Comprehensive Cardiovascular Pathophysiology and Disease Management

Cardiovascular diseases

Leading cause of death globally.

Atherosclerosis

Loss of elasticity/plasticity & accumulation of fatty acids in arterial linings resulting in occlusion of blood vessels, resistance to blood from decreased systemic circulation, thrombi/emboli/aneurism.

Coronary artery disease (CAD)

Obstruction that limits blood flow to the heart muscle, but may not inhibit heart muscle function.

Peripheral artery disease (PAD)

Obstruction that limits blood flow to extremities (usually leg) with gradual onset.

Coronary heart disease (CHD)

Obstruction that causes permanent damage to heart muscle, limiting heart function.

Angina

Chest pain.

Shortness of breath

Difficulty in breathing.

Pain/weakness in extremities

Discomfort or lack of strength in limbs.

Confusion

Can lead to vascular dementia.

Clot formation

Leading to stroke, renal disease, ischemic abdomen.

Epidemiology/risk factors

Factors that can influence the occurrence of cardiovascular diseases.

Heredity

Genetic predisposition to cardiovascular diseases.

Diabetes/metabolic syndrome

Condition that increases the risk of cardiovascular diseases.

Smoking

Tobacco use that increases cardiovascular disease risk.

Sex

Males are at higher risk than females.

Cholesterol levels

High LDL and low HDL levels increase cardiovascular disease risk.

Inflammatory diseases

Conditions that can contribute to cardiovascular disease.

Age

Males over a certain age and females over a certain age are at higher risk.

Diet

Nutritional habits that can affect cardiovascular health.

Lack of physical activity

Sedentary lifestyle that increases cardiovascular disease risk.

Medical diagnosis/testing

Methods used to identify cardiovascular diseases.

Bloodwork

Laboratory tests to assess health indicators related to cardiovascular diseases.

Angiography

Imaging technique to visualize arteries and assess the degree of stenosis and plaque.

Ankle brachial index (ABI)

Compares blood pressure in the ankle and arm.

Stress test

Physical/chemical test that records activity tolerance and determines risk of CAD/PAD.

ECG

Only 12-lead ECG is considered diagnostic.

Statins

Most common medication intervention to control high cholesterol.

Hypertension (HTN)

A condition characterized by consistently high pressure in blood vessels, often due to increased peripheral resistance, usually caused by atherosclerosis.

Clinical Signs/symptoms of Hypertension

Often symptom free; may include headache, ringing in ears, dizziness, chest pain, dysrhythmia, difficulty breathing, nausea/vomiting, anxiety/confusion, fatigue/weakness, vision changes, and nosebleeds.

Epidemiology/risk factors for Hypertension

Modifiable factors include heredity, smoking, diabetes/metabolic syndrome, diet, cholesterol levels, overweight, age, physical inactivity, race, stress, and other diseases.

Medical diagnosis/testing for Hypertension

Includes high BP detected at 2+ separate instances, assessment of risk factors, end-organ damage, 12-lead EKG, bloodwork, imaging, and ankle-brachial indices (ABI).

First medication intervention for Hypertension

Includes diuretics and beta-blockers to control abnormal rhythms.

Cardiomyopathy

A heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction, usually with inappropriate ventricular hypertrophy or dilation.

Etiology of Cardiomyopathy

Can be primary (confined to the heart) or secondary (systemic disease involving other organ systems).

Dilated Cardiomyopathy

The most common form of cardiomyopathy, characterized by dilation and poorly functioning left ventricle with relatively normal wall thickness, leading to progressive heart failure.

Hypertrophic Cardiomyopathy (HCM)

An inherited condition where the left ventricle is hypertrophied but not dilated, causing decreased chamber size and potential blockage of flow out of the left ventricle.

Restrictive Cardiomyopathy

Characterized by normal/near-normal systolic function but reduced diastolic volume, often due to infiltrative processes preventing full ventricular relaxation.

Clinical signs/symptoms of Cardiomyopathy

Includes shortness of breath (even at rest), lightheadedness, edema of lower extremities, fatigue, swollen stomach, weight gain, and chest pain.

Epidemiology/risk factors for Cardiomyopathy

Modifiable factors include excessive alcohol use, heart attack, family history, diabetes, age, cancer treatment, damage to myocardium, uncontrolled hypertension, and pregnancy.

Heart Failure (HF)

A complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood.

PT Implications for Hypertension

Includes monitoring vital signs during sessions, challenging patients with exercise goals, and encouraging lifestyle changes.

Lifestyle medicine education

Involves nutrition, physical activity, restorative sleep, stress management, social connection, and avoidance of risky substances.

Progression of Cardiomyopathy

Leads to heart failure, characterized by reduced cardiac output and potential arrhythmias.

Symptoms of Heart Failure

May include shortness of breath, fatigue, and edema.

Risk factors for Heart Failure

Include structural or functional impairments of the heart.

Assessment of risk factors for Hypertension

Involves evaluating lifestyle choices, family history, and existing health conditions.

Assessment of end-organ damage for Hypertension

Includes evaluating the impact of high blood pressure on organs such as the heart and kidneys.

Imaging techniques for Hypertension

May include carotid ultrasound, echocardiogram, and brain imaging.

Ankle-brachial indices (ABI)

A test used to assess blood flow and detect peripheral artery disease.

Diuretics

Medications used to help reduce blood pressure by eliminating excess fluid.

Beta-blockers

Medications that help control heart rate and lower blood pressure.

Dysrhythmia

An irregular heartbeat that can occur as a symptom of hypertension or heart failure.

Coronary Artery Disease

A common cause of heart failure resulting from the narrowing of coronary arteries.

Ejection Fraction

A measurement of the percentage of blood leaving the heart each time it contracts.

HFrEF

Heart failure with reduced ejection fraction, defined as LVEF ≤ 40%.

HFpEF

Heart failure with preserved ejection fraction, defined as LVEF ≥ 50%.

NYHA Classification

A classification system for heart failure based on the severity of symptoms.

ACC/AHA Stages

A classification system for heart failure that includes stages A through D based on risk and symptom severity.

Stage A

At risk for HF; risk factors present such as hypertension, diabetes, and metabolic syndrome.

Stage B

Pre-heart failure; structural heart disease or evidence of elevated filling pressure.

Stage C

Symptomatic heart failure; symptoms present with structural heart disease.

Stage D

Advanced heart failure; refractory symptoms that interfere with daily life or cause recurrent hospitalization.

Class I (NYHA)

Symptom onset with more than ordinary level of activity.

Class II (NYHA)

Symptom onset with ordinary level of activity.

Class III (NYHA)

Symptom onset with minimal activity.

Class IV (NYHA)

Symptoms at rest.

Left-sided Heart Failure

Characterized by reduced cardiac output and pulmonary congestion.

Right-sided Heart Failure

Commonly caused by conditions that elevate pressures in the pulmonary arterial system.

Biventricular Heart Failure

Usually seen during acute heart failure exacerbation.

Systolic Heart Failure

Heart failure with reduced ejection fraction.

Diastolic Heart Failure

Heart failure with preserved ejection fraction.

Compensated Heart Failure

Stable heart failure with no pulmonary or venous congestion.

Decompensated Heart Failure

Acute exacerbation with new or worsening signs and symptoms.

Clinical Manifestations of HF Exacerbation

Hallmark signs include dyspnea, increased congestion, dry cough, and jugular venous distention.

Myocardial Infarction (MI)

Decreased or complete cessation of blood flow to a portion of the myocardium.

Ischemia

Decreased blood flow resulting in hypoxia, which can be reversible.

Infarction

Complete blockage of flow resulting in necrosis or death of tissue.

Cold sweat

Sweating that feels cold.

Feeling of indigestion

A sensation of fullness or choking; includes heartburn.

Nausea

A feeling of sickness with an urge to vomit.

Weakness

A lack of strength.

Anxiousness

A state of feeling worried or uneasy.

Lightheadedness

A sensation of dizziness.

Fast heartbeat

An irregular or rapid heartbeat.

Stable angina

Regular occurrence of chest pain with anticipated triggers, relieved in the same way.

Unstable angina

Unpredictable chest pain that is not easily relieved.

Risk factors for heart disease

Includes anemia, early menopause, endometriosis, pregnancy complications, and hormonal birth control.

Non-modifiable risk factors

Heredity and sex (male or female).

Modifiable risk factors

Smoking, obesity, and high cholesterol levels.

Manageable risk factors

Age, sedentary lifestyle, diabetes, stress, and alcohol use.

Medical diagnosis requirements

Diagnosis requires 2 of the following: biomarker detection, symptoms of ischemia, abnormal EKG changes.

Cardiac troponins

Serial testing at 0 and 3 hours to detect heart damage.

Peripheral Venous Disease

Inability of lower extremity veins to return blood to the heart.

Chronic venous insufficiency (CVI)

Inadequate venous return over a long period of time.

Clinical manifestations of CVI

Includes edema, slow healing wounds, skin changes, cramps, varicose veins, heaviness, and pain.

Duplex ultrasound

A medical imaging technique used to assess blood flow.

Magnetic resonance venogram (MRV)

An imaging test that uses magnetic resonance imaging to visualize veins.

PT implications

Includes systemic support through physical activity and exercise.

Lymphatic drainage

A treatment technique to promote the flow of lymph.

Lifestyle medicine

An approach to treating disease by changing lifestyle factors.