The document discusses several disorders of the heart and lungs, including: - Coronary artery disease, which involves a reduction of blood flow to the heart muscle due to plaque buildup in the heart's arteries. - Cardiomyopathy, which affects the heart muscle and increases the risk of irregular heartbeats and sudden cardiac death. - Hypertensive heart disease, which includes complications of high blood pressure that affect the heart. - Heart failure, which occurs when the heart is unable to pump sufficiently to meet the body's needs.

1. DISORDERS OF HEART AND
LUNGS
prepared & presented by
SATISH BABU.G
DSA-1

2. HEAR
T

3. Introduction:
 In humans, the heart is located between the lungs, in the middle
compartment of the chest.
 the heart is divided into four chambers: upper left and right atria and lower
left and right ventricles.
 The heart is enclosed in a protective sac, the pericardium, which also
contains a small amount of fluid. The wall of the heart is made up of three
layers: epicardium, myocardium, and endocardium.
 The heart beats at a resting rate close to 72 beats per minute.
Cardiovascular diseases (CVD):
 The most common cause of death globally as of 2008, accounting for 30%
of deaths. Of these more than three quarters are a result of coronary artery
disease and stroke.
 Risk factors include: smoking, being overweight, little exercise, high
cholesterol, high blood pressure, and poorly controlled diabetes, among
others. Cardiovascular diseases frequently do not have symptoms or may
cause chest pain or shortness of breath.
 Diagnosis of heart disease is often done by the taking of a medical
history, listening to the heart-sounds with a stethoscope, ECG,
and ultrasound. Specialists who focus on diseases of the heart are
called cardiologists, although many specialties of medicine may be involved
in treatment.

7. Classification of drugs Name of the drug
Calcium channel blockers Amlodipine (Norvasc), Diltiazem (Cardizem, Tiazac,
others), Felodipine, Isradipine, Nicardipine, Nifedipine
(Adalat CC, Afeditab CR, Procardia),Nisoldipine
(Sular),Verapamil (Calan, Verelan)
Beta-blockers Acebutolol (Sectral),Atenolol (Tenormin),Bisoprolol
(Zebeta), Metoprolol (Lopressor, Toprol XL), Nadolol
(Corgard), Nebivolol (Bystolic), Propranolol (Inderal,
InnoPran XL)
ACE inhibitors Benazepril (Lotensin), Captopril, Enalapril (Vasotec),
Fosinopril, Lisinopril (Prinivil, Zestril), Moexipril.
Angiotensin II receptor blockers Azilsartan (Edarbi), Candesartan (Atacand), Eprosartan,
Irbesartan (Avapro), Losartan (Cozaar), Olmesartan
(Benicar)
Diuretics Bumetanide, Ethacrynic acid, Furosemide, Torsemide.
Anticoagulants Heparin, warfarin, rivaroxaban, dabigatran, apixaban,
edoxaban.
Antibiotics Amoxicillin, doxycycline, cephalexin, ciprofloxacin,
clindamycin, metronidazole azithromycin.

8. Coronary artery disease (CAD): also known as ischemic heart
disease (IHD), involves the reduction of blood flow to the heart muscle due to build-
up of plaque in the arteries of the heart. It is the most common of the cardiovascular
diseases .Types include stable angina, unstable angina, myocardial infarction,
and sudden cardiac death.
Signs and symptoms:
 Chest pain that occurs regularly with activity, after eating, or at other predictable times is
termed stable angina and is associated with narrowing's of the arteries of the heart.
 Angina that changes in intensity, character or frequency is termed unstable. Unstable
angina may precede myocardial infarction. In adults who go to the emergency department
with an unclear cause of pain, about 30% have pain due to coronary artery disease
Diagnosis:
 Baseline electrocardiography(ECG).
 Exercise ECG – Stress test.
 Exercise radioisotope test (nuclear stress test, myocardial scintigraphy.
 Echocardiography (including stress echocardiography).
 Coronary angiography.
 Intravascular ultrasound.
 Magnetic resonance imaging (MRI).
Treatment:
 Medical treatment – drugs (e.g., cholesterol
lowering medications, beta-blockers,
nitro-glycerine,
calcium channel blockers, etc.)
 Coronary artery bypass grafting (CABG)

9. Cardiomyopathy:
 It is a group of diseases that affect the heart muscle. An irregular heart
beat and fainting may occur. Those affected are at an increased risk of sudden
cardiac death. Cardiomyopathies are divided into 3 main types Dilated ,
Hypertrophic , Restrictive.
Signs and symptoms:
Symptoms of cardiomyopathies may include fatigue, swelling of the lower
extremities and shortness of breath. Further indications of the condition may include:
arrhythmia, fainting, and dizziness.

10. Diagnosis:
 Among the diagnostic procedures done to determine a cardiomyopathy are:
 Physical exam.
 Family history.
 Blood test.
 ECG.
 Echocardiogram.
 Stress test.
 Genetic testing.
Treatment:
 55555555555555555555555555555555
55557789632188885556666666
Dilated :
Diuretics, ACE inhibitors,
angiotensin II receptor
blockers, beta-
blockers, spironolactone or e
plerenone, digoxin, ICD,
cardiac resynchronization
therapy, anticoagulants
Hypertrophic:
Beta-
blockers ± verapamil ±disopy
ramide ± septal
myotomy ±catheter alcohol
ablation
Restrictive:
Phlebotomy for
hemochromatosis
Endocardia resection
Hydroxyurea for hyper
eosinophilia

11. Hypertensive heart disease:
It includes a number of complications of high blood pressure that affect the heart.
While there are several definitions of hypertensive heart disease in the medical
literature, the term is most widely used in the context of the International
Classification of Diseases (ICD) coding categories.

12. Signs and symptoms:
 Fatigue, Irregular pulse or palpitations, Swelling of feet and ankles,
Weight gain, Nausea, Shortness of breath.
Diagnosis:
 Urinalysis and urinary albumin: creatinine ratio; if abnormal, consider renal
ultrasonography.
 Blood tests: Fasting lipids, creatinine , potassium.
 Renal ultrasonography if Creatinie increased.
 Evaluate for aldosteronism if potassium decreased.
 ECG: If left ventricular hypertrophy, consider echocardiography.
 Sometimes thyroid-stimulating hormone measurement.
 Evaluate for pheochromocytoma or a sleep disorder if BP elevation sudden and labile or
severe.
Treatment:
Treatment involves lifestyle changes and drugs, including diuretics, beta-
blockers, ACE inhibitors, angiotensin II receptor blockers, and calcium
channel blockers.

13. Cardiac Arrest:

14. Cardiac arrest is the cessation of cardiac mechanical activity resulting in the
absence of circulating blood flow. Cardiac arrest stops blood from flowing to
vital organs, depriving them of oxygen, and, if left untreated, results in death.
Symptoms and Signs
 In critically or terminally ill patients, cardiac arrest is often preceded by a
period of clinical deterioration with rapid, shallow breathing, arterial
hypotension, and a progressive decrease in mental alertness. In sudden cardiac
arrest, collapse occurs without warning, occasionally accompanied by a brief
(< 5 sec) seizure.
Diagnosis
 Clinical evaluation.
 Cardiac monitor and ECG.
 Sometimes testing for cause (eg, echocardiography, chest x-ray, or chest
ultrasonography).
Treatment
 CPR.
 When possible, treatment of primary cause.
 Post resuscitative care.
 If response to IV fluid is inadequate, most clinicians give one or more
vasopressor drugs (eg, norepinephrine, epinephrine, dopamine, vasopressin).

15. Heart failure:
It is also known as congestive heart failure (CHF), is when the heart is unable to pump
sufficiently to blood flow to meet the body's needs.
Signs and symptoms:
Heart failure symptoms are traditionally and somewhat arbitrarily divided into
"left" and "right" sided, recognizing that the left and right ventricles of the heart
supply different portions of the circulation. However, heart failure is not
exclusively backward failure (in the part of the circulation which drains to the
ventricle).
Diagnosis:
Ultrasound, Chest X-ray, Electrophysiology, Blood tests, Angiography.
Drug treatment:
Drug treatment of heart failure involves-
Symptom relief: Diuretics, nitrates, or
digoxin.
Long-term management and improved
survival: ACE inhibitors, beta-blockers,
aldosterone antagonists, angiotensin II
receptor blockers (ARBs), or angiotensin
receptor/neprilysin inhibitors (ARNIs)

16. Pulmonary heart disease:
it is also known as cor pulmonale, is the enlargement and failure of the right
ventricle of the heart as a response to increased vascular resistance (such as
from pulmonic stenosis) or high blood pressure in the lungs.
Signs and symptoms:
 Shortness of breath, Wheezing,
Cyanosis,
 Ascites, Jaundice, Enlargement of
the liver,
 Raised jugular venous pressure.
Diagnosis:
 Chest x-ray ,ECG, Thrombophilia screen.
Treatment:
antibiotics, expectorants, oxygen therapy, diuretics, digitalis, vasodilators,
and anticoagulants.

17. Heart arrhythmia:
it is(also known as arrhythmia, dysrhythmia or irregular heartbeat) is a group
of conditions in which the heartbeat is irregular, too fast or too slow. A heart rate
that is too fast – above 100 beats per minute in adults – is called tachycardia, and a
heart rate that is too slow – below 60 beats per minute – is called bradycardia.
Signs and symptoms:
 if an arrhythmia results in a heartbeat that is too fast, too slow or too weak to
supply the body's needs, this manifests as a lower blood pressure and may
cause light-headedness or dizziness, or syncope (fainting).
 Some types of arrhythmia result in cardiac arrest, or sudden death.
Diagnosis of arrhythmia:
 blood and urine tests.
 ECG (electrocardiogram).
 Holtermonitor - a wearable device that records the heart for 1-2 days.
 Echocardiogram.
 chest X-ray.
 electrophysiological testing (or EP studies).
 heart catheterization.

18. Myocarditis:
Myocarditis, also known as inflammatory cardiomyopathy, is inflammation of the heart
muscle. Symptoms can include shortness of breath, chest pain, decreased ability to
exercise, and an irregular heartbeat. The duration of problems can vary from hours to
months. Complications may include heart failure due to dilated cardiomyopathy or cardiac
arrest.
Diagnosis:
Electrocardiogram (ECG), Chest X-ray, MRI, Echocardiogram, Blood tests, Cardiac
catheterization and end myocardial biopsy.
Treatment:
Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers
(ARBs), Beta blockers, Diuretics.

19. Congenital heart defect:

20. Signs and symptoms:
• Some children have no signs while others may exhibit shortness of
breath, cyanosis, fainting, heart murmur, under-development of limbs
and muscles, poor feeding or growth, or respiratory infections.
Diagnosis:
• Many congenital heart defects can be diagnosed prenatally by foetal
echocardiography. It can be an abdominal ultrasound or transvaginal
ultrasound.
Treatment:
• CHD may require surgery and medications.
• Medications include diuretics, which aid the body in eliminating water,
salts, and digoxin for strengthening the contraction of the heart.
• This slows the heartbeat and removes some fluid from tissues.
• Some defects require surgical procedures to restore circulation back to
normal and in some cases, multiple surgeries are needed.

24. Lung
Diseases:
• Asthma.
• COPD(Chronic
obstructive
pulmonary
disease).
• Lung cancer.
• Pulmonary
emboli.

25. Asthma
• Coughing, wheezing, and shortness of breath that occur in response to specific
triggers are the most common symptoms.
 Doctors confirm the diagnosis of asthma by doing breathing (pulmonary
function) tests.
Asthma is a condition in which your airways narrow and swell and
produce extra mucus. This can make breathing difficult and trigger
coughing, wheezing and shortness of breath.

26. For some people, asthma signs and symptoms flare up in certain situations:
• Exercise-induced asthma, which may be worse when the air is cold and dry
• Occupational asthma, triggered by workplace irritants such as chemical fumes,
gases or dust.
• Allergy-induced asthma, triggered by airborne substances, such as pollen, mild
spores, cockroach waste or particles of skin and dried saliva shed by pets (pet
dander).
CLASSIFICATION OF DRUGS:
I. Bronchodilators:
A. β 2 Sympathomimetic: Salbutamol, Terbutaline, Bambuterol, Salmeterol,
Formoterol, Ephedrine.
B. Methylxanthines: Theophylline (anhydrous), Aminophylline, Choline
theophylline, Hydroxyethyl theophylline, Theophylline ethanol ate of
piperazine, Doxophylline.
C. Anticholinergic : Ipratropium bromide, Tiotropium bromide.
II. Leukotriene antagonists: Montelukast, Zafirlukast.
III. Mast cell stabilizers: Sodium cromoglycate, Ketotifen.

27. IV. Corticosteroids:
 A. Systemic: Hydrocortisone, Prednisolone and others.
 B. Inhalational: Beclomethasone dipropionate, Budesonide, Fluticasone
propionate, Flunisolide, Ciclesonide.
V. Anti- IgE antibody : Omalizumab.

28. COPD:
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung
disease that causes obstructed airflow from the lungs. Symptoms include breathing
difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-
term exposure to irritating gases or particulate matter, most often from cigarette
smoke. People with COP Dare at increased risk of developing heart disease, lung
cancer and a variety of other conditions.
Symptoms:
 Shortness of breath, especially during physical activities.
 Wheezing.
 Chest tightness.
 Having to clear your throat first thing in the morning, due to excess
mucus in your lungs.
 A chronic cough that may produce mucus (sputum) that may be
clear, white, yellow or greenish.
 Blueness of the lips or fingernail beds (cyanosis).
 Frequent respiratory infections.

30. Diagnosis:
 Lung (pulmonary) function tests.
 Chest X-ray.
 CT scan.
 Arterial blood gas analysis.
 Laboratory tests.
Treatment:
Medications
 Doctors use several kinds of medications to treat the symptoms and
complications of COPD. You may take some medications on a regular basis
and others as needed.
 Bronchodilators: albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol
(Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators
include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil,
Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium
(Tudorza).
 Inhaled steroids: Fluticasone (Flovent HFA, Flonase, others) and
budesonide (Pulmicort Flex haler, Uceris, others) are examples of inhaled
steroids.

31.  Combination inhalers
Some medications combine bronchodilators and inhaled steroids. Salmeterol and
fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of
combination inhalers.
 Oral steroids
For people who have a moderate or severe acute exacerbation, short courses (for
example, five days) of oral corticosteroids prevent further worsening of COPD.
However, long-term use of these medications can have serious side effects, such
as weight gain, diabetes, osteoporosis, cataracts and an increased risk of
infection.

32. Lung cancer
Symptoms and Signs:
Symptoms and signs can result from local tumour progression, regional spread, or
distant metastases. Para neoplastic syndromes and constitutional symptoms may
occur at any stage of the disease.
Metastases eventually cause symptoms that vary by location. Metastases can
spread to the.
 Liver, causing pain, nausea, early satiety, and ultimately hepatic
insufficiency.
 Brain, causing behavioural changes, confusion, aphasia, seizures, paresis or
paralysis, nausea and vomiting, and ultimately coma and death.
 Bones, causing severe pain and pathologic fractures.
 Adrenal glands, rarely causing adrenal insufficiency.

34. Classification
Lung cancer is classified into 2 major categories:
 Small cell lung cancer (SCLC), about 15% of cases.
 Non–small cell lung cancer (NSCLC), about 85% of cases.
Diagnosis
 Chest x-ray.
 CT or combined PET–CT.
 Cytopathology examination of pleural fluid or sputum.
 Usually bronchoscopy-guided biopsy and core biopsy.
 Sometimes open lung biopsy.
Treatment:
 Surgery (depending on cell type and stage).
 Chemotherapy :
 Radiation therapy.
 Immunotherapy.

35. Pulmonary emboli

36. Symptoms:
Common signs and symptoms include:
 Shortness of breath: This symptom typically appears suddenly and always
gets worse with exertion.
• Chest pain: You may feel like you're having a heart attack. The pain may
become worse when you breathe deeply (pleurisy), cough, eat, bend or stoop.
The pain will get worse with exertion but won't go away when you rest.
• Cough: The cough may produce bloody or blood-streaked sputum.
Diagnosis:
• Blood tests.
• Chest X-ray.
• Ultrasound.
• Spiral CT scan.
• MRI.
Treatment:
Blood thinners (anticoagulants).
Clot dissolvers (thrombolytic).
Surgical and other procedures: Clot removal and Vein filter.