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Acquired Diseases
Atherosclerosis - hardening of the arteries Scintigraphy - A diagnostic test in which a two-dimensional picture of a body radiation source is obtained through the use of radioisotopes Syndrome X - ... Coronary artery disease (CAD) - Which Cardiovascular disease is the leading cause of death in the U.S. CAD - −Atherosclerotic narrowing of one or more of the coronary blood vessels with fatty deposits called atheromas −Resulting in diminished flow of blood to the myocardium -High LDL levels -Advanced lesion - Pathogenesis of Coronary Artery Disease Atherosclerosis: - -Strong hereditary history -Cigarette smoking -Lack of exercise -Excessive saturated fat intake -High cholesterol intake -Male gender -Diabetes mellitus -Tortuous vessels -Obesity -Lipid metabolism defect •Angina pectoris
•Classic Stable Angina •Variant Angina •Post Infarction Angina •Patient reaction to angina •Diagnosis •Relief of Angina - Angina Principle Symptoms of Heart Disease - •Dyspnea •Chest pain or discomfort •Cyanosis •Syncope •Palpitation •Edema •Cough •Hemoptysis •Fatigue •Nocturia •Anorexia •Nausea and vomiting •Fever Class I Patients - -No resulting limitations of physical activity. Class II Patients - -Slight limitations of physical activity. -Comfortable at rest. Class III - -Marked limitations of physical activity Class IV - -Inability to carry on any physical activity without discomfort.
-Heavy meals -Emotional distress - Symptoms of chronic Angina may be provoked by which 3 factors Pain associated with Chronic stable Angina - -May radiate along the ulnar aspect of the left arm, throat, jaw, interscapular region, and epigastrium. -Often accompanied by shortness of breath, nausea, and diaphoresis. -Typically pain lasts about 5 minutes Other chest pains simiiliar to Angina - Chest pain similar to acute unstable angina or acute but acute MI pain is usually unremitting. •Other causes of chest pain: -Aortic stenosis -Hypertrophic cardiomyopathy -Microvascular dysfunction -Pericarditis -Aortic dissection -Pulmonary embolism -Pleuritis -Acid reflux -Esophageal spasm -Peptic ulcer disease -Biliary disease -Pancreatitis -Gastroesophageal reflux disease -Cervical disk disease -Costochondral syndromes -Shingles -Panic disorder
Acute Coronary Syndromes (ACS) - •Acute or subacute imbalance between the oxygen demand and supply of the myocardium. Three principal presentations of ACS: - -Angina that begins with a patient at rest. -New onset of severe angina (associated with minimal exertion). -A distinct change in frequency, duration or threshold. Differential diagnosis of ACS: - -Musculoskeletal disorders -Gastrointestinal causes -Intrathoracic processes -Neuropsychiatric syndromes Acute Myocardial Infarction - -May simulate the pain of acute pericarditis, peptic ulcer disease or stress gastritis -Deep, dull steady pain Dilated Cardiomyopathy - •Characterized by enlargement of one or both ventricles accompanied by systolic and diastolic contractile dysfunction Hypertrophic Cardiomyopathy - •Unexplained myocardial hypertrophy Restrictive Cardiomyopathy - -Characterized by variable degrees of diastolic dysfunction out of proportion to systolic dysfunction -Often confused with constrictive pericarditis Myocarditis - -Inflammation of the myocardium, may include involvement of the myocytes, the interstitium, and /or the vasculature. -Myocarditis is typically a diagnosis of exclusion after other causes of clinical presentation have been excluded.
Mitral Valve Prolapse - -Superior and posterior displacement of one or both leaflets into the left atrium during systole. -Classified as primary, secondary, or functional -Results in a ―click‖ murmur Aortic Insufficiency - •Defective functioning of the aortic valve with incomplete closure resulting in aortic regurgitation •Results in a loud diastolic murmur •Eventually leads to LV dilation Tricuspid Stenosis - •Pathological narrowing of the tricuspid valve. •Usually congenital, and very rare in adults Tricuspid Regurgitation - •Backflow of blood from the right ventricle into the right atrium due to insufficiency of the tricuspid valve. •Results in a diastolic murmur. Pulmonic Stenosis - -Right ventricular obstruction. May be: •Subvalvular •Valvular •Supravalvular Pulmonic Insufficiency - •Backflow of blood from the pulmonary artery into the right ventricle due to insufficiency of the pulmonic semilunar valve. Infective Endocarditis - •Infection of the endocardial surface of the heart and implies a physical presence of microorganisms in the lesion. •Usually involves the valves •Caused by Staph infection, IV drug use, or other infective process
Acute Pericarditis - •Inflammation of the pericardium Chronic Recurrent Pericarditis - -Recurrent or chronic symptoms develop in approximately one quarter of patients. -Most patients are treated with reinstitution of nonsteroidal anti-inflammatory agents or steroids Constrictive Pericarditis - •Characterized by dense, fibrous thickening of the pericardium that adheres to and encases the myocardium, resulting in impaired diastolic ventricular filling. Pericardial Effusion - -Malignancy -Postoperative causes -Cardiac perforation during a percutaneous procedure Systemic Hypertension - -Disorder of BP regulation that results from: •Increase in cardiac output •Increase in total peripheral vascular resistance -Results in left ventricular hypertrophy -Generally characterized by systolic blood pressure greater than 120 mm/hg
