Coronary vascular disorder
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Coronary artery disease and atherosclerosis occur when plaque builds up in the arteries, restricting blood flow to the heart. Risk factors include high cholesterol, smoking, hypertension, diabetes, and obesity. Symptoms include angina and shortness of breath. Treatment involves controlling risk factors, medications, procedures like angioplasty and stents, and possibly bypass surgery. Valvular disorders like mitral valve prolapse and regurgitation can cause backflow of blood in the heart and result in heart failure if left untreated. Cardiomyopathy directly damages the heart muscle and may lead to arrhythmias or heart failure. Infections of the heart valves and muscle tissue can also severely impact cardiac function if not addressed.
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Coronary vascular disorder
- 2. Coronary Artery Disease CAD also called coronary heart disease, or simply, heart disease, Heart disease is a result of plaque buildup in your arteries, which blocks blood flow and heightens the risk for heart attack and stroke.
- 3. Coronary Atherosclerosis Most common cause of Cardiovascular disease An abnormal accumulation of lipid, or fatty, substances and fibrous tissue in the lining of arterial blood vessel walls. These substances create blockages and narrow the coronary vessels in a way that reduces blood flow to the myocardium.
- 5. Pathophysiology Atherosclerosis begins as monocytes and lipids enter the intima of an injured vessel Smooth muscles cells proliferate within the vessel wall contributing to the development of fatty accumulations and atheroma As the plaque enlarges, the vessels narrows and the blood flow decreases . The plaque may rupture and a thrombus might form obstructing the blood flow, leading to sudden cardiac death or an acute myocardial infarction (MI), which is the death of a portion of the heart muscle
- 6. Clinical Manifestation Angina Pectoris Shortness of breath (SOB) Dyspnea Nausea Weakness
- 7. Risk factors Elevated blood lipid levels Smoking cigarettes Hypertension Diabetes mellitus Obesity Family history of premature cardiovascular disease
- 8. Non-modifiable risk factors o Family history of Coronary heart disease o Increasing age o Gender o Race
- 9. Modifiable risk factors Hyperlipidemia Cigarette smoking Hypertension Diabetes mellitus Lack of estrogen in women Obesity Physical inactivity
- 10. Prevention Controlling Cholesterol Abnormalities Promoting cessation of cigarette use Managing hypertension Controlling Diabetes mellitus Behavior patterns
- 11. Angina Pectoris Is a clinical syndrome usually characterized by episodes or paroxysm of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in a decreased oxygen in response to physical exertion or emotional stress
- 12. Angina Pectoris
- 13. Types of Angina Stable angina- predictable an consistent pain that occurs on exertion and relieved by rest. Unstable angina also called ( also called pre-infarction angina or crescendo angina ) symptoms occur more frequently and last longer than stable angina. Intractable or refractory angina – severe incapacitating chest pain Variant angina ( also called Prinzmetal’s angina ) – pain at rest with reversible ST-segment elevation; thought to be caused by Coronary Artery vasospasm. Silent ischemia: objective evidence of ischemia ( such as ECG changes with a stress test ), but patient reports no symptoms
- 14. FACTORS Physical exertion Exposure to cold Eating a heavy meal Stress or any emotion-provoking situation
- 15. Clinical Manifestation Choking or heavy sensation in the upper chest. Feeling of impending death. Weakness Nausea and vomiting Numbness Shortness of breath Pallor Diaphoresis Dizziness or lightheadedness
- 16. Pharmacologic therapy Nitroglycerin Beta-adrenergic blocking agents Calcium channel blocking agents Antiplatelet and anticoagulant medications Oxygen administration
- 17. Diagnostic findings Electrocardiogram (ECG) CBC Coronary artery angiography
- 18. Myocardial Infarction An area of myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus.
- 19. Clinical Manifestation Chest pain Shortness of breath Indigestion Nausea Anxiety Cool, pale and moist skin
- 22. Invasive coronary artery procedures Percutaneous coronary interventions (PCI)- to treat angina and CAD include PTCA, intracoronary stent implantation, atherectomy and brachytherapy. Percutaneous transluminal coronary angioplasty (PTCA) – an invasive interventional procedure, a balloon tipped catheter is used to open blocked coronary vessels and resolve ischemia. Coronary artery stent –stent is positioned over the angioplasty balloon. When the balloon is inflated, the mesh expands and presses against the vessel wall, holding the artery open.
- 23. Invasive coronary artery procedures Atherectomy –an invasive procedure that involves the removal of the atheroma, or plaque, from a coronary artery by cutting, shaving or grinding. Brachytherapy- reduces the recurrence of obstruction preventing vessel restenosis by inhibiting smooth muscle cell proliferation.
- 24. Structural, infectious and inflammatory Cardiac disorder
- 25. Valvular Disorders Mitral valve prolapse Mitral regurgitation Mitral stenosis Aortic regurgitation Aortic stenosis
- 26. Mitral valve prolapse Formerly known as mitral prolapse syndrome Is a deformity that usually produces no symptoms Is usually an inherited connective tissue disorder resulting in enlargement of one or both of the mitral valve leaflets.
- 28. Clinical manifestations Chest pain Palpitations Anxiety Shortness of breath Syncope Fatigue Lightheadedness Dizziness
- 29. Pathophysiology A portion of one and both mitral valve leaflets balloons back into the atrium during systole. The ballooning stretches the leaflet to the point that the valve does not remain closed during systole. Blood then regurgitates from the left ventricle back into the left atrium.
- 30. Mitral regurgitation Involves blood flowing back from the left ventricle into the left atrium during systole. The margin of the mitral valve cannot close because of the thickening and fibrosis of the leaflets and chordae tendineae, resulting in their contraction
- 33. Pathophysiology Result from problems with one or more of the leaflets, the chordae tendineae, the annulus or papillary muscles. With each beat of the left ventricle , some of the blood is forced back into the left atrium.
- 34. Mitral stenosis Is an obstruction of the blood flowing from the left atrium into the left ventricle. It is most often caused by rheumatic endocarditis which progressively thickens the mitral valve leaflets and chordae tendineae.
- 35. Mitral stenosis
- 37. Pathophysiology The opening narrows to the width of a pencil. The left atrium has great difficulty moving blood into the ventricle because of the increased resistance of narrowed orifice. The left atrium dilates and hypertrophies because of the increased blood volume it holds.
- 38. Aortic Regurgitation Is the flow of blood back into the left ventricle from the aorta during diastole. It may be caused by inflammatory lesions that deform the leaflets of the aortic valve Also may result from infective or rheumatic endocarditis , congenital abnormalities, diseases such as syphilis.
- 41. Aortic stenosis Is narrowing of the orifice between the left ventricle and the aorta Stenosis is often a result of degenerative calcifications. Calcification begin on the flexion lines of the leaflets at the base of the ring of the valve and progressively extend outward over the cusps.
- 42. Aortic stenosis
- 44. Pathophysiology Progressively narrowing of the valve orifice occurs. Usually over several years to several decades. The left ventricle overcomes the obstruction to circulation by contracting more slowly but the greater energy than normal.
- 45. Valve repair and Replacement procedures Valvuloplasty The repair, rather than replacement, of a cardiac valve. Repair may be made to the commissures between leaflets Annuloplasty • Is the repair of the valve annulus
- 46. Cardiomyopathy Is a heart muscle disease associated with cardiac dysfunction. It may lead to severe heart failure, lethal dysrhythmias and death.
- 47. Cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Arrhythmia right ventricular cardiomyopathy Unclassified cardiomyopathy
- 48. Clinical manifestation Dyspnea Orthopnea Peripheral edema Nausea Palpitation Dizziness Syncope
- 49. Infectious diseases of heart Rheumatic endocarditis Infective endocarditis Myocarditis Pericarditis
- 51. Cardiac hemodynamics The basic function of the heart is to pump blood. The heart’s ability to pump is measured by cardiac output (CO), the amount of blood pumped per minute. HR x SV = CO Preload- is the amount of blood presented to the ventricle just before systole. Afterload – refer to the amount of resistance to the ejection of blood from the ventricle. To eject blood.
- 52. Heart failure Is the ability of the heart to pump sufficient blood to meet the needs of the tissues for the oxygen and nutrients Two types of heart failure Systolic heart failure Diastolic heart failure
- 54. Right sided heart failure Congestion in the peripheral tissues and the viscera predominates. Occurs because the right side of the heart cannot eject blood and cannot accommodate all the blood that normally returns to it from the venous circulation.
- 56. Pharmacology therapy Angiotensin-converting enzyme inhibitors Angiotensin II receptor blockers Hydralazine and isosorbide dinitrate Beta-blockers Diuretics
- 57. Pharmacology therapy Calcium channel blockers Digitalis Oxygen