Cardiovascular 2 pathologies Flashcards
Aneurism (inc types)
Abnormal local dilations of arteries due to weakness of the vessel wall (often secondary to atherosclerosis)
Pathophysiology:
Common aneurysms include:
1) Abdominal aortic aneurysm (AAA):
• Asymptomatic until bursts (80% are fatal)
• Pulsatile abdominal mass &‘tearing’ low back pain
2) Berry Aneurysm:
• Occurs in centre of the cerebrum, causing a subarachnoid haemorrhage (presents as a severe headache e.g. thunderclap)
• May lead to haemorrhagic stroke
Causes:
• Often atheroscleosis
Signs and symptoms:
• Palpation
• Ultrasound
Angina Pectoris (inc types)
Ischaemic heart disease due to obstruction or spasm of the coronary arteries. Two types of angina:
1) Stable; pain is precipitated by physical exercise 2) Unstable; Occurs randomly, even at rest. More severe and can last longer
Pathophysiology:
• The symptoms associated with angina result from the demands of the myocardium not being met by its blood supply e.g. due to atherosclerosis or vascular spasm
Signs and symptoms:
• Heavy, constricting chest pain, radiating to arms, neck, jaw & back
• Eases on rest
Allopathic treatment;
• Acute relief; GTN (glyceryl trinitrate) sublingual (converted in blood to nitric oxide – vasodilation)
• Longer term; Anti-hypertensives, low dose aspirin, statins, stents
Other:
• It is not a cardiac arrest or heart attack
Arrhythmias (types)
Arrhythmias – any disorder of the heart. 3 Categories:
1) Bradycardia: Heart rate below 60. Physiological; athlete. Pathological; often caused by diseases affecting the SA or AV node (e.g. myocardial infarction)
2) Tachycardia: Heart rate over 100 3) Fibrillation e.g. A.F: Irregular rhythm and force leading to inadequate blood supply
Ascites
An excessive accumulation of fluid in the peritoneum (serous membrane of the abdominal cavity)
Causes:
• Liver cirrhosis (80%) – portal vein hypertension
• Malignancy of liver, stomach, colon, pancreas, ovary
• Heart failure
• Constrictive pericarditis (fibrotic pericardium)
Signs and symptoms:
• Abdominal distension and later discomfort
• Nausea and suppressed appetite
• Dyspnoea
Allopathic treatment;
• Diuretics may be implicated
• Surgery (hepatic shunt)
Atherosclerosis
(Athero – plaque
Sclerosis – hardening)
Narrowing and hardening of arteries.
Results in reduced blood flow through the affected artery, which negatively impacts the delivery of blood to target organs.
Commonly affects vessels such as the coronary, carotid and cerebral arteries, the aorta and major arteries of the extremities
Pathophysiology:
1) Damage of the vascular endothelium occurs, creating inflammation
2) LDL’s then deposit in the damaged tunica intima in an attempt to repair the damage, but are then oxidized subsequently attracting phagocytes
3) Macrophages surround the fatty material in an attempt to destroy it, & as a result, create foam cells
4) Vascular smooth muscle cells proliferate
5) A cap is formed over the atherosclerotic plaque to wall off the plaque from the blood
Causes:
• Heredity
• Male sex
• Age (men >45, woman >55)
• Ethnicity
• Hyperglycaemia
• Obesity
• Hyperlipidaemia
• Hypertension
• Smoking
• Stress
• Sedentary lifestyle
• Excessive alcohol
• Trans fats
• Gut / oral dysbiosis
• Intestinal permeability
Signs and symptoms:
• Angina pectoris/ myocardial infarction – ischaemic heart pain (from thrombosis and embolism)
• Stroke / transient ischaemic attack (from thrombosis, embolism & haemorrhage)
Allopathic treatment:
• BP meds
• Statins
• Surgery
• Stents
• Lifestyle changes
Other:
• Clinical manifestations are particularly common in western populations and occur largely as preventable factors
Atrial Fibrillation (AF)
(Arrhythmia)
Irregular rhythm (uncoordinated, rapid, small, local atrial contractions)
Associated with stagnation of blood in atria leading to thrombus formation and risk of embolism (stroke)
Signs and symptoms:
• Patients may present with breathlessness, palpitations, dizziness, chest discomfort (stroke)
Diagnostic:
• Palpate pulse to assess for irregularity.
• ECG
Cardiac arrest
(Arrhythmia)
Occurs when the heart develops an arrhythmia causing it to stop.
It is a conductive arrest, not a heart attack
Causes:
• Approximately 70% occur due to coronary heart disease
Signs and symptoms:
• Absence of carotid pulse
Allopathic treatment;
• Cardiopulmonary resuscitation (CPR) to provide circulatory support until availability of defibrillation (application of an electric current to reset the electrical impulses running through the autorhythmic cells)
Deep vein thrombosis (DVT)
Thrombus formation in the deep veins of the legs
Causes:
• Reduced blood flow (immobility, pressure on vein by tumour, long-haul flights)
• Varicose veins
• Changes in blood (dehydration, polycythaemia (high RBC’s), sticky platelets, oral contraceptive pill
• Damage to blood vessel wall
• Smoking
Signs and symptoms:
• Limb pain, calf swelling, tenderness along vein, distension of superficial veins, increased skin temperature and local redness (erythema)
Diagnostic:
• Ultra sound
• D-dimer
Allopathic treatment:
• Complete rest
• Heparin
• Warfarin
Complications:
• Clot may dislodge and cause a pulmonary embolism
Endocarditis
An inflammation of the endocardium and valves (inner lining)
Causes:
• Usually a bacterial infection; can spread from a dental infection (streptococcus viridans) or staphylococcus aureus (found in skin – has been found on prosthetic heart valves)
Signs and symptoms:
• Non-specific symptoms; Fever, fatigue, muscle and joint aching, loss of appetite (flu like symptoms)
• Dyspnoea and persistant cough
• Osler’s nodes (red tedner spots under skin of fingers)
• Splinter haemorrhages (splinter under nail bed)
• Petechiae
Diagnostic:
• Screens – ECG, imaging
• Heart murmur
• Blood tests
Haemorrhoids
Dilated veins in the anal canal.
Some prolapse, others do on straining, and some are permanent
Causes:
• Chronic constipation
• Chronic cough
• Hypertension (portal hypertension)
• Obesity, pregnancy, abdominal bloating
Signs and symptoms:
• Bright red blood with bowel movements
• Protruding haemorrhoids
• Anal itching
Heart failure
The heart is impaired as a pump – failing to supply sufficient blood flow. Can be acute (medical emergency) or chronic
Pathophysiology:
• The heart fails to pump blood forward effectively, so backflow of fluid occurs
Causes:
• Results from various cardiovascular conditions, e.g. coronary heart disease, hypertension, heart valve diseases
• Linked to insulin resistance – impaired myocardial glucose utilization
• Right sided failure:
• Increased vascular resistance in the lungs (lung disease)
• Back pressure from the left side of the heart (e.g. valve problems)
• Previous heart attack
• Left sided failure:
• High BP
• Myocardial weakness
• Valve problems
Signs and symptoms:
• Right sides failure;
• Systemic oedema
• Ascites (fluid around abdomen)
• Portal hypertension (esophageal varices, haemorrhoids)
• Left sided failure:
• Pulmonary oedema
• Congestion bronchitis
• Cardiac asthma
Allopathic treatment;
• Acute - medical emergency; sitting, GTN, cardiopulmonary resuscitation (CPR), 100mg aspirin
• Chronic – ACE inhibitors, beta blockers, diuretics, digoxin, surgery, pacemaker, advised aerobic exercise, smoking cessation, reduce alcohol
Other:• Tend to be a dominant side failure but can be both
Heart valve pathologies
(Valve stenosis and valve regurgitation)
Valve stenosis = Fibrosis and calcification of valve leading to obstruction to blood flow through heart chambers.
Valve regurgitation = Inadequate valve closure causing leakage
Pathophysiology:
• Valve stenosis; to compensate the myocardium hypertrophies (enlarges) – can lead to heart failure
• Valve regurgitation; The heart hypertrophies and dilates to accommodate more blood – can lead to heart failure
Complications:
• Heart failure
Hypercholesterolaemia
(Hyper – high, cholesterol, aemia - blood)
Elevated blood cholesterol
Causes:
• Familial – defect in chromosome 9 = inability to remove LDL from blood
• Age related
• Diet (high refined sugars, trans fats, table salt)
• Sedentary lifestyle
• Diabetes mellitus (insulin resistance)
• Obesity
• Excessive alcohol
• Smoking
Signs and symptoms:
• Xanthelasma (deposits of fat around eyes)
• Corneal Arcus (ring of fat deposits in cornea)
Allopathic treatment:
• Statins - adverse effects; muscle aches, insomnia, dizziness, fatigue, headaches, gastro-intestinal effects, cataracts, induces COQ10 deficiency
Hypertension
(High blood pressure)
Hypertension is high blood pressure. in the UK, it is defined as 140/90 mmHg or higher.
Causes: • There are two types:
1) Primary (95%);
• Generally, lifestyle and family history. Obesity, age, sedentary, stress, excess alcohol, high table salt intake, nutritional deficiencies (e.g. magnesium)
2) Secondary (5%);
• Secondary to another identifiable cause e.g. renal disease, diabetes.
Signs and symptoms:
• Often asymptomatic
Allopathic treatment;
• Medication (anti-hypertensive medication) to reduce and maintain BP e.g. ACE inhibitors, diuretics, calcium channel blockers, beta-blockers
• Weight loss (if appropriate), avoid salt, avoid caffeine, exercise
• Reduce stress and alcohol
Complications:
• Cardiovascular events
• Myocardial infarction
• Heart failure
• Aneurysm
• Stroke
• Chronic kidney disease (CKD)
• Vascular dementia
• Premature death
• Retinal (eye damage)
• Hypertension is a major risk factor for cardiovascular disease and cerebrovascular events. It is often asymptomatic.
Myocardial Infarction
(Heart attack)
(Myo- muscle, Cardial – heart, infarction – death of tissue)
Necrosis (death) of myocardial tissue due to ischaemia. Usually due to blockage of a coronary artery by a thrombus.
Pathophysiology:
• Infarcted areas produce scar tissue. The remaining tissue hypertrophies and can result in heart failure
Signs and symptoms:
• Severe chest pain (central, radiating to arms – usually left, jaw, neck and back)
• Pain can be sharp, tight, heavy; feeling of pressure. Does not improve on rest
• Sweating, nausea, vomiting, pale and clammy skin, lightheaded, SOB
• Overwhelming anxiety / sense of impending doom
Diagnostic:
• ECG (echo cardio gram)
Allopathic treatment:
• Oxygen
• Aspirin/anti-coagulant 300mg
• GTN spray
• Angioplasty procedure
• Thrombolytic therapy
• CPR (cardio pulmonary resuscitation)
Complications:
• Cardiac arrest
