Types of heart disease

• What is aetiology?

  Cause of the disease
• What is pathogenesis?

  How the disease evolves following aetiology event e.g atherosclerosis
• What is morphological changes?

  Structural alterations (shape). How things are changing as a result of the disease.
• What is clinical manifestations?

  How does the disease present itself. Some disease can remain clinically silent.
• What are signs and symptoms?

  Symptoms - What patient is experiencing

  Sign - What we can see
• What is diagnosis?

  Description as to the nature or cause of health problem. It requires a history & physical examination and diagnostic testing.
• What is clinical course?

  How it evolves. Acute phase and chronic phase.
• What is prognosis?


  Survivability - if patient has a good prognosis, hopefully they’ll recover from heart attack, recover from surgery. Some people may go back to normal and some people may go on to have long term condition
• What is epidemiology of disease?

  Study of disease or disease occurrence in a population
• What is incidence and prevalence?

  Incidence - number of new case

  Prevalence - People living with it
• Types of heart disease?

  • Congenital heart disease
  • Hypertensive heart disease
  • Myocardial heart disease
  • Pericardial heart disease
  • Ischaemic heart disease
  • Valvular heart disease
• What is Ischaemic heart disease?


  It affects medium to large size arteries. Ischaemia is an imbalance between supply and demand. Ischaemia can be induced with normal coronary artery.
• Ischaemia

  Insufficient blood supply to a part of the body, especially the heart muscle
• Causes of ischaemia


  • Amount of coronary tone (how constricted or dilated coronary vessels are)
  • Anaemia - not carrying enough oxygen in the haemoglobin
  • Increased heart rate shortening diastole
  • Increased preload stretching heart fibres
  • Increased afterload (amount of pressure the heart needs to exert to eject blood)
  • Increased contractility requiring more oxygenated blood and ATP
• Coronary vessels

  • They have to dilate to increase blood supply
• Increased preload

  Stretches heart fibres, requiring more effort to contract the heart
• Increased afterload


  Raises the resistance of the valve, requiring the heart to contract harder to open the valve
• Increased contractility

  Requires more oxygenated blood and ATP to allow actin and myosin filaments to slide over each other
• What does valves do?

  The valves promotes unidirectional flow (we want blood to be flowing in one way through the heart).

  This makes the heart efficient in terms of circulating oxygenated blood around the body and deoxygenlater blood to the lungs.
• Types of valves

  Aortic valve (AV)

  Tricuspid valve (TV)

  Pulmonary valve (PV)

  Mitral valve (MV)
• What is stenosis and regurgitation?

  Stenosis - narrowed valve

  Regurgitation - Leaking

  Cusp and leaflets not co-acting can cause leak
• What differentiates a pulmonary valve from an aortic valve?

  The sinus of valsalva
• What is congenital heart disease?

  This means the disease has been present from birth as a result of abnormal embryonic development. Congenital valvular heart disease - Born with a valve problem.
• Acquired valvular heart disease?

  Developed over time. Some people grow out of it and some need intervention.
• What is Atrial Septal Defect (ASD)?

  A congenital defect. There will be a hole between upper heart chambers. There will be left to right shunt - oxygenated blood mixing with deoxygenated blood. Shunt can be left to right or right to left.
• How co-actation affects afterload?

  Co-actation increase afterload. We can go in there cut it out and put a patch there.
• Hypertensive Heart disease?

  Manifestation - The tall R wave can be a clue that the patient is hypertensive.

  Increased after load - makes myocyte get bigger. Cavity size will shrink - This will be significant concentric left ventricular hypertrophy (LVH).

  End organ damage - Blood vessels are being exposed to elevated pressure chronically.
• Myocardial disease


  It is typically present with normal coronary arteries.

  Cardiomyopathy - heart muscle disease

  Amyloidosis - This is a granular deposits that infiltrate myocardium. This makes the heart stiff, it makes it non-compliant so it can‘t fill properly.

  Manifestations - Lower electro activity. only myocytes conducting.

  Decreased amplitude
• Pericardial disease?

  Fluid between parietal and visceral pericardium allows the surface to slide over each other to protect the heart from toxins and friction.
• What does accumulation in pericardium cause?

  Viral tuberculosis

  Radiotherapy

  Rheumatoid patients
• What is cardiac tamponade?

  Fluid is built up and it’s now stopping the heart from filling
• What is pericarditis?

  Inflammation of the pericardium.
• Manifestation of pericarditis?

  pulsus alternans - we can see voltage changing from B to B

  Pulsus alternans - with alternating strong and weak beats.
• Principles of cardiac dysfunction?

  P - Pump

  O - Obstruction

  R - Regurgitation

  C - Conduction
• What is pump?

  If the pump fails or stop working, it becomes damaged. Damaged heart muscle = ineffectively contracting, Systolic dysfunction, Infarction = cell death.
• What is obstruction?

  Obstruction to flow, a lesion preventing valve opening or narrowing causing increased chamber pressure. E.g mitral stenosis, aortic stenosis, tricuspid stenosis and pulmonary stenosis.
• What is regurgitation?

  A leaking valve and it’s adding volume. This will have a haemodynamic consequence on the rest of the heart. E.g mitral regurgitation, aortic regurgitation, tricuspid regurgitation, pulmonary regurgitation.
• What is conduction?

  The heart is an electromechanical pump, it needs electrical activity to cause a mechanical action. If activity starts to fail, it will have mechanical consequence.