Cardiovascular Pathology Pt. 2 Flashcards
Heart Failure - Definition
Unable to pump enough blood to meet body’s demand. A weak heart or it cannot overcome increased blood pressure. Not a disease but a complex of symptoms.
Main types of failure:
Systolic heart failure: can’t pump with enough force (pump problem).
Diastolic heart failure: can’t fill with enough blood (filling problem).
Heart Failure - Classification
- Left or Right (according to the heart side)
- High or Low output (according to the blood volume pumped)
- Acute or Chronic
Heart Failure - Consequences
Critical reduction of the ejection fraction of the heart.
Beating harder or faster → OK in early stage → can become overworked → needing more O2 → cell death ↓stroke volume.
Heart Failure - Consequences
Critical reduction of the ejection fraction of the heart.
Beating harder or faster → OK in early stage → can become overworked → needing more O2 → cell death ↓stroke volume.
Left Sided Heart Failure - Description and Cause
Most common. Left ventricle not efficiently pumping blood out → Blood stays in lungs, congestion. Cause: - Arterial hypertension - Valve disease - Ischemic heart disease - Myocardial infarction - Arrhythmia
Left Heart Failure - Concequences
- Pulmonary edema
- Pleura effusion
- Dyspnea, tachypnoea, orthopnea
- Reduced exercise capacity
- Can lead to right heart failure => Global failure
Right Heart Failure - Description and Cause
Right ventricle not efficiently pumping blood to lungs → Blood can flow back to body, congestion (feet or abdomen).
Causes:
- Valve failure
- Left heart failure with pulmonary edema
- Pulmonary diseases with pulmonary arterial hypertension
Right Heart Failure - Consequences
- Leg edema
- Nocturia
- Liver edema
- Ascites (accumulation of fluid in abdominal cavity)
- Nausea/loss of appetite
Global Heart Failure - Description and Cause
Limited pump function of both ventricles.
Usually stems from left side failure. Left to right heart failure.
Heart Failure - Consequences and Diagnosis
Consequences: - Reduction of the physical capacity - Risk of cardiovascular fail - Reduced blood flow to visceral organs Diagnosis • Medical history • Echocardiogram • Blood tests
Heart Failure - Classification according to New York Heart Association
I. No dyspnea/symptoms
II. Mild dyspnea during ordinary activity
III. Marked limitation during ordinary activity
IV. Severe limitations, Dyspnea at rest
Heart Failure - Risk Factors
- Arterial hypertension
- Diabetes mellitus
- Smoking
- Abuse of alcohol
- Overweight
- Physical inactivity
Heart Failure - Treatment
• Underlying cause • Medication • Exercise • Education • Nutrition Heart Transplant - LAST RESORT
Disturbances in Cardiac Rhythm
Can originate from normal conduction pathway: SA node, AV node.
Can originate from outside pathway: where myocardium is irritable (depolarization of conduction pathway).
Can arise from atria or ventricle.
Pacemaker/Internal Defibrillator
Stimulate the heart with electrical impulses to maintain or restore a normal heart rhythm and enhance the cardiac function.
- Sinus node dysfunction
- Acquired Atrioventricular(AV) block
- After acute phase of myocardial infarction
- Hypertrophic cardiomyopathy
Cardiac Valve Disease - Stenosis vs Regurgitation
Restriction of valve opening (stenosis) or of valve closing (regurgitation)
• 1) obstruction of flow → ↑ pressure
• 2) inadequate valve closure → volume overloading
Aortic Valve Stenosis
Most common, narrowed opening.
↑ Pressure overloading left ventricle → left ventricle hypertrophy →difficulties pumping blood to rest of body.
Creates a afterload problem.
Aortic Valve Regugitation
Inadequate closing.
Backflow of blood into ventricle.
Volume overloading left ventricle → dilation of ventricle → heart failure.
Mitral Stenosis
infection (rheumatic fever)
→ calcium deposits → scarring mitral valve
- ↑ pressure left atrium – pulmonary veins
- ↓ blood flow
→ tired, dyspnea
Treatment: prevent fever.
Mitral Valve Regurgitation
Mitral valve prolapse (degenerative) Rupture of papillary fibers Rheumatic fever Trauma Congenital heart defect Cardiomyopathy (dilation heart muscle)
Cardiac Valve Disease - Risk Factors and Diagnosis
Age
History of infections that can affect the heart
History of heart disease
High blood pressure – high cholesterol – diabetes
Congenital heart disease
Diagnosis: Echocardiogram.
Cardiac Valve Disease - Symptoms
- At beginning often symptom-free
- Abnormal heart sound
- Fatigue
- Shortness of breath
- Swelling of your ankles and feel
- Dizziness
- Fainting
- Irregular heartbeat
Cardiac Valve Disease - Complications and Treatment
Heart failure, stroke, blood clots, death.
• Healthy lifestyle changes + taking medications to treat symptoms
• Heart valve surgery
• Prevention rheumatic fever
Cardiomyopathy - Descriptions and Types
Modification of cardiomyocytes, size of cardiac wall.
Heart muscle weakens and is unable to pump blood as well as it should.
Primary (inherited) vs Secondary (acquired)
- Dilated Cardiomyopathy
- Hypertonic Cardiomyopathy
- Restrictive Cardiomyopathy
- Arrhythmogenic right ventricular dysplasia (ARVD)
Hypertrophic Cardiomyopathy
Diastolic dysfunction. Thickened left ventricular wall, thickened ventricular septum resulting in a small left ventricle. Can make it harder for the heart to pump blood.
Dilated Cardiomyopathy
Enlargement of all cardiac chambers. Systolic dysfunction. Most common. Makes it harder for the heart to pump blood to the rest of the body.
Restrictive Cardiomyopathy
Rigid ventricular walls, stiff muscle, results in decrease of expansion of the ventricular walls, decrease in blood volume of the ventricles. Diastolic dysfunction. Least common.
Arrhythmogenic right ventricular dysplasia (ARVD)
Deposition of fatty tissue on right ventricle instead of muscle.
The right ventricle is dilated and contracts poorly.
Very rare, but it’s the leading cause of sudden death in young athletes.
Cardiomyopathy - Cause and Symptoms
Cause: idiopathic, inherited, alcohol, coronary heart disease, cocaine use and viral infection. Symptoms: not present in early stages. - Shortness of breath - Tired - Swelling of the legs (heart failure) - Irregular heart beat - Fainting
Cardiomyopathy - Diagnosis and Treatment
Presentation of symptoms - exclusion of other causes.
Lifestyle changes (physical activity), medication or surgery (last resort).
Pericardial Disease - Types
Inflammation of pericardium.
- Acute pericarditis: inflammation
- Pericardial effusion: extra fluid between layers.
- Cardiac tamponade: medical emergency, quick increase in fluid in pericardial sac, compressing the heart → decrease in cardiac output and shock.
- Constructive pericarditis: chronic scarring – thickening of pericardium.
Pericardial Disease - Cause and Symptoms
Cause: Viral, bacterial, parasite infection, autoimmune disease, traumatic chest injury.
Symptoms: Sharp chest pain (worse when coughing), dry cough, anxiety/fatigue, edema.
Pericardial Disease - Diagnosis and Treatment
Echocardiogram, x-ray, blood test. Treatment: depends on severity. Mild cases often spontaneous recovery. Medication: pain killers, corticosteroids, antibiotics. Surgery
Aortic Disease - Aneurysm
Dilation arterial wall >150%
Due to degeneration of connective tissue / inflammation.
Often asymptomatic
Aortic Disease - Aorta Dissection
Tear inner layer of aorta → blood entering aortic wall → possible rupture → often fatal.
Acute stabbing chest pain, hypotension.
Aortic Disease - Diagnosis and Treatment
CT-scan, MRI, chest X-ray.
• Medication (prevent worsening: lower blood pressure)
• Healthy lifestyle
• Surgery (removal + reconstruction)
Varicosis - Definition, Symptoms, Cause and Treatment
Venous valves not working, blood pools in veins → enlarged.
Symptoms: leg edema, itchiness, spider veins.
Cause: standing activity, obesity, age, pregnancy.
Therapy: irreversible, compression socks, lymphatic drainage, activity, respiratory exercises.
Thrombophlebitis, Deep Venous Thrombosis - Definition
Inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs.
Cause: prolonged immobility, traveling, pregnancy, inherited disorder, injury to vein, aging.
Thrombophlebitis, Deep Venous Thrombosis - Diagnosis and Treatment
Ultrasound.
Therapy:
avoid sitting long
walking and lying better than sitting, standing.
Medication (blood thinners)
Deep breaths
Deep venous thrombosis - RED FLAG → pulmonary embolism
Peripheral Arterial Occlusive Disease
Blockage of arteries to extremities. Pain due to low blood flow. Decrease or loss of peripheral pulse, cold extremity.
Therapy: manage symptoms, fight cause, stop smoking, physical activity, nutrition.
Physiotherapy Goals in Thoracic Surgery
- Respiratory physiotherapy. Prevent respiratory functional impairment (airway clearance, improve ventilation and efficiency of respiratory muscles)
- Prevent circulatory impairment
- Maintain or restore muscles strength and ROM
- Reduce length of stay , health care cost
Congenital Heart Disease - Definition and Classification
Most common defects involve:
• the inside walls of the heart,
• the valves of the heart, or
• the large blood vessels that carry blood to and
from the heart.
Classification: According to the altered cardiac structure
(Septum, valves, ventricle, atrium).
Congenital Heart Disease - Atrial/Ventricular Septal Defect
Hole in the wall between the atria/ventricle, causing blood flow mixture (from the left to the right). It may close by it own.
Congenital Heart Disease - Patent Ductus Arteriosus
Occurs when a connection between the pulmonary arteries and aorta does not close. Small openings may close on their own. Mixture of high and low oxygenated blood, from systemic to pulmonary circulation.
Congenital Heart Disease - Tetralogy of Fallot
Most common.
combination of four defects:
1. large ventricular septal defect
2. Overriding aorta (when aorta is located between the left
and right ventricles and over the the septal defect).
3. Right ventricular hypertrophy (caused by the increased
workload).
4. Pulmonary stenosis (narrowing of pulmonary valve).
Surgical treatment.
