Coronary Vascular Disorder

Coronary Artery DiseaseCAD

also called coronary heart disease, or simply, heart disease,

Heart disease is a result of plaque buildup in your arteries, which blocks blood flow and heightens the risk for heart attack and stroke.

Coronary Atherosclerosis

Most common cause of Cardiovascular disease

An abnormal accumulation of lipid, or fatty, substances and fibrous tissue in the lining of arterial blood vessel walls. These substances create blockages and narrow the coronary vessels in a way that reduces blood flow to the myocardium.

Coronary Atherosclerosis

Pathophysiology Atherosclerosis begins as monocytes and lipids enter the

intima of an injured vessel

Smooth muscles cells proliferate within the vessel wall contributing to the development of fatty accumulations and atheroma

As the plaque enlarges, the vessels narrows and the blood flow decreases .

The plaque may rupture and a thrombus might form obstructing the blood flow, leading to sudden cardiac death or an acute myocardial infarction (MI), which is the death of a portion of the heart muscle

Clinical Manifestation

Angina PectorisShortness of breath (SOB)Dyspnea Nausea Weakness

Risk factors Elevated blood lipid levels Smoking cigarettes Hypertension Diabetes mellitus Obesity Family history of premature cardiovascular

disease

Non-modifiable risk factors

o Family history of Coronary heart disease

o Increasing ageoGender oRace

Modifiable risk factors Hyperlipidemia Cigarette smoking Hypertension Diabetes mellitus Lack of estrogen in women Obesity Physical inactivity

Prevention

Controlling Cholesterol AbnormalitiesPromoting cessation of cigarette useManaging hypertensionControlling Diabetes mellitus Behavior patterns

Angina Pectoris Is a clinical syndrome usually

characterized by episodes or paroxysm of pain or pressure in the anterior chest.

The cause is insufficient coronary blood flow, resulting in a decreased oxygen in response to physical exertion or emotional stress

Angina Pectoris

Types of Angina Stable angina- predictable an consistent pain that occurs on

exertion and relieved by rest.

Unstable angina also called ( also called pre-infarction angina or crescendo angina ) symptoms occur more frequently and last longer than stable angina.

Intractable or refractory angina – severe incapacitating chest pain

Variant angina ( also called Prinzmetal’s angina ) – pain at rest with reversible ST-segment elevation; thought to be caused by Coronary Artery vasospasm.

Silent ischemia: objective evidence of ischemia ( such as ECG changes with a stress test ), but patient reports no symptoms

FACTORSPhysical exertion Exposure to coldEating a heavy mealStress or any emotion-

provoking situation

Clinical Manifestation Choking or heavy sensation in the upper chest.

Feeling of impending death.

Weakness

Nausea and vomiting

Numbness

Shortness of breath

Pallor

Diaphoresis

Dizziness or lightheadedness

Pharmacologic therapy

Nitroglycerin Beta-adrenergic blocking agentsCalcium channel blocking agents Antiplatelet and anticoagulant

medicationsOxygen administration

Diagnostic findingsElectrocardiogram (ECG)CBCCoronary artery angiography

Myocardial Infarction

An area of myocardium is permanently destroyed.

Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus.

Clinical Manifestation

Chest painShortness of breathIndigestionNauseaAnxiety Cool, pale and moist skin

Diagnostic findingsElectrocardiogram Laboratory testsEchocardiogram

Pharmacology therapy

ThrombolyticsAnalgesic Angiotensin-converting enzyme (ACE)

Invasive coronary artery procedures

Percutaneous coronary interventions (PCI)- to treat angina and CAD include PTCA, intracoronary stent implantation, atherectomy and brachytherapy.

Percutaneous transluminal coronary angioplasty (PTCA) – an invasive interventional procedure, a balloon tipped catheter is used to open blocked coronary vessels and resolve ischemia.

Coronary artery stent –stent is positioned over the angioplasty balloon. When the balloon is inflated, the mesh expands and presses against the vessel wall, holding the artery open.

Invasive coronary artery procedures

Atherectomy –an invasive procedure that involves the removal of the atheroma, or plaque, from a coronary artery by cutting, shaving or grinding.

Brachytherapy- reduces the recurrence of obstruction preventing vessel restenosis by inhibiting smooth muscle cell proliferation.

Structural, infectious and inflammatory Cardiac disorder

Valvular Disorders Mitral valve prolapse Mitral regurgitation Mitral stenosis Aortic regurgitation Aortic stenosis

Mitral valve prolapse Formerly known as mitral prolapse

syndrome Is a deformity that usually produces no

symptoms Is usually an inherited connective tissue

disorder resulting in enlargement of one or both of the mitral valve leaflets.

Mitral valve prolapse

Clinical manifestations

Chest pain Palpitations Anxiety Shortness of breath Syncope Fatigue Lightheadedness Dizziness

PathophysiologyA portion of one and both mitral valve

leaflets balloons back into the atrium during systole. The ballooning stretches the leaflet to the point that the valve does not remain closed during systole. Blood then regurgitates from the left ventricle back into the left atrium.

Mitral regurgitation Involves blood flowing back from

the left ventricle into the left atrium during systole. The margin of the mitral valve cannot close because of the thickening and fibrosis of the leaflets and chordae tendineae, resulting in their contraction

Mitral regurgitation

Clinical manifestation

DyspneaFatigueWeakness PalpitationShortness of breath

Pathophysiology Result from problems with one or

more of the leaflets, the chordae tendineae, the annulus or papillary muscles. With each beat of the left ventricle , some of the blood is forced back into the left atrium.

Mitral stenosisIs an obstruction of the blood

flowing from the left atrium into the left ventricle. It is most often caused by rheumatic endocarditis which progressively thickens the mitral valve leaflets and chordae tendineae.

Mitral stenosis

Clinical manifestation

DyspneaWheezePalpitation OrthopneaFatigue

Pathophysiology The opening narrows to the width of a

pencil. The left atrium has great difficulty moving blood into the ventricle because of the increased resistance of narrowed orifice. The left atrium dilates and hypertrophies because of the increased blood volume it holds.

Aortic Regurgitation Is the flow of blood back into the left

ventricle from the aorta during diastole.

It may be caused by inflammatory lesions that deform the leaflets of the aortic valve

Also may result from infective or rheumatic endocarditis , congenital abnormalities, diseases such as syphilis.

Aortic Regurgitation

Clinical manifestation

PalpitationFatigueOrthpnea Dyspnea

Aortic stenosis Is narrowing of the orifice between the

left ventricle and the aorta Stenosis is often a result of

degenerative calcifications. Calcification begin on the flexion lines of the leaflets at the base of the ring of the valve and progressively extend outward over the cusps.

Aortic stenosis

Clinical manifestation

Dyspnea OrthopneaDizziness Syncope Angina pectoris

Pathophysiology Progressively narrowing of the

valve orifice occurs. Usually over several years to several decades. The left ventricle overcomes the obstruction to circulation by contracting more slowly but the greater energy than normal.

Valve repair and Replacement procedures

Valvuloplasty

The repair, rather than replacement, of a cardiac valve.

Repair may be made to the commissures between leaflets

Annuloplasty

• Is the repair of the valve annulus

Cardiomyopathy Is a heart muscle disease associated with cardiac dysfunction.

It may lead to severe heart failure, lethal dysrhythmias and death.

CardiomyopathyHypertrophic cardiomyopathy Restrictive cardiomyopathy Arrhythmia right ventricular cardiomyopathy

Unclassified cardiomyopathy

Clinical manifestation

Dyspnea OrthopneaPeripheral edema NauseaPalpitation Dizziness Syncope

Infectious diseases of heart

Rheumatic endocarditis Infective endocarditisMyocarditis Pericarditis

Complications from heart disease

Cardiac hemodynamics

The basic function of the heart is to pump blood. The heart’s ability to pump is measured by cardiac output (CO), the amount of blood pumped per minute.

HR x SV = CO Preload- is the amount of blood presented to the

ventricle just before systole. Afterload – refer to the amount of resistance to the

ejection of blood from the ventricle. To eject blood.

Heart failure Is the ability of the heart to pump sufficient blood to

meet the needs of the tissues for the oxygen and nutrients

Two types of heart failureSystolic heart failure Diastolic heart failure

Clinical manifestation

DyspneaOrthopnea Adventitious breath Palpitation

Right sided heart failure

Congestion in the peripheral tissues and the viscera predominates.

Occurs because the right side of the heart cannot eject blood and cannot accommodate all the blood that normally returns to it from the venous circulation.

Clinical manifestation

Dependent edemaHepatomegalyAscites AnorexiaNausea Weakness

Pharmacology therapy

Angiotensin-converting enzyme inhibitors

Angiotensin II receptor blockersHydralazine and isosorbide

dinitrateBeta-blockersDiuretics

Pharmacology therapy

Calcium channel blockers

DigitalisOxygen

Other complications

Cardiogenic shockThromboembolismCardiac arrest