Causes and Complications Flashcards
Primary Hypertension
Risk Factors
- Family history of hypertension or heart disease
- High sodium diet
- Obesity
- Smoking
- Diabetes
- Excess alcohol intake
- Physical inactivity
- Ethnicity (blacks > whites)
- Advanced age
Secondary Hypertension
Causes
- Primary renal disease (often unilateral parenchymal)
- Renal artery stenosis (fibromuscular dysplasia [young patients] or atherosclerosis [old patients])
- Chronic use of OCPs
- Pheochromocytoma
- Conn’s syndrome (hyperaldosteronism)
- Cushing’s syndrome
- Coarctation of the aorta
Hypertension
Complications
- Cardiovascular:
- Left ventricular hypertrophy
- Congestive heart failure
- Coronary artery disease
- Atrial fibrillation (AF)
- Accelerated atherosclerosis (major risk factor)
- Aneurysm formation and rupture
- Dissection
- Brain:
- Stroke (ischemic or hemorrhagic [major risk factor])
- Impaired cognition (dementia)
- Hypertensive encephalopathy (severe headache, nausea, vomiting [often projectile], focal neurological signs and altered mental status)
- Eyes: hypertensive retinopathy
- Kidneys: hypertensive nephropathy and end-stage renal disease
Atherosclerosis
Major or Modifiable risk factors
- Hyperlipidemia
- Hypertension
- Smoking
- Diabetes
- Obesity
Atherosclerosis
Minor or Non-modifiable risk factors
- Male gender
- Sedentary lifestyle
- Stress (type A personality)
- Elevated homocysteine
- Oral contraceptive use
- Increasing age
- Familial/genetic factors
Atherosclerosis
Complications
- Aneurysms
- Ischemia
- Infarcts
- Peripheral vascular disease
- Thrombus
- Emboli
Aortic Dissecting Aneurysms
Complications
- Organ ischemia due to obstruction of aortic branches by pressure like renal or coronary arteries
- Aortic rupture
- Death
Superficial Varicose veins of lower extremities
Causes
- Lack of structural support from superficial fat
- Incompetent valves
Superficial Varicose veins of lower extremities
Risk factors
- Pregnancy
- Prolonged standing or sitting
Superficial Varicose veins of lower extremities
Complications
- Edema
- Thrombosis
- Stasis dermatitis
- Ulceration
- Source of emboli (rarely)
Esophageal Varices
Causes
Portal hypertension
Esophageal Varices
Complications
Life-threatening hemorrhage
Hemorrhoids
Risk factors
- Constipation
- Pregnancy
Hemorrhoids
Complications
- Bleeding
- Thrombosis (painful)
Stable Angina
Cause
Coronary artery atherosclerosis with luminal narrowing greater than 75%, so the pain is brought up by increased cardiac oxygen demand (stress or exercise). It is a subendocardial ischemia
Prinzmetal variant angina
Cause
Coronary artery vasospasm (invoked usually by cocaine or smoking) that produces episodic pain at rest. It is a transmural ischemia
Unstable (Crescendo) angina
Cause
Formation of non-occlusive thrombus in an area of coronary atherosclerosis (due to recurrent atherosclerotic plaque rupture)
Myocardial Infarction (MI) (Cause)
- Coronary artery atherosclerosis with plaque rupture and superimposed occlusive thrombus formation
- Unrelieved coronary artery spasm
Myocardial Infarction (MI) (Complications according to time line)
- 0-24 hr: Cardiac arrhythmias especially VF [most common cause of death], HF and cardiogenic shock (> 40-50% myocardium is necrotic)
- 1-3 days: Fibrinous pericarditis
- 3-14 days: Free ventricular wall rupture –> cardiac tamponade, Interventricular septum rupture –> left to right shunt, Papillary muscle rupture –> mitral insufficiency
- 2 weeks to several months: Congestive heart failure, Dressler syndrome, arrhythmias, true ventricular aneurysm ( risk of mural thrombus and thromboembolism)
Sudden Cardiac Death
Causes
- Fatal cardiac arrhythmias (usually VT) with 80% being coronary artery disease as the underlying cause
- Hypertrophic and dilated cardiomyopathy
- Mitral valve prolapse
- Aortic valve stenosis
- Congenital heart abnormalities
- Hereditary ion channelopathies (e.g., long QT syndrome and Brugada syndrome)
- Myocarditis
Coronary Artery Disease (CAD)
Risk factors
- Diabetes mellitus
- Tobacco smoking
- Hypertension
- Hyperlipidemia
- Abdominal obesity
- Family history of premature CAD (under 55 in male and under 65 in women)
- Age above 45 in men and above 55 in women
- CAD risk equivalents are DM, symptomatic carotid artery disease, peripheral artery disease and abdominal aortic aneurysm
Myocardial Infarction (MI) (Complications according to presentation)
All of them cause hypotension
- Bradycardia: either sinus bradycardia (vascular insufficiency to SA node) or third degree AV block (cannon A waves). Rx: atropine first then pacemaker
- Tachycardia:
- RV infarction (associated with inferior MI [40%] and clear lungs). Dx: ST elevation in RV4. Rx: high volume fluid replacement and avoid nitroglycerin
- Tamponade: “sudden loss of pulse” and clear lungs
- VT and VF: also cause loss of pulse and should be diagnosed with ECG
- Valve or septal rupture: both cause new onset murmur and pulmonary congestion (septal rupture cause step-up in oxygen saturation on entering RV)
- Extension of infarction or reinfarction (inferior or anterior MI)
- Aneurysm or mural thrombus: most aneurysms need no specific therapy while mural thrombi are treated with heparin followed by warfarin
Dyslipidemia
Causes
- Obesity
- DM
- Alcoholism
- Hypothyroidism
- Nephrotic syndrome
- Hepatic disease
- Cushing’s syndrome
- OCP use
- High dose diuretic use
- Familial or hereditary
Preductal Coarctation of aorta (infantile type)
Complications
Congestive heart failure
Postductal Coarctation of aorta (adult type)
Complications
- Congestive heart failure
- Intracerebral hemorrhage
- Dissecting aortic aneurysm
Transposition of great arteries
Risk factors
Infants of diabetic mothers
VSD
Complications
- Eisenmenger complex (as all other left to right shunt defects)
- Infectious endocarditis (small defect only due to jet stream that may damage the endocardium)
ASD
Complications
- Eisenmenger complex (as all other left to right shunt defects)
- Paradoxical emboli (the most common cause is patent foramen ovale)
PDA
Risk factors
- Prematurity
- Congenital rubella infections
Dilated Cardiomyopathy
Causes
- Idiopathic
- Alcoholism (B1 deficiency)
- Wet Beriberi
- Medications like doxorubicin and cocaine
- Viruses like Coxsackievirus B and enteroviruses
- Parasites like Chagas disease
- Hemochromatosis
- Sarcoidosis
- Pregnancy (peripartum cardiomyopathy)
Dilated Cardiomyopathy
Complications
- Congestive heart failure (systolic)
- Mural thrombi
- Arrhythmias
Hypertrophic Cardiomyopathy
Causes
- Autosomal dominant (> 50% of cases, the most common mutation is beta-myosin heavy chain)
- Idiopathic
- Can be associated with Friedreich ataxia
Restrictive Cardiomyopathy
Causes
- Amyloidosis
- Sarcoidosis
- Post-radiation fibrosis
- Endomyocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children)
- Loeffler endomyocarditis (fibrosis with prominent eosinophilic infiltration)
- Hemochromatosis (although dilated cardiomyopathy is more common)
