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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)

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Common diseases of the heart and circulatory system

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  1. Common diseases of the heart and circulatory system

  2. 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)

  3. 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

  4. 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

  5. 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

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

  7. 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

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

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

  10. Valvular diseases • Mitral valve stenosis • Complaints • Dyspnea • Signs of heart failure • Physical examination • Mitral configuration • Auscultation • Loud S1 • Opening snap • Protomesodiastolic and praesystolic murmur • Pulmonal S2 louder

  11. Valvular diseases

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

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

  14. Valvular diseases

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

  16. 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

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

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

  19. Valvular diseases

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

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

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

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

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

  25. 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

  26. 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)

  27. Heart failure - phases

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

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

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

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

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

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

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

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

  36. Aneurysm • Depends on the localisation - Heart • Arteries

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

  38. 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

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

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