Pathology of Heart and Blood Vessels

Question 1

Aneurysm

Answer 1

Dilation of a blood vessel
Etiology: congenital, vessel wall weakness due to hypertension, connective tissue disease (e.g. Marfan), trauma, infection.
Signs & Symptoms: Aortic often asymptomatic but possible abdominal or low back pain. Abdominal aortic possible pulsations near naval. Cerebral can cause sudden headache, nausea and vomiting, stiff neck, seizure, loss of consciousness, and double vision.
Treatment: Antihypertensives, surgical replacement of aneurysm with synthetic fabric graft in aortic, surgical clipping and endovascular coiling for brain aneurysm.

Question 2

Angina Pectoris

Answer 2

Transient sensation of pressure or discomfort from myocardial ischemia. Can be stable, unstable, or prinzmetal (variant) angina.
Etiology: Inadequate blood flow and oxygen to heart muscle mostly due to coronary artery disease.
Signs & Symptoms: Pressure, heaviness, fullness, squeezing, burning, or aching behind sternum. Can be felt in neck, back, jaw, shoulders, and arms. Possible difficulty breathing, nausea or vomiting, sweating, and anxiety/fear.
Treatment: Acute angina - supplemental O2, nitroglycerin, and rest. Chronic or recurring - long-acting nitrates, beta blockers, and calcium channel blockers. Angioplasty with stenting of the coronary arteries or coronary artery bypass surgery if meds are not effective.

Question 3

Atherosclerosis

Answer 3

Fatty plaque accumulation on the inner walls of arteries. Can restrict blood flow, causing a blood clot.
Etiology: Hypertension, high cholesterol, smoking or diabetes.
Signs & Symptoms: Coronary aa - possible angina pectoris. Cerebral aa - numbness/weakness of arms/legs, difficulty speaking, drooping face. Peripheral aa - intermittent claudication.
Treatment: Lifestyle changes, medications (antihypertensive, antiplatelet, and antilipidemic), and surgery (angioplastly, endarterectomy, and bypass).

Question 4

Cardiomyopathy

Answer 4

Group of conditions that affect the myocardium, impairing ability to contract and relax. 3 types are dilated, hypertrophic, and restrictive.
Etiology: Many causes including coronary artery disease and valvular heart disease.
Signs & Symptoms: None during early stages. with progression, breathlessness with exertion or even at rest; swelling of the legs, ankles, and feet; bloating of the abdomen due to fluid buildup; fatigue; irregular heartbeat; dizziness, lightheadedness, and fainting.
Treatment: Depends on type of cardiomyopathy
-Dilated: ACE inhibitors, beta blockers, digoxin, and diuretics. Surgical biventricular pacemaker or an implantable cardioverter-defibrillator.
-Hypertrophic: Meds to slow HR and stabilize rhythm; Lopressor and calcium channel blockers. Surgical septal myectomy (removal or thickened septum), septal alcohol ablation, pacemaker implant, cardioverter-defibrillator.
-Restrictive: Meds to improve symptoms; diuretics, antihypertensives, and antiarrhythmics. Surgery with severe cases - ventricular assist device or heart transplant.

Question 5

Chronic Venous Insufficiency (CVI)

Answer 5

Veins and valves in LE are damaged and cannot keep blood flowing towards heart. Veins remain filled with blood.
Etiology: Weak/damaged valves. Risk factors include age, female gender, obesity, pregnancy, and prolonged sitting/standing.
Signs & Symptoms: Leg swelling, varicose veins, aching, heaviness or cramping, itching, redness or skin ulcers of the legs and ankles.
Treatment: Compression stockings and elevation of legs. Possible varicose stripping in those with persistent leg pain or skin ulcers due to poor circulation.

Question 6

Atrial Septal Defect (ASD)

Answer 6

There is a hole in the atrial septum in fetal circulation that usually closes at birth. If it does not close, blood can flow between atria.
Etiology: Congenital; genetics and environmental factors.
Signs & Symptoms: Small to moderate sized defects may be asymptomatic until after 30 y.o. Large or long-standing defects may cause heart murmur, SOB, fatigue, swelling of legs/feet/abdomen, heart palpitations, frequent lung infections, stroke, and cyanosis.
Treatment: Surgical closure if defect is large, heart is swollen, or symptoms occur. Non-surgical involves placing a closure device in the heart across the ASD using a catheter.

Question 7

Coarctation of the aorta

Answer 7

Aorta is narrowed, mild to severe based on amount of narrowing and may not show symptoms until adulthood. Usually occurs with other congenital defects like patent ductus arteriosus, ventricular septal defect, and bicuspid aortic valve.
Etiology: Congenital; genetics and environment.
Signs & Symptoms: Severe - pale skin, sweating, and SOB soon after birth. Older children and adults - high blood pressure in the arms but low pressure in the legs; SOB during exercise, intermittent claudication, weakness, and headache.
Treatment: Usually surgical repair (resection, patch, bypass) or balloon angioplasty.

Question 8

Patent ductus arteriosus (PDA)

Answer 8

When the ductus arteriosus, which normally shunts blood from the pulmonary aa to the descending aorta in utero, does not close.
Etiology: Congenital. Risk factors include premature birth, other heart defects, family hx, rubella infection or diabetes during pregnancy, and exposure to alcohol/drugs/chemicals/radiation during pregnancy.
Signs & Symptoms: Small may be asymptomatic while large may present with tachycardia, respiratory distress, poor eating, weight loss, and congestive heart failure.

Question 9

Ventricular septal defect (VSD)

Answer 9

If hole is large, too much blood will be pumped to lungs, causing heart failure.
Etiology: Congenital. Risk factors include rubella and diabetes during pregnancy, exposure to alcohol/drugs/chemical/radiation during pregnancy.
Signs & Symptoms: Small may have no symptoms and may eventually close with growth. Large may cause cyanosis of skin, lips, and fingernails; poor eating/failure to thrive; fast breathing or breathlessness; fatigue; swelling of legs, feet, or abdomen; tachycardia.
Treatment: Surgical patching or stitching

Question 10

Tetralogy of Fallot

Answer 10

Combination of 4 defects 1) ventricular septal defect 2) pulmonary stenosis 3) right ventricular hypertrophy 4) aorta overriding the ventricular septal defect. Often diagnosed during infancy but may not be detected until later in life.
Etiology: Congenital. Risk factors include poor maternal nutrition, viral illness, or genetic disorders.
Signs & Symptoms: Depend on obstruction of blood flow from R ventricle. May include cyanosis, SOB and rapid breathing (especially during feeding), fainting, clubbing of fingers/toes, poor weight gain, tiring easily during play, irritability and prolonged crying, heart murmur.
Treatment: Surgery, usually placing a patch over VSD and widening the pulmonary valve and arteries. Untreated cases develop severe complications including infective endocarditis, which can cause disability or death by early adulthood.

Question 11

Cor Pulmonale

Answer 11

Known as pulmonary heart disease, refers to hypertrophy of the R ventricle caused by altered structure or function of lungs.
Etiology: Pulmonary hypertension from chronically increased resistance in pulmonary circulation.
Signs & Symptoms: Progressive SOB, especially with exertion. Fatigue, palpitations, atypical chest pain, swelling of the LEs, dizziness, and syncope.
Treatment: Supplemental O2 to maintain SaO2 > 90% or PaO2 > 60 mmHg. Diuretics or anticoagulation.

Question 12

Coronary Artery Disease (CAD)

Answer 12

Narrowing or blockage of coronary arteries due to atheromatous plaques.
Etiology: Damage to inner wall of artery, fatty plaques accumulate, plaque rupture, platelets will clump to repair artery, clump blocks artery, leading to heart attack. Risk factors are same for atherosclerosis.
Signs & Symptoms: Angina, SOB.
Treatment: Modification of risk factors (stop smoking, weight loss; diet low in saturated fat, cholesterol, and sodium; regular exercise; modification of serum lipids; control of hypertension and diabetes). Antiplatelet agents (aspirin, Clopidogrel), ACE inhibitors, angiotensin II receptor blockers, and statins. Percutaneous angioplasty and coronary artery bypass graft surgery.

Question 13

Deep vein thrombosis (DVT)

Answer 13

Clot in a deep vein, which can break loose and cause a PE.
Etiology: Risk factors include prolonged sitting or bed rest, inherited blood clotting disorders, injury or surgery of the veins, pregnancy, cancer, birth control or hormone replacement therapy, being overweight, obesity, and smoking.
Signs & Symptoms: 50% asymptomatic. Swelling, pain, redness, and warmth.
Treatment: Anticoagulant and thrombolytic agents. Filters surgically inserted into vena cava. Compression stockings to reduce blood pooling.

Question 14

Endocarditis

Answer 14

Inflammation of the endothelium that lines the heart and cardiac valves. If untreated, can damage or destroy valves and become lift-threatening.
Etiology: Caused by bacteria that can enter blood from catheters or needles, dental procedures, gum disease, sexually transmitted disease, or inflammatory bowel disease.
Signs & Symptoms: Fever, chills, heart murmur, fatigue, SOB, weight loss, blood in urine, and skin petechiae.
Treatment: Antibiotics. Surgery for persistent infections or replace a damaged valve.

Question 15

Heart failure

Answer 15

Known as congestive heart failure. Progressive condition where heart cannot maintain normal cardiac output to meet body’s demands. Often occurs after other conditions damage/weaken the heart. Ventricles weaken/dilate and cannot pump efficiently. Blood backs up in liver, abdomen, LEs, and lungs. Can be acute or chronic.
Etiology: Coronary artery disease, hypertension, diabetes, MI, abnormal heart valves, and cardiomyopathy.
Signs & Symptoms: SOB; fatigue and weakness; swelling in the legs, feet, and abdomen, rapid or irregular heartbeat with S3 and S4 sounds; persistent cough or wheezing; and weight gain from fluid retention.
Treatment: Medications include anticoagulants, antihypertensives, and digitalis to increase strength of contraction. In severe cases, surgery and medical devices include coronary artery bypass graft, heart valve repair, implantable cardioverter-defibrillator, biventricular pacemaker, L ventricular assist device, and heart transplant. Lifestyle changes like smoking cessation, decreasing sodium intake, maintaining healthy weight, limiting alcohol and fluids, stress reduction, and moderate exercise.

Question 16

Heart murmur

Answer 16

Abnormal swishing and whooshing sound.
Etiology: Innocent murmurs occur when blood flows rapidly through the heart due to activity, pregnancy, fever, and anemia. Abnormal murmurs caused by turbulent blood flow through a damaged or narrowed heart valve or a hole in the heart wall. Also rheumatic fever, endocarditis, calcified valves, and mitral valve prolapse.
Signs & Symptoms: Cyanosis, limb edema, SOB, enlarged neck veins, weight gain, chest pain, dizziness, and fainting.
Treatment: Treatment not needed for innocent murmurs. Abnormal murmurs can include meds or surgery. Common meds are digoxin, anticoagulants, diuretics, and antihypertensives. Surgery includes valve replacement or patching atrial or ventricular septal defects.

Question 17

Hypertension

Answer 17

Etiology: Primary has no known cause. Secondary has an identified caused (usually renal disease).
Signs & Symptoms: S4 sound is an early sign. Severe hypertension (DVP > 120) can cause significant CNS symptoms (confusion, cortical blindness, hemiparesis, seizures), cardiovascular symptoms (chest pain, dyspnea), and renal involvement.
Treatment: Lifestyle modification, weight loss for a BMI of 18.5 to 24.9, smoking cessation, reduced sodium and alcohol intake, increased consumption of fruits, vegetables, and low-fat dairy products with reduced saturated and total fat content). Medications include diuretics, beta blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers, and direct vasodilators

Question 18

Myocardial Infarction (MI)

Answer 18

Heart attack, when blood flow through coronary arteries is severely reduced or completely cut off. Irreversible necrosis to the portion of myocardium supplied by the blocked artery.
Etiology: Ruptured atherosclerotic plaque or blood clot.
Signs & Symptoms: Chest discomfort with pressure, squeezing or pain; SOB; discomfort in the upper body including the arms, shoulder, neck, or back; nausea, vomiting, dizziness, sweating, and palpitations.
Treatment: Anticoagulants and thrombolytic agents, pain relievers, antihypertensives, and cholesterol-lowering medications. Surgery may include coronary angioplasty with stenting or coronary artery bypass. Lifestyle changes.

Question 19

Myocarditis

Answer 19

Inflammation and weakness of myocardium. Can cause myocardium to be thick and swollen, which can lead to heart failure.
Etiology: Usually viral or bacterial infection.
Signs & Symptoms: Arrhythmias, chest pain, SOB, fatigue, and signs of fever.
Treatment: Antibiotics, anti-inflammatory agents, diuretics, beta blockers, and calcium channel blockers to reduce workload of heart. Severe cases may requires surgical implantation of a ventricular assist device or intra-aortic balloon pump.

Question 20

Pericarditis

Answer 20

Inflammation of pericardium of the heart. Can lead to pericardial effusion, which can disrupt function and rhythm.
Etiology: Viral infection or bacterial and fungal infections. Heart attack, chest trauma, surgery, immunosuppresive medications, and radiation to the chest.
Signs & Symptoms: Chest pain, SOB, dry cough, anxiety, fatigue, and fever.
Treatment: Analgesics or anti-inflammatory medication to relieve pain; antibiotics if from a bacterial infection. Most cases are mild and clear up on their own with rest and simple treatment. More intense treatment to prevent cardiac tamponade include pericardiocentesis (needle removes excess fluid from pericardium)

Question 21

Peripheral Artery Disease

Answer 21

Stenotic, occlusive, and aneurysmal diseases of the aorta and peripheral arteries.
Etiology: Atherosclerosis and thromboemolic processes that alter the structure and function or the aorta and its branches.
Signs & Symptoms: Fatigue, aching, numbness, or pain primarily in buttock, thigh, calf, or foot at rest or when walking. Poorly healing wounds of the legs or feet; distal hair loss; trophic skin changes, and hypertrophic nails.
Treatment: For those with asymptomatic disease - smoking cessation, lipid lowering medications, and control of diabetes and hypertension (beta blockers). For those with disabling intermittent claudication, treatment consists of revascularization procedures and surgery. Supervised exercise training for at least 30-45 min 3x/week for 12 weeks.

Question 22

Rheumatic fever

Answer 22

Inflammatory disease that can develop from poorly treated strep throat. Can damage heart valves and cause heart failure.
Etiology: streptococcus pyogenes or group A streptococcus that cause strep throat or scarlet fever.
Signs & Symptoms: Red, swollen, fever, and painful joints, heart palpitations, chest pain, SOB, and skin rash from inflammation of the heart, joints, skin, or CNS.
Treatment: Destroy bacteria, relieve symptoms, and control inflammation. Antibiotics and anti-inflammatory agents.

Question 23

Valvular heart disease

Answer 23

Damage to one or more heart valves resulting in regurgitation (insufficiency or incompetence) or stenosis.
Etiology: Congenital defects, calcific degeneration, infective endocarditis, coronary artery disease, myocardial infarction, and rheumatic fever.
Signs & Symptoms: May include heart palpitations, SOB, chest pain, coughing, ankle swelling, and fatigue.
Treatment: Minimal symptoms may not require treatment. Moderate cases include meds to reduce workload of heart, regulate rhythm, and prevent clotting. Digitalis, diuretics, antiplatelet, and anticoagulant agents, beta blockers, and calcium channel blockers. Severe cases may require balloon valvuloplasty or surgery to repair or replace valve.