cardiovascular diseases introduction to human diseases chapter 12

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Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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Page 1: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Cardiovascular Diseases

Introduction to Human Diseases

Chapter 12

Page 2: 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

Page 3: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Review of CV Anatomy

Myocardium Epicardium & endocardium Coronary arteries

Left mainstem Left anterior descending Left circumflex Right coronary artery

Page 4: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Review of CV Anatomy

Aorta Arteries, arterioles Capillaries Venules, veins Vena cava (inferior and superior)

Page 5: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 6: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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)

Page 7: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Reye’s Syndrome

Mortality: 20% Down from 50%

Usual cause of death: Cerebral edema

Common neurological impairment in survivors

Page 8: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 9: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 10: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 11: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

ARF & RHD

Treatment: Antibiotics for strep, anti-inflammatories,

steroids

Page 12: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Carditis

Pericarditis Myocarditis Endocarditis

Page 13: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Pericarditis

Inflammation of pericardium Acute or chronic Etiologies:

Infection (most common), metastases, ARF, uremia, trauma, idiopathic, associated with autoimmune diseases

Page 14: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Pericarditis

S/S: atypical chest pain, effusion, abnormal pulse & BP, dysrhythmias and EKG changes

Treatment: Pericardiocentesis, possibly surgery Antiinflammatories, antibiotics, etc.

Page 15: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 16: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 17: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 18: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 19: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 20: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 21: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 22: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 23: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 24: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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.

Page 25: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 26: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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)

Page 27: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 28: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 29: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

MI

S/S: same as for plaque formation HTN DM Hyperlipidemias Smoking Obesity Sedentarism Past history of CAD or family hx of CAD

Page 30: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 31: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 32: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

MI

Complications: Ventricular fibrillation: fatal dysrhythmia, most

common cause of sudden death Congestive heart failure Cardiogenic shock Ventricular septal rupture Papillary muscle rupture

Page 33: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 34: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 35: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 36: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Heart Failure

Treatments: Diuretics, control of HTN, oxygen, meds to

enhance contractility (digitalis, etc), beta-blockers, etc.

Page 37: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Cardiac Arrest

Cessation of all cardiac activity Pulseless Apneic No other signs of life

No movement, cough, attempts at breathing, pupillary activity

Page 38: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Cardiac Arrest

Numerous causes Everyone will eventually have a cardiac

arrest Most common arrythmias involved:

Ventricular fibrillation Ventricular tachycardia Asystole (flatline)

Page 39: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Cardiac Arrest

Treatment: CPR*** Oxygen administration Defibrillation or pacemaker (varies with the

dysrhythmia)*** Antiarhythmic medicines ***these are most likely to be lifesaving

Page 40: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Blood Vessel Diseases

Arteries Aneurysms Arteriosclerosis/Atherosclerosis

Veins Thrombophlebitis Varicose Veins

Page 41: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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)

Page 42: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 43: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Aneurysms

Complications: Leaking or rupture Thrombus formation in aneurysm, possible

embolism

Treatment: various surgeries

Page 44: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 45: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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.

Page 46: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 47: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Thrombophlebitis

Risk factors: Trauma, turbulent blood flow (endothelial

injury), infection, chemical irritation, prolonged immobility, oral contraceptive or other hormone treatment, smoking

Page 48: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Varicose Veins

Dilated, superficial veins Most commonly in legs Etiology:

usually conditions that cause venous stasis

Populations affected: Females, over age 50, obese

Page 49: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Varicose Veins

Treatment: Pressure stockings Variation of exercise Avoidance of prolonged standing, etc Sclerosing agents (injection) Stripping and ligation (surgical)

Page 50: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 51: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 52: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 53: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 54: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Pernicious Anemia

Testing: Schilling test

Treatment: Vitamin B12 injection supplements

Page 55: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Aplastic Anemia

Insufficient or absent RBC, WBC & platelets due to cessation of bone marrow formation

Effects: Anemia Coagulation/bleeding problems immunodeficiency

Page 56: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Aplastic Anemia

Etiology: Idiopathic 50%, rest due to toxins, drugs,

infections, pregnancy, radiation

Treatment: Avoidance of toxin or drug responsible,

transfusions, immunosuppressive therapy

Page 57: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 58: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 59: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 60: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Polycythemia Vera

S/S: elevated hematocrit, headache, splenomegaly, thrombosis of small vessels

Treatment: phlebotomy, myelosuppression

Page 61: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 62: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 63: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Leukemias

Etiology: exposure to carcinogens, radiation, chemotherapy, genetic predisposition (Down’s)

Treatment: varies with leukemia type Chemotherapy, biological therapy, radiation,

bone marrow transplantation

Page 64: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

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

Page 65: Cardiovascular Diseases Introduction to Human Diseases Chapter 12

Other Lymphatic Diseases

Hodgkin’s Disease Lymphosarcoma (non-Hodgkin’s lymphoma)