Heart Disorders

• Heart Disease


  Is ranked as a major cause of morbidity and morality in North America
• Common Heart Diseases


  • Congenital heart defects
  • Hypertensive heart disease
  • Angina and Heart attacks
  • Cardiac arrhythmias
  • Congestive heart failure
• To Prevent Heart Disease

  • Healthy diet
  • Regular exercise
  • Moderation in alcohol intake
  • Cessation of smoking
  • Safe sexual practices
  • Immunizations
  • Monitoring body weight
  • Blood pressure
  • Basic screening test for cholesterol levels and the presence of cancer
• Electrocardiogram (ECG)


  • Is useful in the initial diagnosis and monitoring of arrhythmias, myocardial infarction, infection and pericarditis
  • A portable Holter monitor may be worn by an individual to record ECG changes while he or she pursues daily activities
• Auscultation


  • Valvular abnormalities or abnormal shunts of blood cause murmurs that may be detected by ausculation of heart sounds by means of a stethoscope
  • A recording of heart sounds may be made with a phonocardiograph
  • In echocardiography, ultrasound or reflected sound waves, is used to record the image of the heart and valve movements
• Exercise Stress Tests


  Are useful in assessing general cardiovascular function and in checking for exercise-induced problems such as arrhythmias
• Chest X-ray Films


  • Can be used to show the shape and size of the heart, as well as any evidence of pulmonary congestion associated with heart failure
  • Nuclear imaging with radioactive substances such as thallium assesses the size of an infarct in the heart, the extent of myocardial perfusion and the function of ventricles
  • Tomographic studies, which illustrates various levels of a tissue mass may be used when available
• Cardiac Catheterization


  Passing a catheter through an appropriate blood vessel, usually a large vein in the leg, into the ventricle, may also be utilized to visualize the inside of the heart, measure pressures and assess valve and heart function
• Doppler Studies


  Blood flow in the peripheral vessels can be assessed with the Doppler studies, in which essentially a microphone that records the sounds of blood flow or obstruction is placed over the blood vessel
• Blood Test


  • Are use to asses serum triglyceride and cholesterol levels and the levels of sodium, potassium, calcium, and other electrolytes
  • Hemoglobin, hematocrit, blood cell counts, and the differential count for white cell are also routine aspects of blood tests
• Arterial blood gas determination


  Is essential in patients with shock or myocardial infarction, to check the current oxygen level and acid-base balance
• General Treatment Measures for Cardiac Disorders

  1. Dietary modifications usually include reducing total fat intake and intake of saturated (hydrogenated or animal) fat

  2. General weight reduction may be recommended for some persons

  3. Salt (sodium) intake is decreased as well in order to reduce blood pressure

  4. A regular exercise program is suggested to improve overall cardiovascular function and circulation to all areas of the body

  5. Cessation of cigarette smoking decreases the risk of coronary disease because smoking appears to increase vasoconstriction and heart rate, thus increasing the workload on the heart

  6. Drug therapy is an important component in the maintenance of cardiac patients
• Common medications


  • Vasodilators such as nitroglycerin or long-acting isosorbide
  • Beta-blockers such as metoprolol or atenolol
  • Calcium channel blockers
  • Digoxin, a cardiac glycoside
  • Antihypertensive drugs
  • Adrenergic-blocking drugs
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blocking agents
  • Diuretics
  • Anticoagulants or "blood thinners"
  • Cholesterol or lipid-lowering drugs
• Coronary Artery Disease (CAD) or Ischemic Heart Disease (IHD)


  Sometime called coronary heart disease (CHD), coronary artery disease includes angina pectoris or temporary cardiac ischemia and myocardial infarction or heart attack, in which part of the muscle is damaged because of obstruction in a coronary artery
• Arteriosclerosis


  May be used as a general term for all types of arterial changes. Its is best applied to degenerative changes in the small arteries and arterioles, commonly occurring in older individuals and diabetes
• Atherosclerosis


  Is differentiated by the presence of atheromas, plaques consisting of lipids, cells, fibrin, and cell debris, often with attached thrombi, which form inside the walls of large arteries
• Lipids


  Lipids, including cholesterol and triglycerides, are essential elements in the body and are synthesizes in the liver; therefore, They can never be totally eliminated from the body
• Low-density lipoprotein (LDL)


  Has a high cholesterol content and transports cholesterol from the liver to cells, is the dangerous component of elevated serum levels of lipids and cholesterol. It is considered the "bad" lipoprotein that promotes atheroma formation
• High-density lipoprotein (HDL)


  Is the "good" lipoprotein; it has low cholesterol content and is used to transport cholesterol away from the peripheral cells to the lover, where it undergoes catabolism and excretion
• Lipids continue to build up at the site if arterial injury, along with fibrous tissue. Platelets adhere and release prostaglandins, which precipitate inflammation and vasospasm
• Risk factors for atherosclerosis


  • Can be modified to some extent
  • Cannot be modified to some extent
• Factors that cannot be changed (non-modified)

  • Age, with atherosclerosis more common after 40 years, particularly in men
  • Gender, that is, women are protected by higher HDL levels until after menopause, when estrogen levels decreased
  • Genetic or familial factors seem to have strong influence on serum lipid levels, metabolism, and cell receptors for lipids
• Modifiable predisposing factors


  • Obesity or diets high in cholesterol and animal fat, which elevate serum lipid levels especially LDL
  • Cigarette smoking. The risk associated with smoking is directly related to the number od packs of cigarettes smoke per day, Smoking decreases HDL, increases fibrinogen and clot formation as well as vasoconstriction
  • Sedentary life style, which predisposes to sluggish blood pressure and stress level and in creases HDL while lowering HDL and cholesterol
  • The presence of diabetes mellitus. In patients with diabetes, especially those whose disease is not well controlled, serum lipid levels are increased and there us a tendency toward enthelial degeneration
  • Poorly controlled hypertension, which causes endothelial damage
  • Combination of some oral contraceptives and smoking
• Diagnostic Tests


  • Serum lipid levels, including those of LDL and HDL, should be checked to identify the patient's risk and to monitor the efficacy of treatment
  • Serum levels of high-sensitivity C-reactive protein(CRP) indicate the presence of inflammatory disease
  • Low CRP levels appear to indicate a low risk of developing cardiovascular disease
  • Exercise stress testing can be used for screening or to assess the degree of obstruction in arteries
  • Radio isotopic studies can be used to determine the degree of tissue perfusion
• Treatment


  1. Lowering serum cholesterol and LDL levels

  2. Sodium intake should be minimized as well to control hypertension

  3. Control of primary disorders such as diabetes or hypertension is important

  4. Cease smoking

  5. If thrombus formation is a concern, oral anticoagulants may be prescribed
• The presence of diabetes mellitus. In patients with diabetes, especially those whose disease is not well controlled, serum lipid levels are increased and there us a tendency toward enthelial degeneration
• Arteriosclerosis


  Poorly controlled hypertension, which causes endothelial damage
• Atherosclerosis


  Combination of some oral contraceptives and smoking
• Diagnostic tests for cardiovascular disease

  • Serum lipid levels, including those of LDL and HDL, to identify the patient's risk and to monitor the efficacy of treatment
  • Serum levels of high-sensitivity C-reactive protein (CRP) to indicate the presence of inflammatory disease
  • Low CRP levels to indicate a low risk of developing cardiovascular disease
  • Exercise stress testing for screening or to assess the degree of obstruction in arteries
  • Radioisotopic studies to determine the degree of tissue perfusion
• Treatment for cardiovascular disease

  1. Lowering serum cholesterol and LDL levels

  2. Minimizing sodium intake to control hypertension

  3. Controlling primary disorders such as diabetes or hypertension

  4. Ceasing smoking

  5. Oral anticoagulant therapy if thrombus formation is a concern

  6. Surgical intervention (PTCA) when atheromas are advanced to reduce obstruction
• Angina pectoris


  Chest pain that occurs when there is a deficit of oxygen for the heart muscle
• Causes of angina pectoris


  • Insufficient myocardial blood supply associated with atherosclerosis, arteriosclerosis, vasospasm, and myocardial hypertrophy
• Anginal pain is usually quickly relieved by rest and the administration of vasodilators, such as nitroglycerin
• Coronary heart disease is the primary cause of death in American males and females as well as a major cause of disability
• Myocardial infarction (MI)


  Occurs when a coronary artery is totally obstructed leading to prolonged ischemia and cell death or infarction of the heart wall
• Ways in which myocardial infarction may develop

  1. The thrombus may build up to obstruct the artery

  2. Vasospasm may occur in the presence of a partial occlusion by an atheroma leading to total obstruction

  3. Part of thrombus may break away, forming an embolus that flows through the coronary artery until it lodges in a smaller branch, blocking that vessel
• Premature atrial contraction or beats


  Extra contractions or ectopic beats of the atria that usually arise from a focus of irritable atrial muscle cells outside the conduction pathway
• Types of atrioventricular node abnormalities (heart blocks)

  • First degree, in which the conduction delay prolongs the PR interval
  • Second degree, in which a longer delay leads periodically to a missed ventricular contraction
  • Total, or third-degree blocks, in which there is no transmission of impulses from the atria to the ventricles
• Ventricular conduction abnormalities


  • Bundle branch block, referring to interference with conduction in one of the bundle branches
  • Ventricular tachycardia, which is likely to reduce cardiac output because the filling time is reduced
  • Ventricular fibrillation, in which the muscle fibers contract independently and rapidly and therefore are ineffective in ejecting blood
  • Premature ventricular contractions, which are additional beats arising from a ventricular muscle cell or ectopic pacemaker
• Treatment of cardiac arrhythmias

  Determine and treat the cause, which may include correcting issues caused by drugs, bradycardia, or potassium imbalance