8 Cardio LOM PathologicalConditions
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- heart block(atrioventricular block)
- arrhythmia. Failure of proper conduction of impulses through the AV node to the bundle of His.
- cardiac pacemaker
- implantation of a cardiac pacemaker can overcome arrhythmias.
- flutter
- rapid but regular contractions of atria or ventricles. up to 300 beats/minute.
- fibrillation
- rapid, random,ineffectual, and irregular contractions of the heart. 350 beats or more.
- atrial fibrillation
- wave of excitation passes through the atrial myocardium more quickly than a flutter. a defibrillator device is applied to the chest wall. an electric shock stops the heart and reverses its abnormal rhythm(cardioversion).
- implantable cardioverter/defibrillator (ICD)
- device which can be implanted in the chest to sense arrythmiasand correct them. it gives shock to change abnormal rhythms.
- radiofrequency catheter ablation (RFA)
- nonsurgical treatment to treat arrhythmias, such as paroxysmal tachycardia. a catheter delivers a high-frequency current to burn a small portion of the muscle. this injury(ablation) destroys the arrhythmia.
- palpitations
- uncomfortable sensations in the chest associated with different types of arrhythmias.
- two cardiac causes of palpitations
- premature ventricular contractions(PVCs), and premature atrial contractions(PACs)
- coarction of the aorta(CoA), cong.hrt.dz.
- narrowing of the aorta. constricted region is removed by surgery, and end-to-end anastomosis of the aortic segments.
- patent ductus arteriosus(PDA)
- ductus arteriosus between the aorta and the pulmonary artery remains open(patent). oxygenated blood flows from the aorta to the pulmonary artery. most often in females.
- causes of PDA
- commonly associated with intrauterine rubella (German measels)infection, prematurity, and infantile respiratory distress syndrome.
- treatment of PDA
- surgery to closethe ductus arteriosus.or minimally invasive surgery, where a metal clip is used to close the PDA) and use of indomethacin, a drug that blocks the effects of prostaglandins which keep the ductus open.
- septal defects
- small holes in the septa between the atria or ventricles. many close spontaneously, others require surgery, using a heart-lung machine.
- treatment of septal defects
- trans-catheter closure, a clamshell device is threaded through the blood via a catheter into the heart and into the septal defect,where it is fixed in place to block the hole. and minimally invasive heart surgery.
- tetralogy of Fallot
- 1.pulmonary artery stenosis,blood is not adequately passed to the lungs for oxygenation. 2.ventricular septal defects, deox blood passes to left ventricle then to aorta. 3.shift of the aorta to the right, to override the septum, deox blood passes even more easily from rt ventricle to aorta. 4.hypertrophy of the rt ventricle, myocardium works harder to pump thru narrowed pulmono artery.
- congestive heart failure(CHF)
- heart is unable to pump its required amount of blood, more blood enters than leaves. bld accumulates in lungs (left-sided heart failure) causing pulmonary edema. damming back of blood results in accumulation of fluid in the abdominal organs(liver and spleen) and subq tissue of the legs.
- most common cause of CHF in the US
- high blood pressure and coronary artery dz.
- treatment of CHF
- lowering dietary intake of Na, and diuretics to promote fluid loss. ACE inhibitors and beta-blockers to lower hypertension. Heart transplantation (while waiting for a donor, use a left ventricular assist device LVAD).
- left ventricular assist device LVAD, "bridge to transplant"
- booster pump implanted in the abdomen, with a cannula insterted into the left ventricle. pumps blood out of the heart to all parts of the body.
- coronary artery disease CAD
- usually the result of atherosclerosis. roughened lining of the artery may rupture or cause abnormal clotting of bld,leading to a thrombotic occlusion. leads to necrosis of part of the myocardium, the dead area is known as an infarction.
- acute coronary syndromes (ACS)
- consequences after plaque rupture in coronary arteries. unstable angina and myocardial infarction. patients benefit from early angiography and surgery to improve bld flow to the heart muscle(revascularization).
- drugs used to treat ACS
- anticoagulants (low-molecular-weight heparin)and antiplatelets like aspirin and colpidogrel(Plavix). For acute attacks of angina, nitroglycerin is given sublingually, powerful vasodilator that increases coronary flow and lowers BP to decrease the work of the heart.
- treatment of CAD and ACS, durgs
- aspirin(prevent aggregation of platelets), beta-blockers (reduce force and speed of the heartbeat and lower BP), ACE inhibitors(reduce high BP and the risk of future heart attacks), calcium channel blockers(relax muscles in blood vessels), statins (lower cholesterol levels).
- treatment of CAD and ACS, surgical
- Coronary Artery Bypass Grafting CABG, replaces clogged vessels. Percutaneous Transluminal Coronary Angioplasty(PTCA), catheterization with balloons and stents opens clogged coronary arteries. Transmyocardial Laser Revascularization (TMLR), a laser makes holes in the heart muscle to induce angiogenesis. Gene therapy.
- endocarditis
- inflammation of the inner lining of the heart caused by bacteria. damage to the heart valves produces lesions called vegetations that break off into bld stream as emboli which lodge in other vessels or in small vessels of skin, causing petechiae. Cured by antibiotics.
- hypertensive heart disease
- High BP affecting heart. Results from narrowing of arterioles which leads to increased pressure in arteries. Heart pumps more vigorously to overcome the iincreased resistance in the arteries.
- mitral valve prolapse MVP
- mitral valve enlarges and prolapses into the lft atrium during systole. physician hears a midsystolic click on auscultation. Most people with MVP live normal lives, but advised to have preventive antibiotics at time of dental proceduresso because on rare occasions the valve becomes infected.
- pericarditis
- usually results from dz elsewhere in the body (pulmonary infection). Bacteria or viruses, or idiopathic etiology. Malaise, fever and chest pain,as well as accumulation of fluid within the pericardial cavity, causing cardiac temponade(compression of the heart). Pressure on the pulmono veins may slow the return of bld from lungs. drained by pericardiocentesis.
- rheumatic heart disease
- caused by rheumatic fever, a childhood disease following a streptococcal infxn. heart valves can be damagedand scarred(with vegetations), so they do not open and close normally. Can result in mitral stenosis, atrial fibrillation, and CHF, caused by weakening of the myocardium.
- treatment of rheumatic heart disease
- reduced activity, drugs to control arrhythmias, surgery to repair valves, anticoagulant therapy to prevent formation of emboli. Mechanical or porcine(pig) valve implants can replace deteriorated heart valves.
- Blood Vessels: aneurysm
- local widening of an arterial wall. usually caused by atherosclerosis and HTN or a congenital weakness in the vessel wall. common in the aorta. danger is that they may rupture or hemorrhage.
- Blood Vessels: aneurysm, treatment
- small vessels in the brain(berry aneurysms), occlusion of the vessel with small clips. larger arteries(aorta), aneurysm is resected and a synthetic graft is sewn within the aneurysm. Stent grafts may also be placed less invasively.
- Blood Vessels: hypertension (HTN)
- most is Essential Hypertension, no identifiable cause, ≥ 140/90mmHg. Secondary hypertension, caused by another associated lesion, such as glomerulonephritis, pyelonephritis, or disease of the adrenal glands.
- Blood Vessels: hypertension, treatment
- Diuretics, beta-blockers, ACE inhibitors, calcium channel blockers. Losing weight, limiting Na intake, stopping smoking, and reducing fat in the diet.
- Blood Vessels: peripheral vascular disease (PVD)
- carotid, femoral, and popliteal arteries can be affected. A sign in lower extremities is intermittent claudication (absence of pain or discomfort in a leg at rest, but pain, tension and weakness after walking has begun).
- Blood Vessels: PVD treatment
- exercise, avoidance of nicotine, control of risk factors(HTN, hyperlipidemia, and diabetes). surgical: endarterectomy, angioplasty, and bypass grafting(around diseased area).
- Blood Vessels: Raynaud disease
- Short episodes of pallor and cyanosis in the fingers and toes. Uncertain cause. Marked by intense constriction and vasospasm of arterioles. May be secondary to other more serious disorder. Episodes triggered by cold temps, emotional stress, or smoking. treatment: protection from cold, vasodilators.
- Drugs: angiotensin-converting enzyme(ACE) inhibitors
- Antihypertensive drugs, block conversion of angiotensin I to angeiotensin II and reduce blood vessel constriction. Prevent heart attacks, CHF, stroke, and death.
- Drugs: beta-blockers
- Used to treat angina, HTN, and arrhythmias. Block the action of epinephrine(Adrenalin) at receptor sites on cells, slowing the heartbeat and reducing workload on the heart.
- Drugs: calcium channel blockers
- Used to treat angina and hypertension. Dilate blood vessels by blocking influx of calcium into muscle cells lining vessels.
- Drugs: digoxin
- Treats arrhythmias and strengthens the heartbeat.
- Drugs: nitrates, nitroglycerin
- Drugs used in treatment of angina. Dilate blood vessels, increasing blood flow and oxygen to myocardial tissue.
- Drugs: statins
- Lower cholesterol in the bloodstream.