxins
Connective Tissue Diseases
Proliferative Disorders
Nutritional Deficiencies

27. Dilated Cardiomyopathy
Causes: MI DM
HTN
Toxins (lead, mercury)
Alcoholism
Drug Use (cocaine)
Infections
Congenital Heart Defects
Characteristics:
Left ventricular thinning (dilation) and weakening
Impaired systolic function
Systolic Heart Failure

28. Dilated Cardiomyopathy
Clinical Manifestations:
Dyspnea
Fatigue
Pedal Edema
Jugular Venous Distension
Pulmonary Congestion
Management:
Ace Inhibitors
Beta Blockers
Diuretics
Positive Inotrope
Blood Thinners
Pacemakers
ICD
Heart Transplant

29. Hypertrophic Cardiomyopathy
Categories:
1. Hypertrophic Obstructive
2. Hypertensive/Valvular Hypertrophic
Causes:
Inherited
Hypertension
Valvular Stenosis
Aortic
Characteristics:
Thickening of the septal wall
Thickening of the left ventricle
Impaired ventricular ejection
Diastolic dysfunction leading to systolic dysfunction

30. Hypertrophic Cardiomyopathy
Clinical Manifestations:
Asymptomatic
Angina
Dyspnea
Palpitations
Atrial and Ventricular Dysrhythmias
Sudden Death
Management:
Beta Blockers
Calcium Channel Blockers
Antidysrhythmics
Blood Thinners
Septal Myectomy/Ablation
ICD

31. Restrictive Cardiomyopathy
Causes:
Idiopathic scar tissue formation
Amyloidosis
Sarcoidosis
Hemochromatosis
Radiation/Chemotherapy Exposure
Characteristics:
Rigid Ventricles
Abnormal Diastolic Function
Normal Systolic Function

32. Restrictive Cardiomyopathy
Clinical Manifestations:
Exercise intolerance
Dyspnea on exertion
Fatigue
Anorexia
Weight gain
Pericardial knock
Edema
Management:
Treatment of underlying condition
Heart transplant
Heart failure meds may be necessary