cardiovascular system disorders 1 · · 2017-01-26o ultrasonic examination o magnetic resonance...
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Cardiovascular System Disorders 1
Lecture 19
Pathology and Clinical
Science 1 (BIOC211)
Department of BioscienceText Reference:
Porth’s Pathophysiology: Concepts of Altered Health States
Sheila C. Grossman & Carol Mattson Porth.
Ninth Edition.
Copyright © 2014 Lippincott, Williams & Wilkins Publishers, Inc.
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Session Learning Outcomes
This session aims to:
o Comprehend how and why the symptoms and signs of
cardiovascular disorders appear
o Describe the aetiology, pathology and principles of
treatment for disorders of heart rate, rhythm and
conduction.
o Understand the complications of cardiovascular
disorders.
o Understand the use of various diagnostic tests and
procedures of cardiovascular system
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THE HEART
From Principles of anatomy and physiology, (14th ed.,), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE HEART
From Principles of anatomy and physiology, (14th ed., p719), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE HEART
From Principles of anatomy and physiology, (14th ed., p723), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE HEART VALVES
From Principles of anatomy and physiology, (14th ed., p725), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE CIRCULATION OF BLOOD
From Principles of anatomy and physiology, (14th ed., p728), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE CORONARY CIRCULATION
From Principles of anatomy and physiology, (14th ed., p729), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE CONDUCTIVE TISSUE
From Principles of anatomy and physiology, (14th ed., p733), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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THE CARDIAC CYCLE
From The Student Physiologist: Online Cardiology Resource. Retrieved from,
https://thephysiologist.org/study-materials/the-cardiac-cycle-and-cardiac-output/
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CLINICAL EXAMINATION OF CVS
Observation
• Breathlessness, body weight/BMI
Pulses
• Rate, rhythm, volume
Blood pressure
Face, mouth, eyes and hand
• Pallor, cyanosis, finger clubbing
Auscultation
• Heart sounds, murmur
Abdomen
• Ascites, hepatomegaly
Legs
• Peripheral pulses, oedema
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CARDIAC FUNCTION
Non-invasive Investigations
o Electrocardiography (ECG)
• Exercise (Stress) ECG
• Ambulatory ECG
o Echocardiography
o Plain x-rays
o Ultrasonic examination
o Magnetic resonance imaging
o Doppler Studies
• Amplifies & records sounds made by blood flowing in
the peripheral vessels
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ELECTROCARDIOGRAM
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ANGIOGRAPHY
Arrow
indicates a
sub-total
occlusion
https://en.wikipedia.org/wiki/File:Coronary_angiography_of_a_STEMI_patient,_showing_partial_occlusion_of_l
eft_circumflex_coronary_artery.jpg
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TESTS OF CARDIAC FUNCTION
Invasive Methods of Assessment
o Nuclear Imaging with radio-labeled chemicals
•Hot Spot Imaging
•Cold Spot Imaging
o Cardiac catheterization
• Performed under local anaesthetic & within a sterile environment
o Coronary Angiography
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Chest pain
o Characteristic - onset, radiation, location, provocation, characteristic of pain
o Cardiac causes - MI, angina pectoris, pericarditis, dissecting aortic aneurysm, mitral valve prolapse
o Other causes - Lung disease (pneumonia, pleurisy, carcinoma, pneumothorax), psychogenic, oesophageal disease, musculoskeletal.
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Breathlessness or Dyspnoea
o Unpleasant subjective awareness of the sensation of
breathing
o Cardiac causes - acute pulmonary oedema, pulmonary
embolism, congestive cardiac failure (CCF), congenital
heart disease
o Respiratory causes - asthma, chronic obstructive
pulmonary disease (COPD), Acute respiratory distress
syndrome (ARDS), bronchial carcinoma
o Other forms - orthopnea, paroxysmal nocturnal
dyspnoea (PND)
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Hypertension
o Systolic BP rises with age and the incidence
of cardiovascular disease is closely related
to BP
o Hypertension will be discussed in session 21
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Syncope (faint) Sudden loss of consciousness
Presyncope – lightheadedness and near collapse
o Cardiac causes - Arrhythmia, left ventricular dysfunction, aortic stenosis, hypertrophic obstructive cardiomyopathy
o Neurogenic causes- epilepsy, transient ischaemic attack (TIA)
o Metabolic causes - hypoglycemia,
o Inappropriate vasodilation - postural hypotension
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Palpitation
Abnormal subjective awareness of the
heartbeat
o Causes - ectopic beats, atrial fibrillation,
paroxysmal tachycardia
o Other causes - anaemia, anxiety and
excitement
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Cardiac arrest and sudden cardiac
death
o Common causes
• Coronary artery disease (CAD) ( 85%)
• Structural heart disease
• No structural heart disease
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CLINICAL PRESENTATIONS OF
HEART DISEASE
Abnormal heart sounds and
murmurs
o May be first clinical manifestation of heart
disease
o Clinical evaluation is helpful
o Echocardiogram is often necessary to
confirm
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DISORDERS OF HEART RATE,
RHYTHM AND CONDUCTIONCardiac arrhythmia is a disturbance of the electrical
rhythm of the heart
• Often a manifestation of structural heart disease
• Present with palpitation, dizziness, syncope, chest
discomfort or breathlessness
Sinus rhythm
• Sinus arrhythmias in autonomic neuropathy
• Sinus bradycardia ( <60/min ) in MI, sinus node disease,
hypothermia, hypothyroidism
• Sinus tachycardia ( > 100/min ) in anxiety, fever,
anaemia, heart failure, thyrotoxicosis
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THE CONDUCTIVE TISSUE
From Principles of anatomy and physiology, (14th ed., p733), by Tortora, GJ & Derrickson, B, 2014, Hoboken, NJ. Wiley.
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ATRIAL TACHYARRHYTHMIAS
Atrial ectopic beats ( extra systoles, premature beats)
• Usually asymptomatic, treatment rarely necessary
Atrial tachycardia
• Increased atrial automaticity, SA node disease, digoxin toxicity
Atrial flutter ( atrial rate = 300/min )
• Associated with AV block
Atrial fibrillation
• CAD, valvular heart disease, hypertension, cardiomyopathy
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ATRIAL TACHYARRHYTHMIAS
Atrial atopic beat
Atrial Tachycardia
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ATRIAL TACHYARRHYTHMIAS
Sinus Bradycardia
Normal Sinus Rhythm
Sinus Tachycardia
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VENTRICULAR
TACHYARRHYTHMIAS
Ventricular ectopic beats ( extra systoles,
premature beats )
• Frequently found in healthy people, incidence
increases with age
• Also in MI, heart failure, digoxin toxicity
Ventricular tachycardia
• CAD, cardiomyopathies
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VENTRICULAR TACHYCARDIA’S
Supraventricular tachycardia
Ventricular tachycardia
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PREMATURE VENTRICULAR
COMPLEX
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SINOATRIAL DISEASE
(SICK SINUS SYNDROME)
oMost common in elderly
oAlso called sinus node dysfunctioning
oMay be due to fibrosis, degenerative
changes and/or ischaemia of the SA
node
oLeads to variety of arrhythmias
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ATRIOVENTRICULAR AND
BUNDLE BRANCH BLOCKAV block
• First degree block – AV conduction is delayed and
usually asymptomatic
• Second degree block – dropped beats occur because
some impulses fail to conduct to ventricles
• Third degree block – AV conduction failed completely
and atria and ventricles beat independently
Bundle branch block
• Interruption of the right or left branch of the bundle of
His
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ATRIOVENTRICULAR AND
BUNDLE BRANCH BLOCK
1st Degree heart block
Bundle Branch Block
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COMPLICATIONS OF
CARDIOVASCULAR DISEASE
Acute circulatory failure - cardiogenic shock
o Shock clinical syndrome due to circulatory failure leading to inadequate delivery of oxygen to tissue
o Features - hypotension, tachycardia, cold and clammy skin, rapid shallow breathing , drowsiness and confusion
o Causes
• MI, pulmonary embolism, pericardial tamponade, myocarditis, endocarditis of mitral valve
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COMPLICATIONS OF
CARDIOVASCULAR DISEASE
www.covenantheartinstitute.com
Heart failure
o Definition - the state that
occurs when the heart is
unable to maintain sufficient
cardiac output to meet the
demands of the individual
body
o Almost all form of heart
disease can lead to heart
failure
o Increased incidence with
increased age
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CAUSES OF HEART FAILURE
Aetiology:
Reduced ventricular contractility (Myocardial
dysfunction)
Ventricular volume overload
Ventricular outflow obstructions
Ventricular inflow obstructions
Arrhythmia
Diastolic dysfunction
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DIFFERENT TYPES OF
HEART FAILURE
Various terms are used in clinical practice
Biventricular or congestive heart failure
• Right heart failure results from preexisting left heart failure
Left heart failure
• Causes include ischaemic heart disease (IHD), systemic
hypertensive nephropathy (HTN), mitral and aortic valve
disease, cardiomyopathies
Right heart failure
• Causes include left heart failure, chronic lung disease,
tricuspid and pulmonary valve disease, left to right shunt
Chronic heart failure can be compensated or decompensated
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PATHOPHYSIOLOGY OF
HEART FAILURE
Initially compensatory physiological changes to
maintain cardiac output
• Increased heart rate, Ventricular dilation,
Hypertrophy, Salt retention, Sympathetic
stimulation
Leads to
• Increased venous return,
• Increased congestion of viscera and lungs
• Dyspnoea
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CLINICAL FEATURES OF
HEART FAILURE
Dependent upon causes and onset
• Dyspnoea / orthopnoea , pink frothy sputum
• Fatigue, restlessness, poor exercise
tolerance, low BP, cold peripheries, oliguria,
uraemia, peripheral oedema, marked weight
loss.
Complications
• Impaired liver function, thromboembolism and
arrhythmia amongst others
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MANAGEMENT OF
HEART FAILURE
General measures
• Education and diet changes
• Moderate alcohol intake
• No smoking
• Moderate exercise
Drug therapy
• Diuretics, vasodilators, angiotensin converting enzyme (ACE) inhibitors, beta blockers, digoxin, amiodarone
Heart transplantation
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Readings and ResourcesResources:
o Set Textbooks:
Colledge, N.R., Walker, B.R. & Ralston S.H. (2014). Davidson’s Principles and Practice of Medicine, (22nd ed.). Edinburgh.
Churchill Livingstone.
Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: concepts of altered health states, (9th ed.). Philadelphia,
U.S.A. Walters Kluwer Health - Lippincott, Williams & Wilkins.
o Additional textbooks:
Davies, A. & Moores, C. (2010). The respiratory system: basic science and clinical conditions, (2nd ed.). Edinburgh. Churchill,
Livingstone, Elsevier.
Field, M., Pollock, C., Harris, D. (2010). Systems of the Body: The Renal System; Basic Science and Clinical Conditions. (2nd
ed.). United Kingdom: Churchill Livingstone.
Jamison, J.R. (2006) Differential Diagnosis for Primary Care: a handbook for health care practitioners. (2nd ed.). Edinburgh.
Churchill Livingstone.
Lee, G. & Bishop, P. (2013). Microbiology and Infection Control for Health Professionals, (5th ed.). Frenchs Forest, NSW.
Pearson Education.
McCance, K.L. & Huether, S.E. (2014). Pathophysiology: the biological basis for disease in adults and children, (7th ed.). St.
Louis, MO. Elsevier.
Murphy, K. (2011). Janeway’s immunobiology, (8th ed.). New York. Garland Science.
Noble, A., Johnson, R. & Bass, P. (2010). The cardiovascular system: basic science and clinical conditions, (2nd ed.).
Edinburgh. Churchill, Livingstone, Elsevier.
Pagana, K.D. & Pagana, T.J. (2013). Mosby’s diagnostic and laboratory test reference, (11th ed.). St. Louis, MO. Elsevier.
Smith, M.E. & Morton, D.G. (2010). The digestive system: basic science and clinical conditions, (2nd ed.). Edinburgh.
Churchill, Livingstone, Elsevier.
VanMeter, K.C. & Hubert, R. (2014). Gould’s pathophysiology for health professions, (5th ed.). St. Louis, MO. Elsevier.
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