9 Heart & Blood Vessels – The Rest Flashcards by Michele Herbert

Introduction

Heart Disease
(Cardiac Disease)

		Blood Vessel Disease 
		(Vascular Disease)

		Disease present from birth 
		(Congenital Cardiovascular 
					Disease)

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Introduction

Cardiac Disease   
Ischaemia and MI (previously covered)
Cardiac Failure
Valvular Heart Disease
Pericarditis and Myocarditis 
Unusual Cardiac Diseases

Vascular Disease 
Atherosclerosis (previously covered)
Aneurysms
Hypertension
Diabetic Vascular Disease   
Vein Diseases

Congenital Cardiovascular disease

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Cardiac Failure

What is the normal function of the heart?

What is a syndrome?

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Definition

Heart unable to pump blood at rate required for normal functioning

What happens when the heart does not pump as effectively as it should?

Oedema – pulmonary and peripheral
Tiredness

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Many Causes

Ischaemic Heart Disease
Hypertension
Valvular Heart Disease
Arrhythmias
Congenital Heart Disease

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Cardiac Failure

Initially the heart ‘Compensates’

Leads to cardiac hypertrophy and/or dilatation, and eventual inability to maintain normal

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Cardiac Failure

Symptoms/Signs:
Shortness of breath (SOB) 
Fatigue 
Fluid in lungs (Pulmonary Oedema)
All-over, excessive, fluid-filled veins (Systemic Venous Congestion &amp; Oedema)

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Classification

Acute vs Chronic

Left vs Right Vs both sided (congestive)

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Treatment

Treat the underlying cause

There are a range of medicines used to help control heart failure

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Valvular Heart Disease

What does a valve do?

A valve regulates flow in one direction only

Think how this works in the heart

4 valves/sites

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Valvular Heart Disease - Mechanisms

Stenosis - Failure to open completely, impeding forward flow

Incompetence/Regurgitation - Failure to close, allowing reverse flow

Vegetations – abnormal tissue growth on valve (fibrin, platelets & bacteria)

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Valvular Heart Disease - Mechanisms

and more

Most common disease - stenoses of the aortic and mitral valves
Account for 2/3rds of all valve disease
Valvular stenosis mainly due to primary valve cusp abnormality, a chronic process
Valvular regurgitation may result from disease of cusps but also damage to supporting structures (tendinous cords, papillary muscles)
Vegetations can result from Infective Endocarditis & Rheumatic Fever

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Valvular Heart Disease – Underlying Causes

Infection – Endocarditis/Rheumatic disease 
Calcific aortic valve disease 
Age-related degeneration
Carcinoid Syndrome
Fibrosis &amp; muscle rupture after MI
Heart failure
Hypertension
Congenital 
Prosthetic Heart Valves
Connective Tissue Disorders 
IV Drug use

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Valvular Heart Disease

Symptoms/Consequences of Valvular disease:
Differ with the site/type lesion
Stroke 
Arrythmias
Ventricular hypertrophy
Angina (Chest pain)
Syncope (Fainting)
Heart failure
Infarcts to kidneys and spleen
Poor prognosis once symptoms

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Infective Endocarditis

Endocardium is the inner lining of the heart and its valves.

Endocarditis is when this lining becomes infected/inflammed

Infection occurs on the edge of heart valves
Vegetation is a mass of bacteria, fibrin, platelets
Right-sided in IV drug use
Left-sided in others

Colonization of the heart valves or mural endocardium usually by bacteria
Streptococci (α haemolytic) affects abnormal valves usually after dental extraction / cleaning / bronchoscopy / tonsillectomy

Staph aureus affects previously normal valves, usually IV drug abusers

PROPHYLAXIS - Imperative to give antibiotics to those at risk of developing endocarditis prior to any procedure that may produce a bacteraemia

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Clinical Presentation

Sepsis
Heart Failure
New murmur

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Pericarditis & Myocarditis

Inflammatory Reaction involving the Heart Sac or Heart Muscle
Many Causes:

Viral
Bacterial
Parasitic
TB
Uraemia - (urine products in blood)
Carcinoma
MI
Post surgery
Drugs
Connective tissue disease
Unknown
Radiation

Pericarditis & Myocarditis

Types:
Acute
Chronic

Symptoms and Signs:
Chest Pain
Cardiac Failure

Treatment:
Anti-inflammatory Drugs
Surgical Excision of the Pericardium

Unusual Cardiac Diseases

Cardiomyopathy
Multisystem Diseases – like Sarcoidosis &amp; Amyloidosis
Thyrotoxicosis
Myxoedema
Alcoholism
Pregnancy
Iatrogenic (drug-induced) disease

Cardiomyopathy

Disease of heart muscle

Cardiac Dilatation(process of expansion/stretching)

Dilation of chambers

Heart large and flabby

Hypertrophic Cardiomyopathy

Heavy, muscular, hypercontracting
Abnormal diastolic filling
1/3 have intermittent left ventricular outflow obstruction
End stage dilatation can occur

Myocardial hypertrophy, disarray

Clinical Features of HCM

SOB, chest pain, palpitations, black-out
Sudden death
Atrial fibrillation

50% Familial, autosomal dominant with variable expression
Genetic defect in 1 of 4 genes that encode cardiac contractile elements

Aneurysms

Localised, permanent, abnormal dilatation of a blood vessel

Causes: Age, Atherosclerosis, Ischaemia, Hypertension, Inflammation, Diabetes, Autoimmune diseases, Bacteria, Bacterial Endocarditis, Fungus, Marfan’s Syndrome, Syphilis

Treatment: Stents, Surgery, reducing arterial pressure

Hypertension

(High Blood Pressure) But what is BP? BP is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats) Measured in millimeters of mercury - mmHg eg 120/80 mm Hg 120/80mmHg or lower is classed as normal BP

Hypertension Diagnosis

No universal definition of what exactly is high BP 140/90 offered 24hr ambulatory monitoring Categories: Mild: diastolic 95 – 104mmHg Moderate: 105 – 114mmHg Severe: >115mmHg

Hypertension

Classified into causes: Primary (essential) hypertension 95% Secondary hypertension 5-10% Further classified Clinically: Benign hypertension Malignant hypertension

Risk Factors for Essential Hypertension

None Modifiable: Genetics- family history ``` Modifiable: Diet- high intake of sodium Lifestyle- stress & physical inactivity Weight- obesity Alcohol & Smoking - usage ```

Secondary Hypertension Causes

Renal eg Polycystic Kidney Disease Endocrine eg Thyrotoxicosis Vascular eg Raised intravascular volume Neurogenic eg Acute stress (surgery)

Clinical Classification of Hypertension

Benign Hypertension - Most remain stable over many years live a relatively normal life until/unless complications arise Malignant Hypertension - Accelerated Hypertensive disease 5% of cases Rapidly rising blood pressure 90% die in the first year!

Complications of Hypertension

Organs Affected: ``` Blood vessels Heart Kidney Eyes (Retina) Brain ```

Complications of Hypertension: Blood Vessels

Large Blood Vessel disease (Macroangiopathy) Atherosclerosis Small Blood Vessel disease (Microangiopathy) Arteriolosclerosis Increased risk of rupture and dissection, & MI

Complications of Hypertension: Heart

Heart disease: Left ventricular hypertrophy Cardiac Failure Myocardial Infarction

Complications of Hypertension: Kidney

Benign nephrosclerosis Renal failure

Complications of Hypertension: Eyes (Retina)

Hypertensive retinopathy Retinopathy Grades: Grade I Thickening of arterioles Grade II Arteriolar spasms Grade III Hemorrhages Grade IV Papilloedema (seen in Malignant Hypertension)

Complications of Hypertension: Brain

Cerebral haemorrhage Cerebral infarction

Factors Indicating Adverse Prognosis in Hypertension

``` Male Young Black Ethnicity Smoker Persistent diastolic BP > 115 mm Hg ``` Diabetes Hypercholesterolemia Obesity Excess alcohol ``` Organ damage: Heart Kidney Eyes Brain ```

Diabetic Vascular Disease

Damage to Vessels Generally - Atherosclerosis Damage to Kidneys Damage to Nerves Damage to Retinas Complications such as: Gangrene Renal failure Blindness Effective control of Diabetes reduces disease!

Specifically Vein Diseases

``` Venous Thrombosis (eg DVT) When normal venous return is impeded, predisposes to Thrombosis Causes: Immobility Malignancy Pregnancy & Childbirth Oestrogens Haematological disorders IV cannulas ``` Danger of PE! ``` Varicosities Common Problem Tortuous and Distended veins Cause Incompetent valves in legs Impaired venous return stasis oedema fibrin deposits around veins Often associated Ulceration – ankles and lower legs ```

Congenital Cardiovascular Disease – Commonest Types

Septal defects - Atrial or Ventricular Failure of blood vessel closure at birth - Patent Ductus Arteriosus Narrowed Aorta - Coarctation of the Aorta Valvular Abnormalities Vessels the wrong-way round - Transposition of the great vessels Coronary artery defects Multiple defects - Fallot’s Tetralogy