1. Cardiac involvement is common in many systemic diseases but often goes unrecognized as symptoms tend to manifest in other organ systems.
2. Diseases like lupus and rheumatoid arthritis can cause pericarditis, myocarditis, and heart valve issues.
3. Conditions involving the endocrine system like hyperthyroidism and hypothyroidism impact heart rate, blood pressure, and cardiac contractility.
The document discusses various pericardial diseases including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade. It provides details on the anatomy and functions of the pericardium, pathophysiology, clinical features, diagnostic tests, and management of these conditions. Key points include that pericardial diseases can present with non-specific symptoms, clinical suspicion is important for diagnosis, and treatment depends on underlying etiology and presence of hemodynamic compromise. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important as treatment approaches differ significantly.
1. Systemic diseases like autoimmune disorders can involve the cardiovascular system and cause manifestations such as pericarditis, coronary artery disease, cardiomyopathy, and congestive heart failure.
2. Diseases such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory myopathies commonly affect the heart.
3. Many systemic diseases are associated with accelerated atherosclerosis and premature cardiovascular disease due to chronic inflammation.
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
Arrhythmogenic right ventricular dysplasiaDomina Petric
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited heart muscle disease characterized by structural abnormalities and fatty replacement of the right ventricle muscle leading to ventricular arrhythmias. It is an important cause of sudden cardiac death in young adults. The disease results from genetic mutations that cause programmed cell death and fibrosis of the right ventricle muscle. Diagnosis is based on ECG findings like inverted T-waves in the right ventricle leads and epsilon waves, along with imaging showing right ventricle structural changes. Treatment involves medications like beta-blockers and implantable defibrillators to prevent arrhythmias.
Refractory heart failure - Diagnosis, Management, Device TherapyImran Ahmed
This document summarizes information about heart failure (HF), including:
1) HF is a major public health problem worldwide, affecting over 23 million people, with rates increasing with age.
2) Stages of HF range from risk factors to end-stage disease and influence treatment approaches.
3) Implantable devices like ICDs and CRT have been shown to improve symptoms and reduce mortality in HF, though guidelines around their use continue to be refined.
4) Ongoing research is exploring expanding the use of CRT to additional patient populations like those with narrow QRS complexes or milder disease.
The document discusses various pericardial diseases including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade. It provides details on the anatomy and functions of the pericardium, pathophysiology, clinical features, diagnostic tests, and management of these conditions. Key points include that pericardial diseases can present with non-specific symptoms, clinical suspicion is important for diagnosis, and treatment depends on underlying etiology and presence of hemodynamic compromise. Differentiating constrictive pericarditis from restrictive cardiomyopathy is important as treatment approaches differ significantly.
1. Systemic diseases like autoimmune disorders can involve the cardiovascular system and cause manifestations such as pericarditis, coronary artery disease, cardiomyopathy, and congestive heart failure.
2. Diseases such as rheumatoid arthritis, systemic lupus erythematosus, and inflammatory myopathies commonly affect the heart.
3. Many systemic diseases are associated with accelerated atherosclerosis and premature cardiovascular disease due to chronic inflammation.
Restrictive cardiomyopathy is characterized by stiff ventricles that do not fill properly, though systolic function is usually preserved initially. It can be caused by infiltrative diseases, fibrosis, or other processes that restrict ventricular filling. On echocardiogram, restrictive cardiomyopathy shows impaired ventricular filling and enlarged atria, while cardiac catheterization reveals elevated diastolic pressures and a distinctive "square root sign" pressure tracing. Treatment focuses on managing symptoms and underlying causes if identifiable, though prognosis is often poor without transplantation.
- Constrictive pericarditis results from scarring and loss of elasticity of the pericardial sac, typically due to chronic inflammation and sometimes calcification. This causes the pericardium to thicken and lose its ability to expand and contract normally.
- The inelastic pericardium prevents normal filling of the heart chambers, especially in mid to late diastole. Inspiration does not decrease pressure in the left ventricle as it normally would due to the thickened pericardium isolating the heart.
- Diagnosis involves physical exam findings like elevated JVP, hepatomegaly, and Kussmaul's sign combined with echocardiography findings like sept
This document provides information on restrictive cardiomyopathy (RCM), including its definition, classification, etiology, symptoms, diagnosis, and treatment. Some key points:
- RCM is characterized by diastolic dysfunction with a stiffened myocardium that impairs ventricular filling. It is usually not associated with ventricular dilation or hypertrophy.
- Causes include infiltrative diseases of the myocardium (e.g. amyloidosis, sarcoidosis), endomyocardial fibrosis, and genetic/familial factors.
- Symptoms are related to reduced cardiac output and include dyspnea, fatigue, arrhythmias. Diagnosis involves echocardiogram, cardiac catheterization and MRI to evaluate
Ventricular tachycardia can occur due to various causes like acute myocardial infarction, chronic infarction, dilated cardiomyopathy, etc. It is classified as sustained, non-sustained, monomorphic, polymorphic, etc. based on characteristics. Diagnosis involves ECG, echocardiogram, and monitoring. Treatment depends on hemodynamic stability and includes electrical cardioversion, antiarrhythmic drugs like amiodarone, lidocaine, ablation, and ICD implantation in selected cases. Recurrence risk is high in structurally abnormal hearts and prevention involves controlling triggers, antiarrhythmics, and ICDs.
Arrhythmogenic right ventricular dysplasiaDomina Petric
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited heart muscle disease characterized by structural abnormalities and fatty replacement of the right ventricle muscle leading to ventricular arrhythmias. It is an important cause of sudden cardiac death in young adults. The disease results from genetic mutations that cause programmed cell death and fibrosis of the right ventricle muscle. Diagnosis is based on ECG findings like inverted T-waves in the right ventricle leads and epsilon waves, along with imaging showing right ventricle structural changes. Treatment involves medications like beta-blockers and implantable defibrillators to prevent arrhythmias.
Refractory heart failure - Diagnosis, Management, Device TherapyImran Ahmed
This document summarizes information about heart failure (HF), including:
1) HF is a major public health problem worldwide, affecting over 23 million people, with rates increasing with age.
2) Stages of HF range from risk factors to end-stage disease and influence treatment approaches.
3) Implantable devices like ICDs and CRT have been shown to improve symptoms and reduce mortality in HF, though guidelines around their use continue to be refined.
4) Ongoing research is exploring expanding the use of CRT to additional patient populations like those with narrow QRS complexes or milder disease.
Heart failure (what a family physician need to know)Ahmed Abouelela
Heart failure is a leading cause of hospitalization in those over 65. The family physician plays an important role in prevention through risk factor assessment, lifestyle counseling, and monitoring for signs and symptoms. When detected early, heart failure has a better prognosis than many cancers. Treatment involves medications like ACE inhibitors, ARBs, diuretics and beta-blockers to reduce symptoms and disease progression.
This document discusses sudden cardiac death (SCD), providing information on:
- SCD is an unexpected death from cardiac causes within one hour of symptoms. It often occurs in people with known or unknown heart disease.
- Autopsies show most SCD victims had prior heart attacks or coronary artery disease. About 92% of SCD victims do not survive.
- Risk factors for SCD include age, male sex, family history of heart disease, smoking, diabetes, and high blood pressure. EKG abnormalities like prolonged QT also increase risk.
- Causes of SCD include coronary artery disease, cardiomyopathies, genetic conditions, and electrical issues in the heart. The most common mechanism is
determining the suitability of the mitral valve for repair most likely in patients with mitral regurgitation due to myxomatous degeneration and is least likely in patients with regurgitation due to endocarditis most likely with posterior prolapse or flail, whereas ileaflet involvement and isolated anterior leaflet prolapse reduce the likelihood of successful repair substantially.
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
The document discusses several types of congenital heart diseases that can present in adults, including atrial septal defects, ventricular septal defects, patent ductus arteriosus, coarctation of the aorta, tetralogy of Fallot, Ebstein's anomaly, and transposition of the great arteries. It provides details on the anatomy, clinical presentation, diagnostic workup, and treatment options for each condition.
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
Dilated cardiomyopathy is characterized by an enlarged and poorly contracting left ventricle. The main causes include inflammatory, toxic, metabolic, inherited, idiopathic and miscellaneous factors. On evaluation, patients typically present with decreased cardiac output, tachycardia and signs of congestion. Tests include echocardiogram, which shows increased left ventricular size and reduced ejection fraction, and ECG, which may show conduction delays. Treatment focuses on managing symptoms with diuretics and blocking neurohormonal activation to prevent worsening, while devices like ICDs are used in eligible patients.
1. Chronic coronary syndromes (CCS) refer to conditions involving atherosclerotic plaque buildup in the coronary arteries that can cause various clinical presentations depending on the dynamic nature of the disease process.
2. The most common clinical scenarios in patients with suspected or established CCS involve those with stable angina symptoms, new onset of heart failure, recent acute coronary syndrome, or asymptomatic patients more than 1 year after initial diagnosis or revascularization.
3. Evaluation and management of patients with suspected CCS involves assessing symptoms, risk factors and comorbidities, performing basic testing, estimating pre-test probability of CAD, selecting appropriate non-invasive testing to confirm diagnosis when needed, calculating risk, and determining long-
Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
The document discusses pericarditis, pericardial effusion, cardiac tamponade, and chronic constrictive pericarditis. It describes the functions of the pericardium, signs and symptoms, diagnostic tests including EKG changes and imaging, and treatments for the different conditions including medications, pericardiocentesis, and pericardial stripping. Chronic constrictive pericarditis results from scarring and thickening of the pericardium limiting ventricular filling, with symptoms of exertional dyspnea and elevated jugular venous pressure.
Brugada Syndrome is a genetic cardiac condition characterized by an abnormal ECG pattern and increased risk of sudden cardiac death. It is caused by mutations that result in loss of function of cardiac ion channels, most commonly sodium channels encoded by SCN5A. The ECG typically shows ST segment elevation in leads V1-V3. Brugada Syndrome presents variably from asymptomatic to sudden cardiac death, usually during sleep. Drug challenges may help diagnose when the ECG is unclear. An ICD is recommended for those with symptoms or inducible arrhythmias on electrophysiological study to prevent sudden death.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Myocarditis is an inflammatory disease of the heart muscle (myocardium) that can be caused by infections or non-infectious triggers. It has variable presentations ranging from mild chest pain to life-threatening cardiogenic shock. Diagnosis involves ECG, cardiac enzymes, echocardiogram, cardiac MRI and endomyocardial biopsy. Treatment focuses on managing arrhythmias, heart failure, and restricting activity in the acute phase. While many cases resolve, some can lead to persistent heart dysfunction or dilated cardiomyopathy.
Here are the key points from the case:
- A 75-year-old post-menopausal woman presented with pneumonia and chest pain
- In the last 24 hours she experienced dyspnea and sputum production
- This physical stressor of pneumonia could potentially trigger Takotsubo cardiomyopathy in this high-risk demographic
- Her symptoms of chest pain could represent Takotsubo cardiomyopathy mimicking an acute coronary syndrome
- Further workup would be needed to evaluate for potential left ventricular dysfunction and regional wall motion abnormalities consistent with Takotsubo cardiomyopathy versus other causes of her symptoms.
Mitral valve stenosis is a narrowing of the mitral valve opening that causes blood to back up in the lungs. The main cause is rheumatic fever which causes thickening and scarring of the mitral valve leaflets. As the opening narrows below 2 cm^2, it causes increased pressure in the lungs and left atrium that can lead to heart failure, pulmonary hypertension, and atrial fibrillation. Diagnosis is made through echocardiogram and symptoms of exertional dyspnea, orthopnea, and cough. Treatment options include medications, surgical repair or replacement of the mitral valve, and percutaneous mitral valvuloplasty using a balloon catheter.
Echocardiography in ischemic heart diseaseBhargav Kiran
This document discusses the clinical utility of echocardiography in ischemic heart disease. Echocardiography is useful for diagnosing IHD and its complications through detection of wall motion abnormalities. It can assess haemodynamic status, viability, and guide therapy. Key uses include diagnosing acute MI, evaluating chest pain, detecting complications like thrombus, assessing viability for revascularization, and prognosticating post-MI risk through evaluation of ejection fraction and diastolic function. New technologies like 3D echo, myocardial contrast echo, and speckle tracking further improve detection of IHD, perfusion defects, and quantitative assessment of function.
This document discusses constrictive pericarditis, which occurs when the pericardium thickens and restricts heart function. It can develop acutely from cardiac tamponade, or chronically from conditions like prior cardiac surgery, radiation therapy, or tuberculosis. Symptoms include fluid overload and reduced cardiac output with exertion. Evaluation involves ECG, echocardiogram, CT/MRI, and measuring ventricular filling pressures. Treatment depends on whether the constriction is transient, chronic, or occult. Chronic symptomatic cases require pericardiectomy, while transient cases may resolve with medications over time.
Approach to patient with Dilated CardiomyopathyNizam Uddin
This document provides an overview of dilated cardiomyopathy (DCM), including its definition, classification, etiologies, pathophysiology, clinical presentation, diagnosis and management. Key points include:
1) DCM is characterized by dilation and impaired contraction of the ventricles. Causes include genetic factors, viral myocarditis, toxins and idiopathic cases.
2) Diagnosis involves assessing history, symptoms of heart failure, echocardiogram showing reduced systolic function, and ruling out other potential causes.
3) Presentation varies from asymptomatic to heart failure symptoms. Management focuses on treating heart failure and its causes. Prognosis depends on the severity and reversibility of the underlying
This document discusses various types of arrhythmias and heart conditions including their causes, characteristics, and clinical presentations. It covers topics such as:
- Arrhythmias which can be initiated anywhere in the heart's conduction system and may present as tachycardia, bradycardia, or other irregular rhythms.
- Hypertension can lead to hypertensive heart disease over time due to increased pressure on the heart.
- Valvular heart diseases like rheumatic heart disease and degenerative valve diseases can cause stenosis or insufficiency of the heart valves.
- Infective endocarditis is a bacterial infection of the heart valves that forms vegetations and can cause embol
Cardiac manifestation of systemic diseae.pptxenasfathy3
This document discusses various systemic diseases and their potential cardiac manifestations. Some key points:
- Many systemic diseases like SLE, antiphospholipid antibody syndrome, systemic sclerosis, rheumatoid arthritis, sarcoidosis, amyloidosis, diabetes mellitus, hyperthyroidism and hypothyroidism can involve the heart through mechanisms like inflammation, fibrosis and atherosclerosis.
- Common cardiac manifestations include pericarditis, myocarditis, endocarditis, valvular abnormalities, conduction disorders, cardiomyopathy and coronary artery disease. These can lead to complications like heart failure, arrhythmias and myocardial infarction.
- Early recognition of cardiac involvement is important as it may impact patient management and prognosis. Screen
Heart failure (what a family physician need to know)Ahmed Abouelela
Heart failure is a leading cause of hospitalization in those over 65. The family physician plays an important role in prevention through risk factor assessment, lifestyle counseling, and monitoring for signs and symptoms. When detected early, heart failure has a better prognosis than many cancers. Treatment involves medications like ACE inhibitors, ARBs, diuretics and beta-blockers to reduce symptoms and disease progression.
This document discusses sudden cardiac death (SCD), providing information on:
- SCD is an unexpected death from cardiac causes within one hour of symptoms. It often occurs in people with known or unknown heart disease.
- Autopsies show most SCD victims had prior heart attacks or coronary artery disease. About 92% of SCD victims do not survive.
- Risk factors for SCD include age, male sex, family history of heart disease, smoking, diabetes, and high blood pressure. EKG abnormalities like prolonged QT also increase risk.
- Causes of SCD include coronary artery disease, cardiomyopathies, genetic conditions, and electrical issues in the heart. The most common mechanism is
determining the suitability of the mitral valve for repair most likely in patients with mitral regurgitation due to myxomatous degeneration and is least likely in patients with regurgitation due to endocarditis most likely with posterior prolapse or flail, whereas ileaflet involvement and isolated anterior leaflet prolapse reduce the likelihood of successful repair substantially.
Diagnosis, management, workup in a case of Takayasu's arteritis. Definition, synonyms, history, epidimiology, pathophysiology, etiology of Takayasu's arteritis.
The document discusses several types of congenital heart diseases that can present in adults, including atrial septal defects, ventricular septal defects, patent ductus arteriosus, coarctation of the aorta, tetralogy of Fallot, Ebstein's anomaly, and transposition of the great arteries. It provides details on the anatomy, clinical presentation, diagnostic workup, and treatment options for each condition.
The document discusses constrictive pericarditis, providing details on:
1) The pathology of constrictive pericarditis which involves thickening and scarring of the pericardium leading to loss of elasticity.
2) The pathophysiology of constrictive pericarditis where the inelastic pericardium constrains cardiac filling and prevents adaptation to volume changes.
3) Key diagnostic features of constrictive pericarditis seen on echocardiogram include septal bounce, rapid early diastolic mitral inflow, and increased mitral annular velocities that rise with inspiration.
Dilated cardiomyopathy is characterized by an enlarged and poorly contracting left ventricle. The main causes include inflammatory, toxic, metabolic, inherited, idiopathic and miscellaneous factors. On evaluation, patients typically present with decreased cardiac output, tachycardia and signs of congestion. Tests include echocardiogram, which shows increased left ventricular size and reduced ejection fraction, and ECG, which may show conduction delays. Treatment focuses on managing symptoms with diuretics and blocking neurohormonal activation to prevent worsening, while devices like ICDs are used in eligible patients.
1. Chronic coronary syndromes (CCS) refer to conditions involving atherosclerotic plaque buildup in the coronary arteries that can cause various clinical presentations depending on the dynamic nature of the disease process.
2. The most common clinical scenarios in patients with suspected or established CCS involve those with stable angina symptoms, new onset of heart failure, recent acute coronary syndrome, or asymptomatic patients more than 1 year after initial diagnosis or revascularization.
3. Evaluation and management of patients with suspected CCS involves assessing symptoms, risk factors and comorbidities, performing basic testing, estimating pre-test probability of CAD, selecting appropriate non-invasive testing to confirm diagnosis when needed, calculating risk, and determining long-
Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
The document discusses pericarditis, pericardial effusion, cardiac tamponade, and chronic constrictive pericarditis. It describes the functions of the pericardium, signs and symptoms, diagnostic tests including EKG changes and imaging, and treatments for the different conditions including medications, pericardiocentesis, and pericardial stripping. Chronic constrictive pericarditis results from scarring and thickening of the pericardium limiting ventricular filling, with symptoms of exertional dyspnea and elevated jugular venous pressure.
Brugada Syndrome is a genetic cardiac condition characterized by an abnormal ECG pattern and increased risk of sudden cardiac death. It is caused by mutations that result in loss of function of cardiac ion channels, most commonly sodium channels encoded by SCN5A. The ECG typically shows ST segment elevation in leads V1-V3. Brugada Syndrome presents variably from asymptomatic to sudden cardiac death, usually during sleep. Drug challenges may help diagnose when the ECG is unclear. An ICD is recommended for those with symptoms or inducible arrhythmias on electrophysiological study to prevent sudden death.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Myocarditis is an inflammatory disease of the heart muscle (myocardium) that can be caused by infections or non-infectious triggers. It has variable presentations ranging from mild chest pain to life-threatening cardiogenic shock. Diagnosis involves ECG, cardiac enzymes, echocardiogram, cardiac MRI and endomyocardial biopsy. Treatment focuses on managing arrhythmias, heart failure, and restricting activity in the acute phase. While many cases resolve, some can lead to persistent heart dysfunction or dilated cardiomyopathy.
Here are the key points from the case:
- A 75-year-old post-menopausal woman presented with pneumonia and chest pain
- In the last 24 hours she experienced dyspnea and sputum production
- This physical stressor of pneumonia could potentially trigger Takotsubo cardiomyopathy in this high-risk demographic
- Her symptoms of chest pain could represent Takotsubo cardiomyopathy mimicking an acute coronary syndrome
- Further workup would be needed to evaluate for potential left ventricular dysfunction and regional wall motion abnormalities consistent with Takotsubo cardiomyopathy versus other causes of her symptoms.
Mitral valve stenosis is a narrowing of the mitral valve opening that causes blood to back up in the lungs. The main cause is rheumatic fever which causes thickening and scarring of the mitral valve leaflets. As the opening narrows below 2 cm^2, it causes increased pressure in the lungs and left atrium that can lead to heart failure, pulmonary hypertension, and atrial fibrillation. Diagnosis is made through echocardiogram and symptoms of exertional dyspnea, orthopnea, and cough. Treatment options include medications, surgical repair or replacement of the mitral valve, and percutaneous mitral valvuloplasty using a balloon catheter.
Echocardiography in ischemic heart diseaseBhargav Kiran
This document discusses the clinical utility of echocardiography in ischemic heart disease. Echocardiography is useful for diagnosing IHD and its complications through detection of wall motion abnormalities. It can assess haemodynamic status, viability, and guide therapy. Key uses include diagnosing acute MI, evaluating chest pain, detecting complications like thrombus, assessing viability for revascularization, and prognosticating post-MI risk through evaluation of ejection fraction and diastolic function. New technologies like 3D echo, myocardial contrast echo, and speckle tracking further improve detection of IHD, perfusion defects, and quantitative assessment of function.
This document discusses constrictive pericarditis, which occurs when the pericardium thickens and restricts heart function. It can develop acutely from cardiac tamponade, or chronically from conditions like prior cardiac surgery, radiation therapy, or tuberculosis. Symptoms include fluid overload and reduced cardiac output with exertion. Evaluation involves ECG, echocardiogram, CT/MRI, and measuring ventricular filling pressures. Treatment depends on whether the constriction is transient, chronic, or occult. Chronic symptomatic cases require pericardiectomy, while transient cases may resolve with medications over time.
Approach to patient with Dilated CardiomyopathyNizam Uddin
This document provides an overview of dilated cardiomyopathy (DCM), including its definition, classification, etiologies, pathophysiology, clinical presentation, diagnosis and management. Key points include:
1) DCM is characterized by dilation and impaired contraction of the ventricles. Causes include genetic factors, viral myocarditis, toxins and idiopathic cases.
2) Diagnosis involves assessing history, symptoms of heart failure, echocardiogram showing reduced systolic function, and ruling out other potential causes.
3) Presentation varies from asymptomatic to heart failure symptoms. Management focuses on treating heart failure and its causes. Prognosis depends on the severity and reversibility of the underlying
This document discusses various types of arrhythmias and heart conditions including their causes, characteristics, and clinical presentations. It covers topics such as:
- Arrhythmias which can be initiated anywhere in the heart's conduction system and may present as tachycardia, bradycardia, or other irregular rhythms.
- Hypertension can lead to hypertensive heart disease over time due to increased pressure on the heart.
- Valvular heart diseases like rheumatic heart disease and degenerative valve diseases can cause stenosis or insufficiency of the heart valves.
- Infective endocarditis is a bacterial infection of the heart valves that forms vegetations and can cause embol
Cardiac manifestation of systemic diseae.pptxenasfathy3
This document discusses various systemic diseases and their potential cardiac manifestations. Some key points:
- Many systemic diseases like SLE, antiphospholipid antibody syndrome, systemic sclerosis, rheumatoid arthritis, sarcoidosis, amyloidosis, diabetes mellitus, hyperthyroidism and hypothyroidism can involve the heart through mechanisms like inflammation, fibrosis and atherosclerosis.
- Common cardiac manifestations include pericarditis, myocarditis, endocarditis, valvular abnormalities, conduction disorders, cardiomyopathy and coronary artery disease. These can lead to complications like heart failure, arrhythmias and myocardial infarction.
- Early recognition of cardiac involvement is important as it may impact patient management and prognosis. Screen
This document summarizes various heart diseases including coronary heart disease, stable angina, acute myocardial infarction, valvular heart diseases, and their appearances on chest radiographs. Coronary artery disease is caused by atherosclerosis and presents as coronary calcification or cardiomyopathy. Acute MI can cause pulmonary edema on CXR. Valvular diseases like aortic stenosis present with left ventricular hypertrophy and calcification while aortic regurgitation causes cardiomegaly. Mitral stenosis presents with left atrial enlargement and pulmonary hypertension.
Cardiovascular manifestation in systemic diseaseAnil Khatri
This document summarizes various cardiovascular manifestations that can occur in systemic diseases. It discusses how thiamine deficiency can cause heart failure and how supplementation can help. It also discusses protein-energy malnutrition and how it can affect the heart. Other conditions mentioned include hyperhomocysteinemia, obesity, carcinoid syndrome, pheochromocytoma, acromegaly, systemic lupus erythematosus, antiphospholipid antibody syndrome, systemic sclerosis, and rheumatoid arthritis; and their potential impacts such as cardiomyopathy, pericarditis, accelerated atherosclerosis, and pulmonary hypertension.
There are four main types of inherited cardiomyopathies: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). HCM causes thickened heart muscle and obstruction of blood flow. DCM results in an enlarged heart with reduced pumping ability. ARVC primarily affects the right ventricle and can lead to ventricular arrhythmias. RCM causes the heart walls to stiffen and resist normal filling with blood. The document provides details on causes, symptoms, examinations, investigations, and treatments for each type of cardiomyopathy.
Cardiomyopathy refers to diseases of the heart muscle that weaken the heart's ability to pump blood. Dilated cardiomyopathy is characterized by the enlargement and weakening of the heart's main pumping chamber, the left ventricle. The major causes of dilated cardiomyopathy include infections, toxins, inherited conditions, and unknown causes. Symptoms include heart failure and arrhythmias. Diagnosis involves echocardiography and treatments focus on managing symptoms through medications, devices, and transplantation if needed.
The document summarizes pericardial diseases. It discusses the anatomy and physiology of the pericardium, acute pericarditis including symptoms, diagnosis and treatment, and pericardial effusion and tamponade. Acute pericarditis is usually self-limited and treated with NSAIDs. Larger effusions may require hospitalization. Pericardial effusion can progress to tamponade, where fluid accumulation compresses the heart and impairs filling.
1. The document discusses various acyanotic heart diseases seen in pediatrics including ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, aortic stenosis, and pulmonary stenosis. Clinical features, diagnosis using tools like echocardiography, and treatment approaches are described for each condition.
2. Complications of untreated defects include heart failure, infections, pulmonary hypertension, and Eisenmenger's syndrome. Critical cases may present in the neonatal period with shock, while milder cases cause symptoms like fatigue later in childhood.
3
Diagnosis and workup of restrictive cardiomyopathy.pptxAmit Gulati
This document provides an overview of restrictive cardiomyopathy (RCM). It defines RCM as heart muscle disease characterized by severe diastolic dysfunction and normal or mildly increased ventricular wall thickness. Causes of RCM include genetic disorders, toxic exposures, infiltration of the myocardium by other tissues/deposits. Common presentations are heart failure and exercise intolerance. Echocardiography and cardiac MRI can help diagnose and characterize RCM. Treatment focuses on managing heart failure symptoms and underlying causes if identified.
Tuberculous pericarditis is caused by Mycobacterium tuberculosis infection of the pericardium. It typically progresses through dry, effusive, absorptive, and constrictive stages. The effusive stage involves a serosanguineous pericardial effusion that is often lymphocytic. Left untreated, tuberculous pericarditis can lead to cardiac tamponade, pericardial constriction, and death. Diagnosis involves identifying M. tuberculosis through smear, culture or molecular testing of pericardial fluid, or demonstrating caseating granulomas on biopsy. Treatment consists of a standard antituberculosis regimen with corticosteroids to reduce mortality
Cardiovascular System Pathology outlines several conditions affecting the heart and blood vessels. Ischemic heart disease is usually caused by coronary artery disease and atherosclerosis, and can manifest as stable or unstable angina or myocardial infarction. Congestive heart failure results from various cardiac diseases that impair the heart's ability to pump blood sufficiently. Valvular heart diseases include calcific aortic stenosis, mitral valve prolapse, and rheumatic heart disease. Congenital heart defects are common, such as coarctation of the aorta, tetralogy of Fallot, and ventricular septal defects.
Dilated cardiomyopathy is the most common type of cardiomyopathy and is characterized by left ventricular dilation and systolic dysfunction. Causes include genetic factors in 20-50% of cases as well as myocarditis, alcohol toxicity, and peripartum cardiomyopathy. Hypertrophic cardiomyopathy is caused by mutations in sarcomeric genes and is characterized by asymmetric hypertrophy of the ventricular septum. Restrictive cardiomyopathy results in stiff ventricles with impaired diastolic filling and is associated with conditions causing fibrosis like radiation, amyloidosis, and sarcoidosis. The main types of cardiomyopathy are dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy.
Cardiomyopathy refers to diseases of the heart muscle that are not caused by coronary artery disease, hypertension, or congenital heart defects. The main types are dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Dilated cardiomyopathy is characterized by decreased contractility and ventricular dilation, while hypertrophic cardiomyopathy involves ventricular hypertrophy with impaired diastolic function. Restrictive cardiomyopathy restricts diastolic filling. Management involves medications to reduce symptoms and progression such as ACE inhibitors, beta blockers, diuretics, and device therapy for refractory cases.
This document discusses various pericardial diseases including acute pericarditis, pericardial effusion, cardiac tamponade, chronic constrictive pericarditis, and tuberculous pericardial diseases. Acute pericarditis is often caused by viral infections and presents with chest pain. A pericardial friction rub may be heard. Pericardial effusion can occur with any disease causing pericarditis and may lead to cardiac tamponade, presenting with Beck's triad of hypotension, muffled heart sounds, and jugular venous distention. Chronic constrictive pericarditis results from fibrosis and scarring of the pericardium, limiting
Cardiomyopathy is a disease of the heart muscle that can cause mechanical and electrical dysfunction. It has many causes including genetic disorders, infections, and metabolic issues.
The prognosis for cardiomyopathy is generally poor if left undiagnosed until advanced stages. Diagnostic tools include echocardiography, chest x-rays, and cardiac catheterization.
Dilated cardiomyopathy is the most common type and is characterized by the enlargement of heart chambers and thinning of the walls. It can lead to heart failure if not properly managed with medications like ACE inhibitors, beta blockers, diuretics, and devices like defibrillators if needed. The prognosis is poor with 50% of patients dying within
This document discusses different types of cardiomyopathy, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy. DCM is characterized by enlarged heart chambers and reduced systolic function. HCM involves thickened heart muscle and potential outflow tract obstruction. Restrictive cardiomyopathy restricts heart filling due to stiff heart muscles. The causes, clinical presentations, diagnostic evaluations, and management strategies are described for each type of cardiomyopathy.
1) The document discusses different types of myocardial diseases including myocarditis, dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy.
2) Myocarditis is defined as an inflammatory process of the myocardium that can be caused by infections, toxins, autoimmune disorders, and other systemic diseases. Common signs and symptoms include chest pain, arrhythmias, and heart failure.
3) Dilated cardiomyopathy is characterized by dilation and impaired contraction of the left and right ventricles and can result from alcohol use, inherited factors, viral infections, and other causes. Treatment focuses on managing heart failure and preventing arrhythmias.
Cardiomyopathy, Myocarditis and Pericarditis_C I lecture_Oct.pptMesfinShifara
The document provides an overview of cardiomyopathy, myocarditis, and pericardial diseases for nursing students. It defines cardiomyopathy as a heterogeneous group of diseases affecting the heart muscle and lists the main types as dilated, hypertrophic, and restrictive cardiomyopathy. Myocarditis is defined as inflammation of the heart muscle and pericarditis as inflammation of the pericardium. The document describes the causes, clinical presentations, diagnoses, and treatments of these conditions.
Cardiomyopathies are diseases of the myocardium that cause mechanical and electrical dysfunction. There are three main types: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy.
Dilated cardiomyopathy is characterized by heart dilation and impaired contraction. It is usually caused by genetic factors or toxins. Hypertrophic cardiomyopathy causes thickened heart muscle and diastolic dysfunction, often due to genetic mutations. Restrictive cardiomyopathy decreases heart compliance through fibrosis from diseases like amyloidosis. Each type has distinct morphological and clinical features.
Similar to Cardiac manifestation of systemic disease.pptx final (20)
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. In systemic disease ,invovlement of multiple
organs is the general rule.Yet cardiac
involvement in many systemic diseses is not
well recognise ,as the dominant manifestation
frequently reside in other organ systems.Cardiac
involvement is very common with many
systemic disease and may account for serious
morbidity or mortality.Early recognisation of
cardiac involvement may impact upon patient
management and prognosis.
3.
4.
5. • Pericarditis -is the most commonly
recognized cardiac problem[30%].Pericardial
effusion
Myocarditis –common histologically but
seldom present as HF unless hypertensive.It
is parallel to disease activity.
Endocarditis—Fibrinous Libman Sacks
endocarditis,lesion may cause embolic
events or infected but rarely cause
haemodynamically important regurgitation.
Vascular –occlusive events as MI,CVA,TIA
increase(3 TO 10 fold).More common if
APLA.
6. • MI—due to primarily accelerated
atherosclerosis.
• Riskfactors for accelerated atherosclerosis
include old age,HTN,Dyslipidemia,Repeated
high score disease activity, diseaseduration,
high total or daily dose of
glucocorticoids,postmenopausal statusand
high homocysteine.
• Babies born to mothers with SLEand havean
increased incidence of congenital completeAV
block.
7. • Unexplained recurrent venous or arterial
thrombosis, or frequent secondor third trimester
miscarriages.
• Venous thrombosis –Superficial and DVT,cerebral
vein throbosis,pulmonary embolism& HTN,retinal vein
thrombosis.
• Arterial thrombosis—stroke,TIA,MI(10%).cardiac
valve involvement or dysfunction(14%),upper and
lower extremities leg ulcer ,digital gangrene and
many more
• Heart valve leaflet thickening, thrombotic masses
extendingfrom the valve ring or leaflets, or
vegetations.
8. Cardiac involvement often silent in SSc
frequently detected when screened with
sensitive tools as TDE,cMRI,thalium screening.
Evident cardiac involvement –poor prognosis.
May involve all layer ,manifest as acute
pericarditis ,pericardial effusion, constrictive
pericarditis, heart block or arrthymia
,ventricular dysfunction to overt HF.
9. • Ventricular conduction abnormalities are
common and, along with a septal pseudo-infarct
pattern (q wave inversion in ecg mimic mi due to
elongation and partial stretching of cardiac nerve
fibres) , correlate with reduced myocardial
function with exercise
• Cardiac involve more in dcSSc than lcSSc
and generally develop within 3yrs of
onset of skin thickening
10. • Most common form of chronicinflammatory
polyarthritis.can involve any layers of
heart.
PERICARDIUM-Pericarditis-pericardial effusion(10-
40%),EXUDATIVE- Decrease Complement.
• MYOCARDIUM-Rare,CMPdueto
necrotising myocarditis.
• ENDOCARDIUM-Coronaryarteritis,intimal
inflammation present 20%,rarelymanifest.
• Valveinvolvement—duetogranuloma,mitral
andaorticvalve,MR
11. Associated with pancarditis and proximal
AORTITIS.
Aortic involvement mainly in aortic root but
may extent upto aortic and mitral
valve,ventricular myocardium.
1/10 significant AR and 1/3 present with
conduction block (even CHB)
AR may precedes onset of arthritis ,SO DX OF
SERONEGETIVE ARTHRITIS SHOULD BE
CONSIDERED IN YOUNG MALE WITH
ISOLATED AR
12. • Granulomatous inflammatory diseaseof
unknown cause.
• Pericarditis though uncommon –usually
clinically insignificant
• Granulomatous infiltrative diseaseof the
myocardium is often asymptomatic, but can
causearrhythmias, conduction diseaseand,
rarely, otherwise unexplained congestive
heart failure
13. • Pulmonary artery hypertension and cor
pulmonale canoccur in sarcoidosis,generally
asaresult of pulmonary fibrosis.
• Systemicvasculitis - anuncommon
complication of sarcoidosis.
• Sarcoidvasculitis canaffect small- to large-
caliber vessels,including the aorta.
14.
15. CAD is the most common causeof death in
adults with DM.
• DM, is an independent risk factor for CAD
and accounts for 14–50% of new casesof
cardiovasculardisease.
• Pathogenesis-
• endothelial dysfunction
• increased lipoprotein peroxidation
• increased inflammation,
• aprothrombotic state,
• associated metabolic abnormalities.
16.
17. Diabetic patients aremore likely to have
MI ,greater burden of CAD,
larger infarct size,
more post infarct complications( HF, shock,death).
•.“SILENT ISCHEMIA,”resulting from ANS
dysfunction, accounting for up to 90%of their
ischemic events.
•ATYPICALischemic symptoms-
nausea,dyspnea,arrthymias,pulmonaryedema,heart
block,syncope—ANGINALEquivalent
18. Patients with DM also may have
• Abnormal LV systolic anddiastolic function,
reflecting concomitant hypertension,
Coronary microvascular disease,
• Endothelial dysfunction,
• Ventricular hypertrophy,
• Autonomic dysfunction.
• Restrictive cardiomyopathy
• INSULIN THERAPY MAY DECREASE
OVERALL MYOCARDIAL DYSFUNCTION.
19.
20. Bp is altered across the entire spectrum thyroid
function.
HYPERTHYROID ISM:-
Widened pulse pressure
arterial stiffness ISOLATED SYS HTN
low systemic VR
HYPOTHYROIDISM:-
Endothelial dysfunction
Impaired VSM relaxation Diastolic HTN
21. INCREASES in
– heart rate
– cardiac contractility,
– systolic and mean pulmonary artery pressure,
– cardiac output, diastolic relaxation, and
– myocardial oxygen consumption
REDUCTIONS in
– systemic vascular resistance and
– diastolic pressure
22. Tachycardia, at rest, during sleep, and
exaggerated
during exercise.
• Palpitations – tachy/forceful cardiac
contractility
• Hyperdynamic precordium.
• Systolic hypertension with widened pulse
pressure
• Exertional dyspnea, which is due to respiratory
and skeletal muscle weakness
23. • Uncommon heart murmur which occurs in
patients with hyperthyroidism.
• It is a mid-systolic scratching sound best heard
over the second left intercostal space at the end of
expiration.
• Results from the rubbing of
the pericardium against the pleura in the context
of hyperdynamic circulation and tachycardia,
• Mimic the sound of a pericardial rub.
24.
25. Major cardiovascular changes
– decrease in cardiac output
– decrease in cardiac contractility
– reduction in heart rate
– increase in peripheral vascular resistance.
• Others
– Hypercholesterolemia ,
– diastolic hypertension,
carotid intimal media thickness
26. • Exertional dyspnea
• Cardiac dysfunction with poor contractility.
• Bradycardia.
Pericardial effusions, in approximately 25% of patients
and may be quite large.
•Increased systemic capillary permeability and
disturbances in electrolyte metabolism.
• characterized by a high protein and cholesterol content.
27. – Hypercholesterolemia
– Diastolic hypertension, and
– Elevated homocysteine levels
– Elevated C-reactive protein and
– Endothelial dysfunction
• Patients with angina pectoris probably have
less symptoms as they are less active and
peripheral oxygen demands decrease.
28. • Exposureof the heart toexcessivegrowth hormone
may causeCHFasaresult of high cardiac output,
diastolic dysfunction owing to ventricular
hypertrophy global systolicdysfunction.
• Hypertension occurs in up to one-third of patients
with acromegaly and is characterized by
suppression of the renin-angiotensin-aldosterone
axisand increases in total-body sodium andplasma
volume.
• Some form of cardiac disease occurs in about one-
third of patients with acromegaly and is associated
with adoubling of the risk of cardiac death.
29. • In addition to causing labile or sustained
hypertension, the high circulating levels of
catecholamines resulting from a
pheochromocytoma may causedirect myocardial
injury.
• Focalmyocardial necrosis and inflammatory cell
infiltration are present in ~50%of patients whodie
with pheochromocytoma and may contribute to
clinically significant left ventricular failure and
pulmonary edema.
• Left ventricular dysfunction and CHFmay resolve
after removal of thetumor.
30.
31. The pulseless disease or occlusive
thromboaortopathy.
Aneurysm most common and clinically
most significant in aortic root where
they can lead to valvular
regurgitation(aprox 20%)
32. • Causeof GCAremains unknown, the
inflammatory lesion begins in theadventitia.
• Most characteristic features of GCAare new
onset of atypical and often severe headaches,
scalp and temporal artery tenderness, acute
visual loss, polymyalgia rheumatica, and painin
the muscles of mastication.
• GCAmay produce clinically apparent aortitisin
~15%of casesand involve the primarybranches
of the aorta, especially thesubclavian arteries,
33. • Raresyndrome that includes ahistory of asthma,
eosinophilia, pulmonary infiltrates, upper airway
inflammation, and avariable frequency of renal,
neurological, cutaneous, and cardiac
involvement.
• Cardiacdiseasein CSSis the most commoncause
of death. It is reported in 15 to 55 percent of
casesand may include pericarditis, myocarditis,
and coronary arteritis. Congestive heart failure
occurs in 15 to 30 percent ofcases.
34. • Nongranulomatous disease of onlymedium-
sized arteries.
• Necrotizing changesseen, with weakening of
the vesselwall and aneurysm formation or
myointimal proliferation, causingstenosisand
occlusion.
• cardiac disease(10 to 30 percent; congestive
failure, angina, infarction, pericarditis)
hypertension (approximately 30 percent)
35. • Acute febrile systemic illness of childhood.
• Cardiacabnormalities - pericardial effusions (~30
%),myocarditis, mitral regurgitation (~ 30 %),
aortitis and aortic regurgitation (infrequent),
congestive heart failure, and atrial andventricular
arrhythmias.
• Deaths usually result from acute coronaryartery
thrombosis in aneurysms that form following
vasculitis.
36.
37. • Thiamine deficiency hasbeen found in 20–90% of
patients with chronic heart failure. This deficiency
appears to result from both reduced dietary intake
and adiuretic-induced increase in the urinary
excretion ofthiamine.
• The acute administration of thiamine to these
patients increases the left ventricular ejection
fraction and the excretion of saltand water.
• The classic associated cardiovascular syndrome is
characterized by high-output heart failure,
tachycardia, and often elevated biventricular filling
pressures
38. • In patients whose intake of protein,calories,
or both is severely deficient, the heart may
become thin, pale, and hypokinetic with
myofibrillar atrophy and interstitial edema.
• Generalized edema is common and relates to
a variety of factors, including reduced serum
oncotic pressure and myocardialdysfunction.
• Open-heart surgery posesincreased risk in
malnourished patients.
39. • 50%of patients with carcinoid syndrome
havecardiac involvement, usually manifesting
asabnormalities of the tricuspid or pulmonic
valves.
• Carcinoid heart diseasemost often presents
as tricuspid regurgitation, pulmonic stenosis,
or both. In some cases,ahigh cardiac output
state may occur, presumably asaresult of a
decrease in systemic vascular resistance
resulting from vasoactive substancesreleased
by the tumor
40. • Obesity is associated with an increased
prevalence of hypertension, glucose
intolerance, atherosclerotic CAD,atrial
fibrillation, obstructive sleep apnea, and
pulmonary hypertension, and is associated
with increased cardiovascular morbidity and
mortality rates.
• In addition, obesepatients haveadistinct
hemodynamic profile characterized by
increased total and central bloodvolumes,
increased cardiac output, and elevatedleft
ventricular filling pressure
41. • In part asaresult of chronic volume overload,
eccentric cardiac hypertrophy with cardiac dilation
and ventricular diastolic and/or systolicdysfunction
may develop.
• In addition, altered levels of adipokines secretedby
adipose tissue may contribute to adverse
myocardial remodeling via direct effects on cardiac
myocytes and other cells.