Chronic Heart diseases Flashcards
What is coronary heart disease? (CHD)
Coronary Heart Disease (CHD) is a disease characterised by reduced blood supply to the heart muscle, usually due to a narrowing of the coronary arteries as a result of atherosclerosis.
What is angina pectoris?
discomfort in the chest that radiates to the jaw, shoulder, back or arm
o Aggravated by exertion, emotional stress
o Relived by Nitro-glycerine and rest
What are some revascularisation procedures commonly done for people with CHD?
coronary artery bypass surgery or percutaneous transluminal coronary plasty
What are risk factors for development of CHD?
o Age, with CHF predominantly affecting middle-aged
o Gender – more common in men than women due to the protective effects of oestrogen until 65 – from which point women have equal risk to men
o Family history
o Dyslipidaemia, a metabolic derangement that can be hereditary or acquired
o Hypertension
o Diabetes
o Renal failure – cause or consequence of CHD
o Tobacco smoking – increases blood pressure and blotting tendencies
o Poor nutrition or excessive food consumption
o High consumption of alcohol
o Physical inactivity
o Being overweight or obese
o Depression
o Stress
o Social isolation
o Poor social support
What psychological conditions are commonly linked with CHD?
- Depression is prevalent in CHD
* Anxiety may be responsible for an increased susceptibility to unhealthy lifestyles
What is Chronic heart failure?
Complex clinical syndrome with typical symptoms (e.g. dyspnoea, fatigue) that can occur at rest or on effect, and is characterised by objective evidence of an underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood (particularly during physical activity). A diagnosis of CHF may be further strengthened by improvement in symptoms in response to treatment.
what are the causes of chronic heart failure?
- Most common cause is Chronic Heart Disease
- Left ventricular hypertrophy contributes to the development of CHF due to changes in the heart muscle caused by the stress of pressure and volume overload
- Remodelling is characterised by a change in the dimension of the left ventricle and the ventricular wall causing myocardial fibrosis, myocyte hypertrophy and hypertrophy or the coronary artery smooth muscle cells
What is Systolic heart failure?
Impaired ventricular contraction
- Hypertension may also contribute to CHF through increasing afterload and accelerating the progression of CHD
- Less common causes of systolic heart failure (heart does not pump effectively) include valvular heart disease, alcoholic dilated cardiomyopathy, peripartum cardiomyopathy, myocarditis and thyroid dysfunction
- CHD resulting in decreased perfusion of the myocardium
What is Heart failure with preserved ejection fraction?
impaired ventricular relaxation
• Results in the lack of ability of the ventricles to fill with blood, rather than a problem of pumping
• Most common cause is hypertension
• Diabetes is a contributing factor in CHF and can also be associated with myocardial ischaemia
o Aortic stenosis (condition where the opening of the aortic valve is narrowed)
o Hypertrophic (enlargement of the constituent heart cells)
o Restrictive cardiomyopathy (where the chambers of the heart are unable to fill)
What are the compensatory mechanisms that are activated in CHF?
Renin-angiotensin-aldosterone system
Sympathetic nervous system response
What are the signs and symptoms of CHF?
- Dyspnoea (shortness of breath) is the most common symptom
- Fatigue
- Cachexia
- Oedema
- Tachycardia
- Heart murmurs
Explain the 4 different classes of severity for CHF
CLASS 1
No limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations
CLASS 2
Slight impairment of physical activity: comfortable at rest but ordinary activity results in fatigue, palpations
CLASS 3
Marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
CLASS 4
Unable to carry out any physical activity without discomfort: symptoms of CHF are present even at rest with increased discomfort with any physical activity
How is chronic heart failure diagnosed?
• Based on clinical features, chest x-ray and assessment of ventricular function and echocardiography
What are the key steps for a physical examination of CHF?
- Measuring blood pressure and heart rate both lying and standing
- Assessment of heart rate and rhythm
- Checking peripheral pulses and tissues perfusion
- Examining the veins in the neck for elevated venous pressure
- Listening to breath sounds and auscultation of the chest cavity
- Listening to the heart for murmurs or extra heart sounds
- Checking the abdomen for swelling caused by fluid-build up and for enlargement or tenderness over the liver
- Assessing the legs and ankles for swelling caused by oedema
- Measuring and recording body weight
- Xray, ECG
What pharmacological therapy is used for treatment and management of CHF?
- Angiotensin-converting enzyme inhibitors that prevent disease progression and prolong survival
- Beta-blockers that prolong survival in symptomatic patients
- Diuretics that provide symptom relief and restoration or maintenance
- Aldosterone receptor antagonists
- Angiotensin II receptor antagonists and digoxin in patients who remain symptomatic
