cardiovascular diseases introduction to human diseases chapter 12
TRANSCRIPT
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
Myocardium Epicardium & endocardium Coronary arteries
Left mainstem Left anterior descending Left circumflex Right coronary artery
Review of CV Anatomy
Aorta Arteries, arterioles Capillaries Venules, veins Vena cava (inferior and superior)
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
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)
Reye’s Syndrome
Mortality: 20% Down from 50%
Usual cause of death: Cerebral edema
Common neurological impairment in survivors
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
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
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
ARF & RHD
Treatment: Antibiotics for strep, anti-inflammatories,
steroids
Carditis
Pericarditis Myocarditis Endocarditis
Pericarditis
Inflammation of pericardium Acute or chronic Etiologies:
Infection (most common), metastases, ARF, uremia, trauma, idiopathic, associated with autoimmune diseases
Pericarditis
S/S: atypical chest pain, effusion, abnormal pulse & BP, dysrhythmias and EKG changes
Treatment: Pericardiocentesis, possibly surgery Antiinflammatories, antibiotics, etc.
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
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
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
Valvular Disease
Types Improper valve closure
Incompetance, regurgitation, insufficiencyAllows backward flow of blood into previous chamber
Narrow valve openingStenosisBlood is more slowly pumped out of the chamber
prior to the stenotic valve, higher pressure there
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
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
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
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
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
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.
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
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)
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
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
MI
S/S: same as for plaque formation HTN DM Hyperlipidemias Smoking Obesity Sedentarism Past history of CAD or family hx of CAD
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
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
MI
Complications: Ventricular fibrillation: fatal dysrhythmia, most
common cause of sudden death Congestive heart failure Cardiogenic shock Ventricular septal rupture Papillary muscle rupture
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
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
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
Heart Failure
Treatments: Diuretics, control of HTN, oxygen, meds to
enhance contractility (digitalis, etc), beta-blockers, etc.
Cardiac Arrest
Cessation of all cardiac activity Pulseless Apneic No other signs of life
No movement, cough, attempts at breathing, pupillary activity
Cardiac Arrest
Numerous causes Everyone will eventually have a cardiac
arrest Most common arrythmias involved:
Ventricular fibrillation Ventricular tachycardia Asystole (flatline)
Cardiac Arrest
Treatment: CPR*** Oxygen administration Defibrillation or pacemaker (varies with the
dysrhythmia)*** Antiarhythmic medicines ***these are most likely to be lifesaving
Blood Vessel Diseases
Arteries Aneurysms Arteriosclerosis/Atherosclerosis
Veins Thrombophlebitis Varicose Veins
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)
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
Aneurysms
Complications: Leaking or rupture Thrombus formation in aneurysm, possible
embolism
Treatment: various surgeries
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
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.
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
Thrombophlebitis
Risk factors: Trauma, turbulent blood flow (endothelial
injury), infection, chemical irritation, prolonged immobility, oral contraceptive or other hormone treatment, smoking
Varicose Veins
Dilated, superficial veins Most commonly in legs Etiology:
usually conditions that cause venous stasis
Populations affected: Females, over age 50, obese
Varicose Veins
Treatment: Pressure stockings Variation of exercise Avoidance of prolonged standing, etc Sclerosing agents (injection) Stripping and ligation (surgical)
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
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
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
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
Pernicious Anemia
Testing: Schilling test
Treatment: Vitamin B12 injection supplements
Aplastic Anemia
Insufficient or absent RBC, WBC & platelets due to cessation of bone marrow formation
Effects: Anemia Coagulation/bleeding problems immunodeficiency
Aplastic Anemia
Etiology: Idiopathic 50%, rest due to toxins, drugs,
infections, pregnancy, radiation
Treatment: Avoidance of toxin or drug responsible,
transfusions, immunosuppressive therapy
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
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
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
Polycythemia Vera
S/S: elevated hematocrit, headache, splenomegaly, thrombosis of small vessels
Treatment: phlebotomy, myelosuppression
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
Leukemia: Categories
Acute myelogenous leukemia (AML) Immature WBC precursors (myeloblasts), 30-60 YOA
Acute lymphocytic leukemia (ALL) Lymphocyte precursors (lymphoblasts), children
Chronic myelogenous leukemia (CML) Abnormal granulocytes, ages 40-60 YOA
Chronic lymphocytic leukemia (CLL) Immature, ineffective B-cell lymphocytes, geriatric age
Leukemias
Etiology: exposure to carcinogens, radiation, chemotherapy, genetic predisposition (Down’s)
Treatment: varies with leukemia type Chemotherapy, biological therapy, radiation,
bone marrow transplantation
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
Other Lymphatic Diseases
Hodgkin’s Disease Lymphosarcoma (non-Hodgkin’s lymphoma)