Cardiovascular Pathology Pt. 1 Flashcards
Factors Affecting Preload (Left Ventricle Diastolic Volume)
- Total volume
- Venous tone (sympathetic)
- Body position
- Intrathoracic and intrapericardial pressure
- Atrial contraction
- Pump action of the skeletal muscle
Factors Affecting Afterload (amount of pressure that the heart needs to exert to eject the blood during ventricular contraction)
- Peripheral vascular resistance
- Left ventricular stroke volume
- Elasticity of the arterial tree or presence of obstructions.
Factors Affecting Contractility (independent of preload and afterload)
Increasing contractility: • Sympathetic nerve impulses • Circulating catecholamines • Digital, calcium other inotropic agents • Heart rate increase or, post-extrasystolic increase Decreasing contractility: • Anoxia, acidosis • Pharmacologic depression • Myocardial loss • Intrinsic depression.
Factors Affecting Heart Rate
- Autonomous nervous system
* Temperature, metabolic rate
Stages of Hypertension
Systolic Diastolic
Normal <120 and <80
Elevated 120-129 and <80
Stage I 130-139 or 80-89
Stage II >140 or >90
Hypertension crisis >180 and/or >120
Hypertension - Definition, Symptoms and Diagnosis
Blood pressure in arteries persistently increased - Damage.
Often symptom-free for decades.
Symptoms: headache, dizziness, nosebleed, dyspnea, chest pain.
Monitored for 24h with a holster.
Hypertension - Risk Factors
50% of population over 50 has hypertension. 95% of cases have no identifiable cause (primary/essential hypertension) Medication Other diseases Genetic Overuse of sodium chloride Renal diseases Abuse of cigarettes Stress Overweight Abuse of alcohol, caffeine
Hypertension - Consequences
↑ morbidity and mortality in cardiovascular diseases Damage on heart, vessels, brain, kidneys Hypertrophy of the left ventricle Ischemic heart diseases Stroke
Hypertension - Therapy
Medication (Beta-blockers, diuretics..., useful for acute phase, useless if no life style changes are made) Endurance sports Nutrition (+weight) Stress reduction Quit smoking
Hypotension - Definition
Systolic pressure < 90 mmHg OR diastolic < 60mmHg
Without symptoms: not unhealthy
Pathologic: (if symptomatic)
Dizziness, unconsciousness, fainting, orthostatic hypotension
Hypotension - Causes
Blood loss, dehydration.
Female, pregnancy.
Physical inactivity, immobilization.
Cardiovascular: Heart Failure, Aortic Stenosis, cardiac arrythmia.
Infections.
Medication (anti-hypertensive medication).
Idiopathic (chronic asymptomatic hypotension).
Hypotension - Diagnosis and Therapy
Find underlying cause.
Blood tests (haemogram), Electrocardiogram, Echocardiogram, Stress test.
Therapy will depend on underlying cause.
Exercise training. Medication: fludrocortisone.
Orthostatic Hypotension
Disturbance in regulation of heart rate and peripheral resistance in change of positions i.e. lying to standing.
Drop of blood pressure >20mmHg systolic or diastolic >10mmHg.
Hypovolemic Shock - Definition and Symptoms
Not enough blood flow to the tissues of the body, extreme hypotension, life-threatening.
- Confusion (especially in older subjects)
- Cold, clammy and pale skin
- Rapid, shallow breathing
- Weak and rapid pulse
Hypovolemic Shock - Cause and Compensation
Anaphylactic, septic, cardiogenic, hypovolemic, neurogenic.
Compensation:
- Increase heart rate, vasoconstriction, ischemia of non-vital organs.
Ischemic Heart Disease
Also called coronary heart disease or coronary artery disease.
Narrowed heart (coronary) arteries that supply blood to the heart muscle.
Decreased perfusion of myocardium to meet metabolic demands (hypoxemia).
Atherosclerosis.
12.8% of deaths in the world.
Atherosclerosis - Definition
Plaque build up in arteries. Chronic, progressive inflammatory disease/degenerative changes of the arterial endothelium.
Artery diameter ↓, ↓ O2 -supply myocardium.
Atherosclerosis - Cause/risk factors
Modifiable: hypertension, smoking, diabetes mellitus, obesity, depression, physical inactivity.
Non-modifiable: genes, age, M>F.
Atherosclerosis - Consequences and Therapy
Constriction or occlusion of arteries
Decreased perfusion with hypoxemia and ischemia
Peripheral artery disease
Ischemic heart disease
Stroke (carotid artery)
Therapy: Medication, prevention!, treating risk factors.
Ischemic Heart Disease - Clinical Manifestation and Diagnosis
• Stable angina pectoris • Unstable angina pectoris • Acute myocardial infarction Latter two: acute coronary syndromes, can be life-threatening. Diagnosis: Coronary angiography.
Coronary Angiography
Catheter examination for evaluation of coronary arteries.
Dilatation and implantation of stent.
Angina Pectoris - Definition
Retrosternal pain due stenosis with perfusion disturbances and hypoxemia.
Reversable. O2-demand > O2-supply.
Angina Pectoris - Stable vs Instable
Stable: most common, exertion-regular pattern, relieve after rest/nitroglycerine, effort angina.
Instable: no pattern, more severe - with or without exertion, no relieve after rest/nitroglycerine, crescendo pattern (more severe, prolonged or frequent than before).
Angina Pectoris - Symptoms/Therapy
• Chest tightness • Pressure-like pain in the heart area • Pain in left>right arm, back, face • Increase in exertion • Acute dyspnea Medication, elimination of risk factors, exercise training, percutaneous coronary intervention with stent, coronary artery bypass graft surgery.
Coronary Artery Bypass Surgery - Basics for Physiotherapy
- Chest pain due to extension of the thorax during surgery
- First 6-8 weeks no charged shoulder-arm exercises
- No thorax rotations end-of-range
- Cough with fixation
- Prevention of atelectasis, pneumonia, thrombosis, decubitus
Myocardial Infarction - Definition
Necrosis of myocardium after a (complete) stenosis of one or several coronary arteries.
Classification:
STEMI, NSTEMI.
Localization: anterior wall, posterior wall, side wall, septum.
Myocardial Infarction - Symptoms
Violent retrosternal pain Radiating pain: belly, left>right arm, back, face Dyspnea Nausea, vomiting Cold sweat Paleness Rapid, irregular heartbeats
Myocardial Infarction - NSTEMI vs STEMI
Both: Symptoms and clinical signs (not specific) Blood test: Biomarkers (↑ Troponin T) NSTEMI: ECG: no ST Elevations Coronary artery is only partially blocked Ischemia partial thickness myocardium STEMI: ECG: ST-Elevations Coronary artery is completely blocked Ischemia full thickness myocardium
Myocardial Infarction - Complications
Arrhythmia Cardiogenic shock Rupture of papillary muscles Rupture of the myocardium Heart failure Valve disease
Myocardial Infarction - Therapy
Within the first 4-6 hours to avoid lasting damages
• Medication
• Percutaneous coronary intervention with stent
• Coronary artery bypass graft surgery
• Exercises training
• Elimination of risk factors
