Systemic effects of cardiovascular disease Flashcards
Define cardiac failure
Failure of the heart to pump sufficient
blood, and deliver sufficient oxygen, to satisfy
metabolic demands]resulting in under perfusion which may cause fluid retention and increased BV
• Acute heart failure
– rapid onset of symptoms, often with definable cause e.g. myocardial infarction
• Chronic heart failure
– slow onset of symptoms, associated with, for
example, ischaemic or valvular heart disease
• Acute-on-chronic heart failure
– chronic failure becomes decompensated by an acute event
Systolic failure
- Failure of the pump to move blood in systole
- Reduced ejection fraction
- Reduced ventricular contraction
Systolic failure causes
- Myocardial ischaemia
- Myocardial infarction
- Myocardial scarring
- Myocarditis
- Drugs eg alcohol, anti-cancer cytotoxics, cocaine
- Muscular disorders eg DMD
systolic failure effects
- Reduced cardiac output
- Feedback to atria and right side of heart
- Pulmonary oedema then
- Peripheal oedema
support is used to treat
Diastolic failure
- Failure of ventricular wall to relax
- Restrictive, stiff ventricle
- Reduced ventricular filling leads to reduced blood for systole •Elevated end diastolic pressure
causes of diastolic failure
•Scarring plus most causes of systolic •Infiltrative disease eg amyloid
effects of diastolic failure
- None
- Pulmonary and peripheral oedema •Response to exercise
- Tachycardia and pulmonary acute oedema
treatment is to reduce the conduction of the AV node
right ventricular heart failure
effects the systemic
left ventricular heart failure
effects the pulmonary
Left ventricular failure
- Particularly resulting from hypertensive and ischaemic heart failure
- Causes pulmonary oedema, with associated
- symptoms
- Leads to pulmonary hypertension and, eventually, right ventricular failure
- Combined left and right ventricular failure often called ‘congestive’ cardiac failure
Right ventricular failure common causes
- Secondary to left ventricular failure
- Related to intrinsic lung disease
- ‘Cor pulmonale’ due to pulmonary hypertension
- Primary pulmonary hypertension
Clinical features pf heart failure
• “Forward” failure
– Reduced perfusion of tissues
– Tends to be more associated with advanced failure
• “Backward” failure
– Due to increased venous pressures
– Dominated by fluid retention and tissue congestion
Key features of the clinical examination inpatients with heart failure
• Appearance -alertness, nutritional status, weight
• Pulse rate -rhythm, and character
• Blood pressure -systolic, diastolic, pulse
pressure
• Fluid overload -jugular venous pressure
• Peripheral oedema -(ankles and sacrum),
hepatomegaly, ascites
• Respiratory rate, crackles, effusion (transudate)
• Apex displacement, gallop rhythm, third heart sound, flow murmurs suggesting valvular dysfunction
B-natriuretic protein
one of of the natriuretic peptide hormone family, produced by ventricular muscle. It is a stress response protein that increases in heart failure.
other types of BNP
- ANP produced in atrial muscle
- CNP from large blood vessels
- DNP present in blood probably originates from heart
roles of BNP
- Vessel dilatation
- Natriuresis
- Modulation angiotensin and aldosterone
- Reduction in blood pressure
Systemic hypertension
• Classification
– Primary vs secondary (based on cause)
– Benign vs malignant (based on clinical presentation)
– (be aware of the previous use of the term “essential” hypertension)
definition of systemic hypertension
– Persistent raised blood pressure above 140/90 mmHg (Framingham,Multiple Risk Factor Intervention Trial –both suggest systolic pressure more important in determining cardiovascular risk)
• Optimal BP
120/80 mm Hg
– Normal <130/<85 mm Hg
– High normal 130-139/85-89 mm Hg (labelled ‘pre- hypertension’ in the USA)
• Hypertension and grades
– Mild hypertension Grade 1 140-159/90-99 mm Hg
– Moderate hypertension Grade 2 160-179/100-109 mm Hg
– Severe hypertension Grade 3 180/110 mm Hg
• Isolated systolic hypertension
– Grade 1 140-159/<90 mm Hg
– Grade 2 160/<90 mm Hg
Causes of secondary hypertension
- Renal disease
- Endocrine disease
- Others
- Drugs and toxins,
Describe the end-organ effects of systemic hypertension - essential
• Slow changes in vessels and heart with chronic end-organ dysfunction
Describe the end-organ effects of systemic hypertension - malignant/accelerated
• Rapid changes in vessels with acute end- organ dysfunction
effects of systemic hypertension on the heart
• Left ventricular hypertrophy – Fibrosis – Arrhythmias • Coronary artery atheroma – Ischaemic heart disease • Cardiac failure
effects of systemic hypertension on the kidney
• Nephrosclerosis
– Drop-out’ of nephrons due to vascular narrowing
– Proteinuria
– Haematuria
• Chronicrenalfailure
• Acuterenalfailure associated with malignant hypertension
effects of systemic hypertension on the brain
Atherosclerosis Ischaemia and TIA Infarct Haemorrhage
Describe the causes of pulmonary hypertension
• Increased pulmonary vascular resistance
• Diffuse lung disease, for example COPD
• Elevated left atrial pressure e.g. left ventricular failure, mitral valve stenosis
• Recurrent pulmonary emboli
• Primary pulmonary hypertension (unknown
cause) - genetics
• Left-right shunts e.g. ASD, VSD
Describe the end-organ effects of pulmonary hypertension
- Pulmonary arteries
- Heart
- Treat underlying cause, give symptomatic relief, transplant
