Common diseases of the heart and circulatory system

Common diseases of the heart and circulatory system

Ischaemic heart diseases • Acute coronary syndrome (ACS) • Acute myocardial infarction (AMI) • Unstable angina pectoris • Sudden cardiac death • Stable angina pectoris • Variant angina pectoris (Prinzmetal-angina – vasospastic angina) • Silent ischaemia • X-syndrome (small vessel diseases)

Ischaemic heart diseases • Stable angina pectoris – Complaint • the same effort – the same complaint • resolves on rest or on nitrates – Physical alteration: no – Diagnostics: • EKG • Stress EKG or other stress tests • Coronarography

Ischaemic heart diseases • Unstable angina pectoris – Complaint • Increasing angina or angina at rest– crescendo angina • Doesn’t resolves on rest • Nitrate may help – No specific physical alteration – Diagnostics • EKG • Lab tests (troponine, creatine kinase) • Acute coronarography

Ischaemic heart diseases • Acute myocardial infarction – Complaints • • Longer and more serious pain It relives on morphin only Sweating, pallor Acute heart failure – Dyspnea – Decreased blood pressure – Shock • Arrhythmia – premature beat

Ischaemic heart diseases • Acute myocardial infarction – Physical alterations • Arrhythmia • Heart failure • Shock – Diagnostics • EKG • Lab tests (troponine, creatine kinase) • Coronarography – therapeutical possibility

Valvular diseases • Stenosis – Pressure load – hypertrophy • Isufficiency – regurgitation – Volume load – dilatation • Combined valvular disease – More than one valve affected – Stenosis and regurgitation on the same valve

Valvular diseases • Diagnostics – Physical examination • Shape alterations • Murmurs • Signs of heart failure – Instrumental diagnostics • Echocardiography • EKG • Heart angiography-catheterisation

Valvular diseases • Mitral valve stenosis – Consequences • • Left atrium dilatation Sec. pulmonary hypertension Right side congestion Right ventricle hypertrophy and dilatation • Chr. right heart failure

Valvular diseases • Mitral valve stenosis – Complaints • Dyspnea • Signs of heart failure – Physical examination • Mitral configuration • Auscultation – – Loud S 1 Opening snap Protomesodiastolic and praesystolic murmur Pulmonal S 2 louder

Valvular diseases

Valvular diseases • Mitral regurgitation – Consequences • • • Left atrial dilatation Pulmonal hypertension Right side congestion Right heart failure Left ventricular dilatation

Valvular diseases • Mitral regurgitation – Complaint • Dyspnea • Signs of heart failure – Physical examination • Mitral configuration • Auscultation – Systolic murmur – radiates to the left axilla

Valvular diseases

Valvular diseases • Aortic stenosis – Consequences • • • Systemic hypoperfusion Coronary hypoperfusion Left ventricular hypertrophy Myocardial hypoxia Low pulse amplitudo

Valvular diseases • Aortic stenosis – Coplaints • Angina pectoris effort angina • Sudden death • Signs of heart failure – Physical examination • Aortic configuration • Auscultation – Systolic murmur – radiates to the carotid artery

Valvular diseases • Aortic regurgitation – Consequences • Systemic hypoperfusion • High pulse amplitudo • Left ventricular dilatation

Valvular diseases • Aortic regurgitation – Complaints • Dyspnea • Signs of heart failure – Physical examination • Aortic configuration • Auscultation – Diastolic murmur

Valvular diseases

Valvular diseases • Aortic regurgitation – Consequences of wide pulse amplitudo • Corrigan’s pulse (quickly elevating and high) • Capillary pulsation

Valvular diseases • Tricuspidal valve – Regurgitation –systolic murmur – Stenosis – diastolic murmur • Pulmonal valve – Regurgitation –diastolic murmur – Stenosis – systolic murmur

Heart failure • Not disease itself – syndrome • Causative diseases – Acute • Myocardial infarction • Myocarditis – Chronic • • Valvular diseases Chr. ischaemic diseases Chr. arrhythmias Heart muscle abnormities

Heart failure • Components – Forward – hypoperfusio – Backward – congestion, pressure elevation • Subtypes – Left heart failure – Right heart failure – Combined (global) heart failure

Heart failure • Left heart failure – Forward: systemic hypoperfusion – Backward: pulmonary congestion • Complaints: – Dyspnea – Orthopnea – Coughing – Weakness

Heart failure Left heart failure – Signs • Inspection – Dyspnea, cyanosis, othopnea • Auscultation – Crackles » During inspiration and expiration » Early: bibasal Later: extensive crackles » Most serious form: pulmonary edema

Heart failure • Right heart failure – Backward: systemic congestion – Forward: pulmonary hypoperfusion • Complaints: – Oedema (ankles, in laying position: sacral) – Fluid accumulation (pleural transsudate, ascites, pericardial transsudate) – Organ congestion (hepatomegaly)

Heart failure - phases

Inflammatory heart diseases • Pancarditis - all the layers are inflamed ie. : rheumatic pancarditis • Endocarditis • Myocarditis • Pericarditis

Rheumatic fever • 1. Streptococcal infection (ie. tonsillitis) • 2. Pancarditis – Endo-, myo- and pericarditis – Most important: endocarditis • Consequence: valvular disease

Infective endocarditis • Valvular disease + bacterial infection • Signs: – Change in the signs of valvular disease – Heart failure – Microembolism – Fever • Diagnosis – Blood culture – Echocardiography

Myocarditis • Complaints: – Weakness – Decreased loadibility • Signs – Tachycardia (on res) – Soft heart sounds – Sometimes arrhythmia, heart failure

Pericarditis • 1. Pericarditis sicca – Pericardial friction rub – Chest pain • 2. Exsudative pericarditis – Enlarged heart – Soft heart sounds

Hypertension • Functional phase • • Headache Fatigue Troubled Sleeping disorders • Phase of organic failures • • Vascular disease Heart Brain Kidney

Hypertension • Diagnostic criteria – Normal RR: – Elevated normal – Hypertension Systolic < 130 -139 ≥ 140 Diastolic < 85 85 -89 ≥ 90 The cardiovascular risk doubling by every 20/10 Hgmm elevation!

Arteriosclerosis • The signs depends on the affected site – Ischaemic heart disease – Cerebral vascular disease – Abdominal angina – Intermittent claudication

Aneurysm • Depends on the localisation - Heart – Arteries

Aneurysm • Complaints – – – Symptomless Pain Dissection Rupture Signs due to compression Thrombosis - Embolism • Physical examination – Sometimes palpable (abdominal) – Systolic murmur

Arterial embolism • Complaint – Sudden, heavy pain – Pale, cold extremity, later cyanosis – General symptomps • Sign – Unpalpable pulse on the cold, pale extremity • Source of embolism – – – Atrial fibrillation After myocardial infarction Aneurysm Valvular disease Endocarditis

Venous thrombosis • Superficial vein - thrombophlebitis – Painful, inflamed, palpable vein • Deep vein thrombosis – Unilateral swelling – Pain – Signs of inflammation