Lecture 9 - Cardiovascular Pathologies Flashcards
Cardiovascular Pathologies
Heart
Angina Pectoris (Angina)
Endocarditis
Myocardial Ischemia
Myocarditis
Arrhythmias (Dysrhythmias)
Pericarditis
Congestive Heart Failure (CHF
Mitral Stenosis
Rheumatic Fever (RF)
Aortic Stenosis
Rheumatic Heart Disease
Myocardial Infarction
Cardiomyopathy (myocardiopathy)
Cardiac Arrest
Cor Pulmonale
Right and Left Heart Failure
Angina Pectoris
đau thắt ngực
Description: chest pain caused by reduced blood supply to theheart, can also be a symptom of coronary artery disease (CAD).
Stable angina: most prevalent, a predictable pattern, triggered by emotional stress, cold temperatures or physical exertion gắng sức, resolves with rest or nitroglycerin (vasodilator )
Unstable angina: may signal an imminent sắp xảy ra heart attack, not in a predictable có thể dự đoán được pattern, not triggered by the above, prolonged pain at rest, does not resolve with rest or nitroglycerin
Variable angina: coronary artery spasm narrows the lumen, reduces blood supply to heart muscle, pain is reduced by medication
Etiology (cause): reduced blood flow to the myocardium due to narrowed blood vessels, (atherosclerotic plaques mảng xơ vữa động mạch in blood vessel walls) causing blockage or obstruction.
Pathogenesis: imbalance of myocardial blood supply and oxygen demands.
Clinical Features: sudden left side chest pain, squeezing ép, tightness, pressure, heaviness, pain may radiate down left arm, upper back, neck or throat. Other symptoms include nausea, disorientation, shortness of breath, anxiety, fatigue and profuse sweating.
Treatment: sublingual dưới lưỡi nitroglycerin dilates blood vessels, discontinue strenuous activity ngừng hoạt động gắng sức, if caused by atherosclerosis xơ vữa động mạch nitroglycerin becomes less effective.
Myocardial Ischemia
Thiếu máu cơ tim
Description: blood flow to the heart is reduced causing muscle myocardial tissue to be depleted cạn kiệt of oxygen. Usually due to a partial or complete blockage of an artery. The heart is unable to pump blood may lead to abnormal heart rhythms or a myocardial infarction nhồi máu or heart attack. Most common cause of angina.
Etiology: CAD, atherosclerosis xơ vữa động mạch, blood clot, coronary artery spasm.
Pathogenesis: myocardium damage due to hypoxia tình trạng thiếu oxy
Clinical Features: sometimes asymptomatic không có triệu chứng, chest pain, neck or jaw pain, shoulder or arm pain, tachycardia, dyspnea khó thở shortness of breath, nausea & vomiting, sweating and fatigue.
Treatment: medications, angioplasty nong mạch vành or stent, bypass surgery
Arrhythmias or Dysrhythmias
Rối loạn nhịp tim
Description: dysfunction of the heart’s conduction system creating an abnormal heartbeat or rhythm.
Too fast: over 100 = tachycardia
Too slow: under 50 = bradycardia
Normal: 50-100 beats per minutes.
An abnormal heart rate reduces the heart’s efficiency and it’s pumping capability.
Arrhythmia: variation biến thể in normal rhythm
Dysrhythmia: abnormal disturbed rhythm
Etiology (cause): damage to the conduction sự dẫn truyền
system of the heart from scar tissue, ischemia from rheumatic bệnh thấp khớp heart disease, myocardial infarction nhồi máu or cardiomyopathies bệnh cơ tim. May also be caused by electrolyte imbalances, fever, stress, systemic infection, hypertension coronary artery disease diabetes, heart valve defect, drug use and cigarette smoking.
Pathogenesis: scar tissue, ischemia or other damage on or near the nodes or neurons connection the conduction system to the heart are disabled.
Clinical Features: too fast or too slow heartbeat, skipped heartbeat, irregular heartbeat, chest pain, fatigue, shortness of breath, lightheadedness sự choáng váng, dizziness and fainting.
Treatment: when life threatening; antiarrhythmic agents or anticoagulant thuốc kháng đông medications, pacemaker or implantable cardioverter defibrillator máy khử rung tim cấy ghép or used to treat arrhythmias. .
Pacemaker
A small device placed in the chest under the skin to help control abnormal heart rhythms. It uses electrical impulses to stimulate the heart to beat at a normal rate. Used to treat arrhythmias. The electrodes of a pacemaker are attached inside the heart via veins at different points, depending on the type of pacemaker.
Congestive (sung huyết) Heart Failure
Description: This is the inability of the heart
To pump blood to meet the body’s demands.
When this happens the blood backs up and
congests the ventricles of the heart (60% of the time it is on the left side of heart) or the lungs. More like a syndrome than a disease and is often associated with many other chronic diseases like hypertension or CAD (Coronary artery disease) . It is the most common reason for hospitalization for the 65 and over age group. Frequently causes arrhythmias.
Etiology: attributed to an underlying condition such as myocardial infarction, valvular defects khiếm khuyết van tim, diabetes, obesity, anemias, hyper or hypothyroidism suy giáp, cardiomyopathy bệnh cơ tim or from increased demands on the heart by way of long standing hypertension.
Left-sided heart failure (left ventricle can’t pump out to the aorta): coronary artery disease, MI (Myocardial ischemia ), Rheumatic Heart Disease, long-standing hypertension & cardiomyopathy. Blood backs up into lungs.
Right-sided heart failure (right ventricle can’t pump out to the lungs): lung pathologies, such as COPD (chronic obstructive pulmonary disease – chronic bronchitis, emphysema), pulmonary disease is often referred to as cor pulmonale bệnh tâm phế. Blood backs up in the body’s veins and causes swelling in lower extremity.
Pathogenesis: adaptive mechanisms become less effective or less efficient, heart is unable to pump enough blood
Clinical Features:
Left sided heart failure: congestion in lungs, pulmonary congestion & edema. Shortness of breath, coughing (that may produce foamy, frothy pink-tinged sputum đờm có bọt màu hồng), awaking in panic gasping for air, fatigue, exercise intolerance, cold intolerance, dizziness and tachycardia.
Right sided heart failure: congestion in liver (liver enlarges-hepatomegaly gan to) and GI tract and lower extremities. Heart may enlarge-cardiomyopathy, venous congestion and distension căng thẳng in jugular vein, abdominal ascites cổ chướng bụng(a welling of ab), spleen may enlarge-splenomegaly lách to, may also progress to renal failure.
Treatment: ACE (Angiotensin converting enzyme) inhibitors and vasodilators open up narrowed blood vessels, beta blockers to reduce blood pressure, diuretics. Surgery called angioplasty nong mạch vành to open up blocked arteries.
Rheumatic Fever
Sốt thấp khớp
Description: rare inflammatory condition that develops after untreated streptococcal throat infection (usually group A). May cause an autoimmune tự miễn dịch reaction that can cause damage to the heart, joints, CNS or the skin. Mostly occurs in children 5-15 years old and only in susceptible dễ bị tổn thương people.
Etiology (cause): unknown, but group A streptococcal infection in the throat plays a significant role by creating antibodies that then cross-react and attack normal tissues. Some of these antibodies migrate to the heart’s endocardium where it forms vegetations mảng bám on the mitral hai lá and possibly aortic valve. These vegetations are abnormal growths made of fibrin, platelets and bacteria. They can break away and form emboli tắc mạch and cause infarction or may also infect other tissues.
Pathogenesis: streptococcal infection forms antibodies that cross react with normal tissues, forming vegetations especially on heart valves, making them less effective, also causes emboli that can cause infarcts.
Clinical Features: fever, painful, tender joints, chest pain, shortness of breath, fatigue, chorea múa giật type movements.
Treatment: analgesics thuốc giảm đau, anti inflammatories, antibiotics
Rheumatic Heart Disease
Bệnh thấp tim
Description: after rheumatic fever infection (strep throat), infection can manifest rõ ràng in all three layers of the heart (endocarditis, myocarditis, pericarditis). Endocarditis may lead to valve damage (mitral and aortic) or stenosis sự hẹp lại (narrowing) as it is made of the same tissue. The valve damage produced is called vegetations. These vegetations called Aschoff Bodies can break off and give rise to an embolism tắc mạch which can cause an infarction. They may also cause Rheumatic arteritis where the artery wall is damaged due to a local immune response to the Aschoff bodies. This leads to fibrosis sự xơ hóa and constriction of the lumen of arteries lòng động mạch. These Aschoff bodies are round, spindle shaped nodules and are found in the myocardium made of clumps of lymphocytes and fibroblasts. If these nodules are near the conduction system they interfere with the rhythmicity nhịp điệu of the heart.
Etiology (cause): unknown, but related to rheumatic fever
Pathogenesis: Endocarditis may lead to valve damage (mitral and aortic) or stenosis (narrowing) as it is made of the same tissue. The valve damage produced is called vegetations. These vegetations can break off and give rise to an embolism which can cause an infarction.
Round, spindle shaped nodules called Aschoff bodies are found in the myocardium made of clumps of lymphocytes and fibroblasts. If these nodules are near the conduction system they interfere with the rhythmicity of the heart.
Clinical Features: (all similar to CHF congestive heart failure), shortness of breath, dry cough, tachycardia, lower extremity edema, fatigue, low fever, loss of appetite, nosebleeds, chest pain, nodules on skin, red rash on chest, back and abdomen.
Treatment: antibiotics, anti inflammatories, analgesics thuốc giảm đau, valve damage is irreversible so surgical replacement if severe.
Cardiomyopathy
Description: a disease of the heart muscle that changes in the myocardium, associated with inadequate heart pumping. May lead to heart failure.
There are three types:
1. Dilated: a dilated left ventricle, decreases heart’s contractility so blood is pumped less forcefully, predisposes có khuynh hướng to thrombi huyết khối and emboli.
2. Hypertrophic phì đại : thickening of the left ventricle, interferes can thiệp with the heart’s ability to expand and fill up before contraction
3. Restricted: myocardium becomes rigid and less elastic, also interferes with the heart’s ability to expand and fill up before contraction
Etiology: most often unknown, also genetic, viral infection, myocardial infarction, drug abuse lạm dụng, alcoholism (enlarges the heart and thins the myocardium), severe long standing high blood pressure and kidney failure.
Pathogenesis: structural or functional abnormalities negatively affect the heart’s pumping action. The hearts is unable to contract as forcefully as normal so is less able to pump an adequate blood supply.
Clinical Features: similar to CHF, shortness of breath, fatigue, tachycardia, palpitations đánh trống ngực, dizziness, lightheadedness, fainting, occasional chest pain, lower extremity edema and bloating.
Treatment: blood pressure reducers, depending on the cause: surgically implanted devices to improve the heart’s function.
Cor Pulmonale
bệnh tâm phế
Description: the right ventricle of the heart becomes enlarged and eventually dysfunctional due to pulmonary artery hypertension. This causes right ventricular failure. It is usually chronic.
Etiology: pulmonary hypertension (caused by COPD mostly, or embolism, vasoconstriction, mechanical ventilation)
Pathogenesis: this increases afterload, causes ventricular hypertrophy phì đại tâm thất and dilation
Clinical Features: initially asymptomatic, dyspnea, fatigue, peripheral edema, neck vein distension giãn tĩnh mạch cổ, hepatomegaly gan to and parasternal lift nâng cơ cạnh ức.
Treatment: treat underlying condition and manage symptoms,
Endocarditis
(Viêm nội tâm mạc)
(Infective Endocarditis)
Description: infection and then inflammation of the interior lining of the heart (endocardium) from a bacterial infection. Because the heart valves are part of the same tissue as the endocardium, they are also involved and disrupt blood flow through the heart impairing general function. Can be a complication of another disease such as a respiratory or urinary tract infections, inflammatory bowel diseases, sexually transmitted diseases (gonorrhea bệnh lậu, chlamydia) or rheumatic fever and rheumatic heart disease.
Etiology: a pathogen, usually a bacteria enters the bloodstream and attaches to defects in the endocardium or on the heart valves. This causes inflammation and the formation of vegetations on the cusps of the valves, making them dysfunctional but also they may break away and cause an embolism which can later cause an infarct somewhere else in the body. If it is a replacement valve, or the person is immunosuppressed or it is a congenital valve defect that puts them at a higher risk.
Pathogenesis: bacterial infection in bloodstream
Clinical Features: because it is secondary to infection: fever, chills, fatigue, shortness of breath, night sweats, loss of appetite, heart murmur, painful red nodules on fingers (Osler nodes see right), edema in lower extremity and may lead to congestive heart failure (CHF).
Treatment: antibiotics, if valves are damaged-surgical repair.
Myocarditis
Viêm cơ tim
Description: inflammation of the heart muscle or myocardium caused by infection of viruses or parasites, related to cardiomyopathy. May affect myocardium but also may affect the heart’s conduction system.
Etiology: most common: virus: coxsackie enterovirus, or common cold virus or Covid 19, hep B and C and
parasites: toxoplasma gondii or trypanosoma cruzi.
T lymphocytes come to kill the invaders but also destroy infected myocardium cells making things worse. Can also be a complication of influenza, diphtheria bệnh bạch hầu, mumps, systemic lupus erythematosus (SLE), also rheumatic heart disease (RHD), toxic agents like lithium (toxic dosage), arsenic or hydrocarbons (methane, propane, hexane, benzene, paraffin wax, napthalene, polyethylene, polypropylene) can also be an unknown cause.
Pathogenesis: inflammation of the myocardium causes necrosis and kills myocytes
Clinical Features: symptoms are often vague, mild fever, shortness of breath, fatigue, fluid retention or swelling in lower extremity, arrhythmias and mild chest pain.
Treatment: anti inflammatories or steroids, antibiotics, diuretics, cardiac medications
Pericarditis
Viêm màng ngoài tim
Description: inflammation of the pericardium surrounding the heart. Causes a fluid build up in the pericardial space which can compress the heart. The pericardial layers may also become adhesed, which also impairs function.
Etiology: viral infections, renal failure,
cancer, less common: bacterial, tubercular bệnh lao
or fungal infections. May also be a
complication of rheumatic heart disease,
myocardial infarction, SLE, radiation to the
chest region or after open heart surgery. Often unknown cause.
Pathogenesis: inflammation of the pericardium causes an increase in fluid in the pericardial sac which compresses the heart.
Clinical Features: shortness of breath, chest pain-can be severe with sudden onset, tachycardia, lower extremity edema, dry cough, pounding heart sensation cảm giác tim đập thình thịch, if accompanied by systemic infection then infection
Treatment: heart medications, analgesics, steroids,
Mitral Stenosis
Hẹp hai lá
(Bicuspid (mitral) Valve Stenosis)
Description: narrowing of the bicuspid valve, causing abnormal opening and blocking blood flow from the left atrium to the left ventricle.
Etiology: streptococcus infection called rheumatic fever, calcium deposits
Pathogenesis: invasion of bacteria cause scarring on the delicate leaflets of the valve
Clinical Features: fatigue, shortness of breath, swollen feet, heart palpitations, heart murmur, arrhythmias, dizziness or fainting, coughing up blood, chest pain, symptoms may worsen with exercise.
Treatment: medications, valve repair or replacement
Aortic Stenosis
Hẹp động mạch chủ
Description: narrowing of the aortic valve, preventing the valve from opening fully reducing or blocking blood flow into the aorta and onward to the rest of the body. The left ventricle now has to work harder to pump a sufficient amount of blood into the aorta to the body. This weakens the heart, causes it to enlarge and may lead to heart failure.
Etiology: congenital heart defect, calcification of the valve, rheumatic fever
Pathogenesis: defect, calcification or invasion of bacteria cause scarring on the delicate leaflets of the valve
Clinical Features: heart murmur, chest pain, faint or dizzy, dyspnea, shortness of breath, fatigue and palpitations
Treatment: monitoring, medications, valve repair or replacement
