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Flashcards in Heart and Blood Vessels Deck (34)
1

Cardiac Failure

Heart unable to pump blood at rate required for normal functioning
Initially the heart ‘Compensates’
Leads to cardiac hypertrophy and/or dilatation, and eventual inability to maintain normal

2

What happens when the heart does not pump as effectively as it should?

Oedema – pulmonary and peripheral
Tiredness

3

Signs/Symptoms of Cardiac failure

Shortness of breath (SOB)
Fatigue
Fluid in lungs (Pulmonary Oedema)
All-over, excessive, fluid-filled veins (Systemic Venous Congestion & Oedema)

4

Valvular Heart Disease - Mechanisms

Stenosis - Failure to open completely, impeding forward flow
Incompetence/Regurgitation - Failure to close, allowing reverse flow
Vegetations – abnormal tissue growth on valve (fibrin, platelets & bacteria)

5

Valvular Heart Disease – Underlying Causes

Infection – Endocarditis/Rheumatic disease
Calcific aortic valve disease
Age-related degeneration
Carcinoid Syndrome
Fibrosis & muscle rupture after MI
Heart failure
Hypertension
Congenital
Prosthetic Heart Valves
Connective Tissue Disorders
IV Drug use

6

Symptoms/Consequences of Valvular disease

Differ with the site/type lesion
Stroke
Arrythmias
Ventricular hypertrophy
Angina (Chest pain)
Syncope (Fainting)
Heart failure
Infarcts to kidneys and spleen
Poor prognosis once symptoms

7

Infective Endocarditis

Endocardium is the inner lining of the heart and its valves.
Endocarditis is when this lining becomes infected/inflamed
Infection occurs on the edge of heart valves
Vegetation is a mass of bacteria, fibrin, platelets
Right-sided in IV drug use
Left-sided in others
Colonization of the heart valves or mural endocardium usually by bacteria
Streptococci (α haemolytic) affects abnormal valves usually after dental extraction / cleaning / bronchoscopy / tonsillectomy
Staph aureus affects previously normal valves, usually IV drug abusers

8

PROPHYLAXIS

Imperative to give antibiotics to those at risk of developing endocarditis prior to any procedure that may produce a bacteraemia

9

Pericarditis & Myocarditis Causes

Viral
Bacterial
Parasitic
TB
Uraemia (urine products in blood)
Carcinoma
MI
Post surgery
Drugs
Connective tissue disease
Radiation

10

Pericarditis &Myocarditis Types

Acute
Chronic

11

Pericarditis & Myocarditis Symptoms and Signs

Chest Pain
Cardiac Failure

12

Pericarditis & Myocarditis Treatment

Anti-inflammatory Drugs
Surgical Excision of the Pericardium

13

Unusual Cardiac Diseases

Cardiomyopathy
Multisystem Diseases – like Sarcoidosis & Amyloidosis
Thyrotoxicosis
Myxoedema
Alcoholism
Pregnancy
Iatrogenic (drug-induced) disease

14

Cardiomyopathy

Disease of the heart muscle

15

Hypertrophic Cardiomyopathy

Heavy, muscular, hypercontracting
Abnormal diastolic filling
1/3 have intermittent left ventricular outflow obstruction
End stage dilatation can occur
Myocardial hypertrophy, disarray

16

Clinical Features of Hypertrophic cardiomyopathy

SOB, chest pain, palpitations, black-out
Sudden death
Atrial fibrillation

50% Familial, autosomal dominant with variable expression
Genetic defect in 1 of 4 genes that encode cardiac contractile elements

17

Aneurysms

Localised, permanent, abnormal dilatation of a blood vessel

18

Types of Aneurysm

Atherosclerotic
Aortic Dissection
Berry
Micro-Aneurysms
Syphilitic
Mycotic (infective)

19

Hypertension

BP is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats)
Measured in millimeters of mercury - mmHg
eg 120/80 mm Hg
120/80mmHg or lower is classed as normal BP
No universal definition of what exactly is high
BP 140/90 offered 24hr ambulatory monitoring
Categories:
Mild: diastolic 95 – 104mmHg
Moderate: 105 – 114mmHg
Severe: >115mmHg

20

Benign Hypertension

Most remain stable over many years
live a relatively normal life
until/unless complications arise

21

Malignant Hypertension

Accelerated Hypertensive disease
5% of cases
Rapidly rising blood pressure
90% die in the first year!

22

Complications of Hypertension: Blood Vessels

Large Blood Vessel disease (Macroangiopathy)
Atherosclerosis
Small Blood Vessel disease (Microangiopathy)
Arteriolosclerosis
Increased risk of rupture
and dissection, & MI

23

Complications of Hypertension: Heart

Heart disease:
Left ventricular hypertrophy
Cardiac Failure
Myocardial Infarction

24

Complications of Hypertension: Kidney

Benign nephrosclerosis
Renal failure

25

Complications of Hypertension: Eyes (Retina)

Hypertensive retinopathy
Retinopathy Grades:
Grade I Thickening of arterioles

Grade II Arteriolar spasms

Grade III Hemorrhages

Grade IV Papilloedema (seen in Malignant Hypertension)

26

Complications of Hypertension: Brain

Cerebral haemorrhage
Cerebral infarction

27

Factors Indicating Adverse Prognosis in Hypertension

Male
Young
Black Ethnicity
Smoker
Persistent diastolic BP > 115 mm Hg
Diabetes
Hypercholesterolemia
Obesity
Excess alcohol
Organ damage: Heart, Kidney, Eyes, Brain

28

Diabetic Vascular Disease

Damage to Vessels Generally - Atherosclerosis
Damage to Kidneys
Damage to Nerves
Damage to Retinas
Complications such as:
Gangrene
Renal failure
Blindness
Effective control of Diabetes reduces disease!

29

Venous Thrombosis
(eg DVT)

When normal venous return is impeded, predisposes to Thrombosis

30

Varicosities

Common Problem
Tortuous and Distended veins
Cause
Incompetent valves in legs
Impaired venous return
stasis
oedema
fibrin deposits around veins
Often associated Ulceration – ankles and lower legs

31

Congenital Cardiovascular Disease – Commonest Types

Septal defects - Atrial or Ventricular
Failure of blood vessel closure at birth - Patent Ductus Arteriosus
Narrowed Aorta - Coarctation of the Aorta
Valvular Abnormalities
Vessels the wrong-way round - Transposition of the great vessels
Coronary artery defects
Multiple defects - Fallot’s Tetralogy

32

Causes of aneurysms

Causes: Age, Atherosclerosis, Ischaemia, Hypertension, Inflammation, Diabetes, Autoimmune diseases, Bacteria, Bacterial Endocarditis, Fungus, Marfan’s Syndrome, Syphilis

33

Treatment of Aneurysms

Treatment: Stents, Surgery, reducing arterial pressure

34

Causes of Venous Thrombosis
DVT

Causes:
Immobility
Malignancy
Pregnancy & Childbirth
Oestrogens
Haematological disorders
IV cannulas
Danger of PE