cardiovasular alerations week 1

disorder of the pericardium roots from…

• localized manifestation of another disorder (infection, bacterial, fungal, parastitial), tramua, surgery, metabolic immune or vascular disorder

types of pericardium disorders

• acute pericarditis

• constrictive (Restrictive) pericarditis

• pericardial effusion

what is acute pericarditis

• inflammation of the pericardium

what happens when pericardial membranes become inflammed

• release of inflammatory cytokines

• pericardial effusion can occur

what are the clinical manifestations of acute pericarditis?

• several days of fever

• myalgias

• malaise

• sudden onset of severe chest pain in recumbent position

DX of acute pericarditis?

two of the four

• chest pain characterizing pericarditis

• pericardial rub(friction rub)

• electrocardiographic changes

• new or worsening pericardial effusion

• ECHOCARDIOGRAPHY, CT, CMR

TX acute pericarditis?

• EXPLORE UNDERLYING CAUSE

• Salicylates and nonsteroidal anti-inflammatory drugs: combined nonsteroidal and colchicine

• rest

what is constrictive (Restrictive) pericarditis

• fibrous scarring with calcification (harden) pericardium that causes the visceral and parietal layers to stick together

constrictive (Restrictive) pericarditis patho?

• scarred pericardium -→ visceral and parietal layers stick → heart cant expand properly → heart not filling properly → cant pump blood to the body→ decreased output →faitgue/SOB

manifestations of constrictive (Restrictive) pericarditis?

• exercise intolerance

• dyspnea on exertion

• fatigue

• anorexia

• edema

• distended jugular vien

• hepatic congestion

• systematic HYPOTN

TX of constrictive (Restrictive) pericarditis ?

• resist sodium intake

• direutics to improve cardiac output

• anti-inflammatory drugs

• if these are not successful then surgical excision is performed

what is pericardial effusion?

• accumulation of fluid in pericardial cavity

what is tamponade?

• Accumulation of fluid rapidly causes pressure and cardiac compression

• Fluid builds up → pressure on the heart → the heart cannot fill properly → less blood is pumped → decreased cardiac output

disorders of myocardium caused from…

• neurohumoral responses to ischemic heart disease

• hypertension

• unknown

• CAUSES REMODELLING

what are the types of myocardium cardiomyopathies?

• dilated cardiomyopathy

• hypertropic cardiomyopathy

  • hyperthrophic obstructive cardiomyopathy

  • hypertensive or valvular hypertrophic cardiomyopathy

what is dilated cardiomyopathy

• impaired systolic function (heart cannot pump/squeeze blood out properly) → blood does not get pumped effectively → increase in intracardiac volume (more blood stays inside the ventricle) → ventricular dilation (ventricle gets enlarged/stretched) = systolic heart failure

causes of dilated cardiomyopathy?

• ischemic heart disease, valvular disease; diabetes, alcohol, drug toxicity, renal failure; hyperthyroidism, diabetes, deficiencies of niacin, vitamin D and selenium, infection

clinical manifestations dilated cardiomyopathy?

• dyspnea, fatigue, pedal edema

TX of dilated cardiomyopathy?

• reduce blood volume

• increase contractility

• reverse the underlying disorder

what is hypertrophic obstructive cardiomyopathy

• the septum (wall between two ventricles) becomes abnormally thick and buldges into left ventricles outflow tract, making there less room for blood to leave the heart

• thicken septum partially blocks the pathway where blood leaves the left ventricle

  • left ventricle→ narrow pathway →aorta

  • heart works harder to push blood out

causes of hypertrophic obstructive cardiomyopathy

• commonly inherited; runs through families

manifestations of hypertrophic obstructive cardiomyopathy

• angina

• syncope

• palpitations

• MI like symptoms

• left-sided heart failure symptoms

  • since it is harder to fill the thick/stiff ventricle, blood backs up into the lungs→ pulmonary congestion, SOB, crackles, difficulty breathing

TX for hypertrophic obstructive cardiomyopathy

• beta blockers

  • slower heart→less forceful contractions→better filling

• calcium channel blockers

  • slows heart, helps heart relax and improve filling

• surgical resection

  • need to remove some of the extra thick muscle

• septal ablation

  • procedure intentionally destroys small amount of thickened septal muscle

  • prophlyatic placement of an implantable cardioverter-defibllator in high risk indivdual

    • electrical shock to restore safer rhythm

what is hypertensive or valvular hypertrophic cardiomyopathy

• heart is being forced to work harder → heart muscle get thicker to compensate

• increased workload → heart has to work harder → myocytes (heart muscle cells) get bigger → heart wall becomes thicker

• thicker muscle→ less flexible/stiffer ventricles → harder to fill with blood

causes of hypertensive or valvular hypertrophic cardiomyopathy

• hypertension

• valvular disease

manifestations of hypertensive or valvular hypertrophic cardiomyopathy

• person may be asymptomatic

• angina

• syncope

• dyspnea on exertion

• palpitations

what is restrictive cardiomyopathy

• heart muscle becomes rigid and stiff→unable to relax/expand properly → blood has trouble getting into ventricles

• problem with filling during diastole

• blood tries to enter and fill ventricle but it does not hace enough room so pressure builds up because there is no where for blood to go

clinical manifestations of restrictive cardiomyopathy

• right heart failure with systemic venous congestion

  • stiff ventricles→poor filling→increasing filling pressures→right heart becomes affected→blood backs up into systemic veins

• peripheral edema, ascites, JVD, weight gain

tx for restrictive cardiomyopathy

• correct underlying cause

what is valvular dysfunction?

• bad valve→ heart works harder → heart changes → either gets thicker or larger and dilated

manifestations of cardiac valve disease?

• depends on valve involved + type of problem + severity + how quick it develops

TX for valvular heart disease

• careful fluid management

• valvular repair or valve replacement with prostheic valve, with long-term anticogulation therapy and life-long antibotic prophylaxis before invasive procedures

function of a normal valve?

• opens when blood needs to go forward and closes to stop blood from going backwards

what is regurgiation?

• valve does not close properly so the blood goes backwards

what is stenosis?

• valve does not open properly, too narrow

• narrow valve→ blood has difficulty getting through → heart has to push harder → heart muscle works harder

are valve problems inherited or acquired?

• two types;

  • congential

    • valve develops abnormally when the baby's heart is developing

  • acquired

    • develops later in life

why is acquired valve disease more common in adults?

• inflammatory, ischemic, traumatic, degenerative, or infectious alterations of valvular structure and function

• most common cause is degeneration of inflammation of the endocardium secondary to rhematic heart disase

structural alterations of the heart valves are caused …

• remodelling changes in the valvular extracellular matrix and can lead to stenosis incompetence or both

  • if valve is repeatedly damaged → valve structure changes/remodels → valve becomes abnormal → becomes too narrow or unable to close properly

can valve disease be undiagnosed?

• undiagnosed mild valvular disease is present in half of people over the age of 65.

• dont have symptoms

risk factors for valvular heart disease

• age

• gender

• tobacco use

• hypercholesteromia

• rheumatic heart disease

• HTN

• type 2 diabetes

patho of vavlular disease

• valve open and closes about 10 million times every year → constant pressure → constant movement→ wear and tear → valve damage

• the aging and wear and tear causes calcification (calcium to build up in the valve) making the valve hard and stiff.

what factors speed up calcifcation

• hyperlipidemia

• hypertension

• inflammation

what valves are most affected

• aortic valve

• mitral valve

aortic valve calcification

• calcium builds up in the valve cusps

  • cusps (little flaps of valve)

• calcium deposits become to large and fuse cusps together, valve does not open properly

• LEADS TO AORTIC STENOSIS

mitral valve calcification?

• calcium forms around the fibrous annulus (ring around the valve), does not interfere as much with valve but sometimes it can cause regurgitation, stenosis, arrthymias (calcium can interfere with the heart, cause abnormal heart rhythm.

common valves with stenosis

• aortic stenosis

• mitral stenosis

• constricted and narrowed

valvular regurgitation

• valve fails to shut completely

• also called insufficiency or incompetence

• three common valves

  • aortic

  • mitral

  • tricuspid

what can help in determining which valve is abnormal?

• characteristic heart sounds, cardiac murmurs and systemic complaints(symptoms patient reports)

what is mitral valve prolapse syndrome?

• mitral valve bulges backward into left atrium when left ventricle contracts

what is aortic stenosis?

• aortic valve = valve between left ventricle and aorta

• narrowing of the aortic valve means less blood is able to leave the ventricle and less blood gets to the aorta→ less blood reaches body

clinical manifestations of aortic stenosis?

• angina

• syncope

• dyspnea

TX for aortic stenosis?

• valve repair or replacement with prosthetic valve, followed by long term anticoagulation therapy

• transcathether aortic valve implantation

what is mitral stenosis

• mitral valve → left atrium to left ventricle

• narrow of mitral valve so hard time gettin blood from left atrium to left ventricle

• blood cannot get into the Left ventricle

common cause of mitral stenosis?

• acute rheumatic fever

clinical manifestations of mitral stenosis?

• opening snap

  • special heart sound

  • when the stiff and narrow valve opens it makes a sudden “SNAP”

TX for mitral valve stenosis?

• repair the valve

• replace the valve

what is aortic regurgiation

• inability of aortic valve to close during diastole

• aorta leaks back into the LV and adds with the blood coming from LA

clinical manifestations of aortic regurgitation ?

increased stroke volume

• left ventricle pumps extra blood leaked backward during the previous heartbeat, compensates by pumping a larger anmount → higher systolic pressure

• diastolic backflow

  • during diastole, blood leaks from the aorta back into the left ventricle →less blood remains in aorta → lower diastolic pressure

• wide pulse pressure

  • high systolic BP and low diastolic BP

TX for aortic regurgitation

• valve replacement may be delayed for many years, if medications can reduce the workload of the heart

  • vasodilators

    • relax blood vessels, decrease afterload, reduce amount of regurgitation and cardiac workload

  • intotropic agents

    • increase force of ventricular contraction, help the heart pump blood forward

what is mitral regurgitation

• backflow of blood from the left ventricle to the left atrium

what are common causes of mitral regurgitation

• mitral valve prolapse

• rheumatic heart disease

• infective endocarditis

• MI

• connective tissue disease

• dilated cardiomyopathy

TX for mitral regurgitation

• surgical repair or valve replacement

what is tricuspid regurgitation

• volume overload in right atrium and ventricle

• increased systemic venous blood pressure

• right heart failure

what is mitral valve prolapse syndrome

• valve are floppy, when ventricle contracts, they bulge upward in the left atrium

clinical manifestations of mitral valve prolapse syndrome

• asymptomatic

TX for mitral valve prolapse syndrome

• none needed or beta blockers

what is congential heart disease?

• heart condition present at birth

causes of congential heart disease?

• M

  • maternal factors

    • rubella, lupus, insulin-dependant diabetes, alcholism, illict drug use, age >40, pheylektouria, hypercalciuma

• G

  • genetic/chromosal factors

• E

  • environmental factors

four classifications of congestive heart disease

• increased pulmonary blood flow

• decreased pulmonary blood flow

• obstructive lesions

• mixing lesions

increased pulmonary blood flow

• too much blood is going to the lungs → pulmonary congestion

• shunt (shortcut) from the high-pressure left side to the low-pressure right side

• LEFT → RIGHT → LUNGS

• acyanotic; body receiving oxygen-rich blood

decreased pulmonary blood flow

• not enough blood is reaching the lungs

  • RIGHT→ LEFT→ BODY

• skips the lungs

  • THIS IS A PROBLEM BECAUSE blood needs to go to lungs to be oxygenated

• body receives blood with less oxygen

• CYANOSIS

obstructive lesions

• blood is trying to leave the heart but something is narrow/blocking the exit

• blood cannot get out!

• no shunt here

mixing lesions?

• oxygen rich blood and oxygen-poor blood mix together from chambers or arteries of heart

• blood going to body is not oxygen-rich as it should be

• cyanosis can occur

what is acyanotic hear defects

• shunting blood flow from left to right heart is called ; left-to-right-shunt

  • increases volume in right side of heart

  • increased blood flow in pulmonary circulation

  • no decrease in tissue oxygenation or cyanosis since the blood still gets oxygenated before reaching the body

what is cyanotic heart defects

• shunting of blood from right side of heart directly to left side : right to left shunt

  • decreases blood flow through pulmonary system

  • less than normal oxygen delivery to tissues results in cyanosis

what is Patent ductus arterisus (PDA)

• failure of ductus arteriosus to close

  • should close first few hours of birth

• before birth, PDA allows blood to shunt from pulmonary artery to aorta

clinical manifestations of PDA?

• continous, machinery-type murmur

• bounding pulses, active percordium, thrill upon pallopation and signs and symptoms of pulmonary overcirculation

tx of PDA?

• surgical closure involving ligation by incision, cathether or video assisted thoracoscopy

what is atrial septal defect

• hold in right atrium and left atrium

• blood shunts from left to right

• increased pulmonary blood flow

manfestations of atrial septal defect

• often asymptomatic

• diagnosed with a murmur

what are the three types of atrial septal defects?

• ostium secundum

  • hole middle portion of atrial septum

• ostium primum

  • hole in lower portion of atrial septum

• sinus venosus

  • hole near where large veins enter right atrium

TX of atrial septal defect

• surgical closure before school age results in better health

what is ventricular septal defect?

• abnormal communication between ventricles

  • shutning from high pressure left side to low pressure right side

clinical manifestations of ventricular septal defect

• depends on age of child, size of defect and level of PVR (pulmonary vascular resistance)

  • heart failure

  • poor weight gain

  • mumur and systolic thrill

TX of ventricular septal defect

• minimal treatment to surgical repair

what is atrioventricular canal defect?

• endocardial cushion (heart building blocks that help form walls between atria, ventricle and AV valves) ) did not fuse properly

• hole/problem between atria and between ventricles + abnormal AV valves

• complete, partial and transitional AVC defects

manifestations of atrioventricular canal defect?

• murmur, heart failure, resp tract infections

TX for atrioventricular canal defect

• complete repair within 3-6 months

what is conarctation of aorta

• narrowing of the aorta

  • harder for blood to flow through

• usually found in juxtaductal position

  • next to the ductus arteriosus; connects to the aorta

• can occur anywhere from the aortic arch down towards the abdominal aorta

clinical manifestations of conarctation of aorta - newborns

• Newborns usually show HF

  • Once the ductus closes, rapid deterioration occurs from

    • decreased blood flow to the lower body → decreased oxygen delivery + poor circulation → hypotension, acidosis, and shock

clinical manifestations of conarctation of aorta - adults

• hypertension in upper extermities

• decreased or absent pulses in lower exteremities

• cool mottled skin

• leg cramps during exercise

TX for conarctation of aorta

• prostaglandin adminstration

  • helps keep ductus open

• mechanical ventiliation

• inotropic support

  • medications that increase strength of heart contractions

• maintain cardiac output

• surgery

what is aortic stenosis in children

• narrow of aortic valve ; blood has a hard time getting through

• causes increased workload on the left ventricle

cause of aortic stenosis in children

• the aortic valve has cusps which can be malformed or fused together

clinical manifestations of aortic stenosis in children

• often asymptomatic

• exercise intolerance in preadolescence

• syncope episodes

• epigastric pain

• exertional chest pain in more severe forms

• murmur

TX for aortic aortic stenosis

• commissuotomy

  • seperate fused cusps

• aortic valvotomy

  • open/enlarge narrow valve

• ross procedure

  • replace aortic valve with pulmonary valve and replace pulmonary valve with a doner

what is pulmonic stenosis children?

• narrowing of pulmonary valve

  • valve between right ventricle and pulmonary artery

• abnormal thickening of valve leaflets

  • harder for the blood to leave right ventricle and go to lungs

• pulmonary atresia is a severe form

  • closed or absent openeing

  • valve does not open, no blood can pass

pulmonic stenosis children manifestations

• often asymptomatic

• exertional dyspnea

• murmur

• faitgue

• thrill

• cyanosis

• HF

tx for pulmonic stenosis children

• mild; not treated, closely observed

• severe: balloon angioplasty; pulmonary valvotomy

what is tetralogy of fallot?

• syndrome represented by four defects

  • large ventricular septal defect

    • hold between ventricles

  • overriding aorta straddles the ventricular septal defect

    • recieves blood from both ventricles

  • pulmonary stenosis

    • narrow of pulmonary valve

  • right ventricle hypertrophy