cardiovascular diseases

Atherosclerosis

Disease where fats, cholesterol and other substances build up in artery walls and form plaque

Coronary Artery Disease

Common heart condition where major blood vessels supplying the heart struggle to deliver oxygen rich blood

Stable plaque

Thick, well developed fibrous cap

Produces predictable symptoms (stable angina)

Vulnerable plaque

Thin fibrous cap over large, lipid rich core

Can rupture, hemorrhage

Sinus bradycardia

SA node fires less than 60 bpm

Can be normal in trained athletes

Heart block

Delayed or blocked conduction through the AV node or His-Purkinje system

Supraventricular tachyarrhythmias

A-fib, loss of atrial kick, reduces CO2 by 20-30%

Ventricular tachycardia (V-tach)

Sustained rapid ventricular rate, often from a reentry circuit around scar tissue

Ventricular fibrillation (V-fib)

Chaotic, disorganized ventricular activity – no effective cardiac output

Stable angina

Fixed plaque, predictable with exertion, relieved by rest

Unstable angina

Acute plaque change – rupture, hemorrhage, or erosion

Variant angina

Coronary artery vasospasm often at rest, occurs at rest, often early morning, ST elevation

STEMI

Full thickness wall involvement, complete coronary occlusion

ST segment elevation, evolving Q waves

NSTEMI

Innermost layer only, incomplete occlusion

ST depression, T wave inversion, no Q waves

Left Heart Failure

Dyspnea, orthopnea

Pulmonary crackles, S3 gallop

Fatigue weakness

Pallor, cyanosis

Right Heart Failure

Peripheral edema, jugular vein distension, weight gain from fluid retention

Most common cause: left sided HF

Dilated cardiomyopathy

All 4 chambers dilate, ventricular mass dec., systolic function dec., reduced ejection fraction, biventricular failure

Hypertrophic cardiomyopathy

Marked ventricular hypertrophy, preserved/inc. ejection fraction

Often hereditary, leading cause of sudden death in athletes  

Restrictive cardiomyopathy

Rigid, noncompliant ventricular walls, normal chamber size

Impaired diastolic filling, systolic function preserved

stenosis

Valve fails to open properly, chamber behind it must generate more pressure to maintain output, leads to pressure overload

Insufficiency (regurgitation)

Valve fails to close completely – blood leaks backward

Chamber behind it dilates to accommodate the extra volume, volume overload

Pericarditis

Inflammation of the pericardium. Sharp chest pain worsened by breathing/lying supine, relieved by sitting forward

Endocarditis

Infection of the endocardium/valves, usually bacterial, risk from IV drug use, prosthetic valves, dental/GI procedures

Pericardial effusion & tamponade

Fluid accumulation in the pericardial sac, rapid accumulation -> tamponade: elevated intrapericardial pressure restricts ventricular filling -> dec. CO, dec. BP, inc. HR medical emergency

Myocarditis

Inflammation of the myocardium, often viral. May cause chest pain, arrhythmia, and HF. Often follows respiratory illness

Aneurysm

Localized dilation of the full vessel wall, most common in abdominal aorta, below renal arteries, often asymptomatic

Aortic dissection

Tear in the intima allows blood to dissect through the media, splitting the vessel wall

Most commonly driven by chronic hypertension, also seen with Marfan syndrome

Often mimics MI – always a key differential for acute chest/back pain

Peripheral arterial disease

Atherosclerotic occlusion of the aorta, iliac and femoral arteries – same disease as CAD, different territory