Cardiovascular Conditions Flashcards
Non-Modifiable causes of cardiovascular disease
• increasing age
• male gender (until female menopause)
• genetics
• race
• congenital conditions
Modifiable causes for cardiovascular disease
• diet
• lack of exercise
• obesity
• type 2 diabetes mellitus
• tobacco smoking
• stress
• excess alcohol & drug use
• hypertension
What is Atherosclerosis
• progressive, degenerative disease of the coronary arterial system denotes the formation of fibrosis-fatty lesions in intimate lining of arteries.
What are plaques
Fatty deposits (lipids) under the lining of the arteries often near branches of vessels causing reduced blood flow
In atherosclerosis, what do localized plaques do
Protrude into the lumen of the artery and reduces blood flow
How does atherosclerosis begin
As a result of damage, or “insult” to the endothelium
What is Ischemia
Decreased blood supply to an organ or part
What is infarction
Necrosis or death of tissues due to ischemia
When blood vessels rupture, what are the most affected arteries?
• Coronary arteries
• arteries supplying brain, kidneys, lower extremities, small intestine
What is the most common cause for myocardial ischemia
Atherosclerosis of the coronary artery
What is myocardial ischemia associated with
Increased concentrations of blood lactic acid produced by anaerobic respiration of the ischemic tissue
Ischemic heart disease often causes
Substernal pain, (left shoulder and arm), this pain is referred to as angina pectoris
A sudden, irreversible injury of Ischemic heart disease is
Myocardial infarction (MI)
What is hypertension
An intermittent or sustained elevation of diastolic or systolic BP
What BP would be classed as hypertension
140/90
What are the two major types of hypertension
• Essential (aka primary or idiopathic)
• Secondary
Irrespective of cause, hypertension often affects the
Kidneys
Essential hypertensions cause is
Unknown
Symptoms of essential hypertension and diagnosis
Hypertension is symptomless and only discovered through routine examination
First indications of hypertension are
• Heart failure
• cerebrovascular accident
• MI
Causes of Secondary Hypertension
• kidney disease
• adrenal gland disorders
• hyperthyroidism
• structure of the aorta
• nervous system
• alcohol
• obesity
• pregnancy
• drug treatment
Effects of longstanding and rising blood pressure on the heart:
• rate & force of contraction are increased against high arterial pressure
• LV hypertrophied
• back pressure & accumulation of blood in lungs
• predisposes to ischaemic heart disease & aneurysm formation
Effects of longstanding and rising blood pressure on the brain:
• stroke caused by cerebral haemorrhage (ruptured vessel)
Effects of longstanding and rising blood pressure on the kidneys:
• causes direct damage to kidneys
Effects of longstanding and rising blood pressure on the blood vessels:
• small arteries become hardened.
• in large arteries, atheroma is accelerated.
• vessels become less elastic and hypertension worsens.
What is pulmonary hypertension?
• increased blood pressure in lung vasculature.
Clinical manifestations of pulmonary hypertension
• shortness of breath
• fatigue
• non-productive cough
• angina
• cyanosis
• peripheral oedema, ascites
• syncope
• jugular vein dilation
• wide split S2 (second heart sound) and loud P2 (pulmonary valve closure) upon auscultation
Heart failure signs and symptoms
• shortness of breath (at rest or exertion)
• orthopnoea
• paroxysmal nocturnal dyspnoea
• fluid
• chest pain
• difficulty focusing and confusion
• lowered exercise ability and/or fatigue
• heart palpitations
• oedema
• fatigue
Chronic heart failure is caused by:
• an imbalance in the pump function where the heart fails to maintain circulation - affecting preload, after load and contractility
Risk factors for Congestive heart failure:
• poorly controlled high blood pressure
• high cholesterol
• diabetes
• smoking
• family history
• sleep apnoea
• alcohol and drug abuse
• infections
• connective tissue disorders (lupus erythematosus, sarcoidosis and anyloidosis)
Symptoms of left sided heart failure
• restlessness
• confusion
•orthopnoea
• tachycardia
• exertional dyspnoea
• fatigue
• cyanosis
• tachypnoea
• blood-tinged sputum
• wheezes
• crackles
• cough
• elevated pulmonary capillary wedge pressure
• paroxysmal nocturnal dyspnoea
Right sided heart failure symptoms
• secondary to chronic pulmonary problems
• distended jugular veins
• anorexia & complaints of GI distress
• weight gain
• dependent edema
• enlarged liver & spleen
• ascites
• peripheral venous pressure
• fatigue
What is left ventricular failure
• The inability of the left ventricle to function effectively as a forward pump causing excessive volume of fluid to accumulate in the pulmonary circulation.
• inability to pump out the blood returned from the lungs
Clinical manifestations of left ventricular failure
• severe respiratory distress
• severe apprehension, agitation, confusion and feeling of being smothered
• cyanosis
• white frothy sputum (pink frothy in severe disease)
• jugular vein distention
• tachycardia and raised BP
• level of consciousness may very depending on hypoxia
• diaphoresis
• chest pain, usually in the presence of an MI
What is right ventricular failure
• failure of the right ventricle to function effectively enough to act as a pump, causing excessive volume of fluid to accumulate the systemic circulation.
• blood engorges, causing a rise in pressure in the right atrium, RV and systemic veins causing peripheral oedema.
Possible causes for Right Ventricular Failure
• acute right ventricular infarct - inferior MI
• pulmonary disease (COPD, fibrosis, pulmonary hypertension)
• cardiac disease involving left or both ventricles
• results from left ventricular failure
• tricuspid or pulmonary valve disease
• cardiomyopathy
• pneumonia / TB
• pulmonary embolism
Clinical manifestations for right ventricular failure
• weakness or fatigue
• tachycardia
• venous congestion (neck veins)
• engorged liver and/or spleen
• peripheral oedema
• weight gain
• congestion of GI tract can compromise digestion (causes anorexia, nausea, bloating & vomiting)
• arrhythmias
• hypotension
• previous history of MI or CCF
• poor exercise tolerance
Types of cardiomyopathy
• dilated cardiomyopathy
• hypertrophic cardiomyopathy
• arrhythmogenic right ventricular dysplasia (ARVD)
• restrictive cardiomyopathy
What is dilated cardiomyopathy
When the heart muscle is too weak to pump blood efficiently. Muscles stretch and become thinner which causes chambers of the heart to expand. Can be inherited, or due to coronary artery disease
What is hypertrophic cardiomyopathy
• believed to be genetic
• occurs when heart walls thicken and prevent blood flow.
• can be caused by long-term high blood pressure or aging
• diabetes or thyroid disease can cause cardiomyopathy
What is arrhythmogenic right ventricular dysplasia (ARVD)
• leading cause in death in young athletes
• fat and extra fibrous tissue replace the muscle of the right ventricle causing abnormal heart rhythms
What is restrictive cardiomyopathy
• ventricles stiffen and can’t relax enough to fill up with blood.
• scarring of the heart which happens frequently after a heart transplant may be a cause, as well as heart disease
Risk factors of cardiomyopathy
• family history
• coronary heart disease
• diabetes
• severe obesity
• sarcoidosis
• hemochromatosis
• amyloidosis
• heart attack
• long term high blood pressure
• alcoholism
Signs & symptoms of cardiomyopathy
• general weakness and fatigue
• shortness of breaths
• light headedness and dizziness
• chest pain
• heart palpitations
• fainting attacks
• high blood pressure
• oedema of the feet,ankles and legs
Name the 3 types of aneurysms
• fusiform
• dissecting
• saccular/berry
What is fusiform (type of aneurysm)
Wall of the arty expands until it bursts. Repairable using a mesh applied to the artery to stop it expanding further
What is dissecting (type of aneurysm)
• usually found in the highest-pressure areas (aorta)
• split in the inner lining, blood will push out and strip the layers apart.
• blood will end up around the aorta instead of inside.
What is saccular/berry (type of aneurysm)
• a particular part of the arty wall that has failed and forms a berry shape.
• can be repaired with a clip at the bottom where it joins the main artery.
Complications of aneurysms
• potential for unequal blood pressures varying by 20mmHg
• thromboembolism
• stroke
• severe chest and/or back pain if aortic aneurysm in chest ruptures
• angina
• sudden, extreme headache
• low BP
• tachycardia
• light headedness
Clinical signs of abdominal aortic aneurysm
• commonly asymptomatic
• pulsating mass
• mid and or lumbar pain
• large aneurysm might compress lumbar nerves and sciatic pain
•
Effects of hypertension on blood vessels
Small arteries become hardened
Atheroma accelerated in large arteries
Which layer of the heart is affected during a heart attack
Myocardium
