Alterations of Cardiovascular Function

Aneurysm Local dilation or outpouching of a vessel wall or cardiac chamber True aneurysms Involvement of all three layers of the arterial wall Fusiform saccular and/or circumferential False aneurysms Leak between a vascular graft and a natural artery

Aneurysm Clinical manifestations Heart Aorta Thoracic Abdomen Include dysrhythmias, heart failure, and embolism of clots to the brain or other vital organs. Aorta Is asymptomatic until it ruptures, then it becomes painful. Thoracic Dysphagia and dyspnea are caused by the pressure. Abdomen Flow to an extremity is impaired, causing ischemia.

Aneurysm Treatment Maintenance of low blood volume and low blood pressure to decrease the mechanical forces Smoking cessation β-adrenergic blockage Surgery

Aneurysm Complication Aortic dissection Is a devastating complication that involves the aorta (ascending, arch, or descending); can disrupt the flow through the arterial branches. Is a surgical emergency.

Disorders of the Endocardium Valvular dysfunction Stimulates chamber dilation and/or myocardial hypertrophy. Treatment Careful fluid management Valvular repair or valve replacement with a prosthetic valve, followed by long-term anticoagulation therapy and life-long antibiotic prophylaxis before invasive procedures

Disorders of the Endocardium Valvular stenosis Aortic Mitral Valvular regurgitation Tricuspid Characteristic heart sounds, cardiac murmurs, and systemic complaints: Assist in determining which valve is abnormal Mitral valve prolapse syndrome

Disorders of the Endocardium Aortic stenosis Orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta Clinical manifestations: Angina, syncope, and heart failure Treatment Most require valve repair or replacement with a prosthetic valve, followed by long-term anticoagulation therapy Transcatheter aortic valve implantation

Disorders of the Endocardium Aortic stenosis

Disorders of the Endocardium Mitral stenosis Impairment of blood flow from the left atrium to the left ventricle Most common cause: Acute rheumatic fever Clinical manifestation: Opening snap Treatment: Surgical repair; may require valve replacement

Disorders of the Endocardium Aortic regurgitation Inability of the aortic valve leaflets to close properly during diastole Clinical manifestations: Widened pulse pressure as a result of increased stroke volume and diastolic backflow Treatment: Valve replacement may be delayed for many years with the use of vasodilators and inotropic agents

Disorders of the Endocardium Mitral regurgitation Most common causes: Mitral valve prolapse and rheumatic heart disease Permits backflow of blood from the left ventricle into the left atrium Treatment: Surgical repair or valve replacement

Disorders of the Endocardium Tricuspid regurgitation Leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure Mitral valve prolapse syndrome Anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole Clinical manifestations: Asymptomatic Treatment: None needed or beta blockers

Acute Rheumatic Fever and Rheumatic Heart Disease Is a diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic streptococci. Is a febrile illness. Inflammation of the joints, skin, nervous system, and heart If left untreated, rheumatic fever causes rheumatic heart disease. (It may have a genetic component.)

Acute Rheumatic Fever and Rheumatic Heart Disease Abnormal immune response to the M proteins that cross react with normal tissues Fibrinoid necrotic deposits: Aschoff bodies Clinical manifestations Carditis: Murmur Polyarthritis: Large joints mainly affected Chorea: Sudden, irregular, involuntary movements Erythema marginatum: Truncal rash Treatment: 10-day regimen of antibiotics, NSAIDs, may need antibiotics for 5 years

Infective Endocarditis Inflammation of the endocardium from infectious agents Most common: Bacteria, especially streptococci, staphylococci, and enterococci Pathogenesis Endocardial damage Bloodborne microorganism adherence Formation of infective endocardial vegetations

Infective Endocarditis Clinical manifestations Fever New or changed cardiac murmur Petechial lesions of the skin, conjunctiva, and oral mucosa Osler nodes: Painful erythematous nodules on the pads of the fingers and toes Janeway lesions: Nonpainful hemorrhagic lesions on the palms and soles

Infective Endocarditis Treatment Was once a lethal disease, but morbidity and mortality have significantly diminished with antibiotics and improved diagnostic techniques. Antimicrobial therapy is generally administered for 4 to 6 weeks. Begin with intravenous and end with oral administration. May use a combination. Other drugs are administered to treat left heart failure, secondary to valvular dysfunction. Surgery to repair or replace the valve, as prescribed.

Cardiomyopathies Causes: Remodeling due to Neurohormonal changes Ischemia Hypertension Infectious Diseases Exposure to toxins Connective Tissue Diseases Proliferative Disorders Nutritional Deficiencies

Dilated Cardiomyopathy Causes: MI DM HTN Toxins (lead, mercury) Alcoholism Drug Use (cocaine) Infections Congenital Heart Defects Characteristics: Left ventricular thinning (dilation) and weakening Impaired systolic function Systolic Heart Failure

Dilated Cardiomyopathy Clinical Manifestations: Dyspnea Fatigue Pedal Edema Jugular Venous Distension Pulmonary Congestion Management: Ace Inhibitors Beta Blockers Diuretics Positive Inotrope Blood Thinners Pacemakers ICD Heart Transplant

Hypertrophic Cardiomyopathy Categories: 1. Hypertrophic Obstructive 2. Hypertensive/Valvular Hypertrophic Causes: Inherited Hypertension Valvular Stenosis Aortic Characteristics: Thickening of the septal wall Thickening of the left ventricle Impaired ventricular ejection Diastolic dysfunction leading to systolic dysfunction

Hypertrophic Cardiomyopathy Clinical Manifestations: Asymptomatic Angina Dyspnea Palpitations Atrial and Ventricular Dysrhythmias Sudden Death Management: Beta Blockers Calcium Channel Blockers Antidysrhythmics Blood Thinners Septal Myectomy/Ablation ICD

Restrictive Cardiomyopathy Causes: Idiopathic scar tissue formation Amyloidosis Sarcoidosis Hemochromatosis Radiation/Chemotherapy Exposure Characteristics: Rigid Ventricles Abnormal Diastolic Function Normal Systolic Function

Restrictive Cardiomyopathy Clinical Manifestations: Exercise intolerance Dyspnea on exertion Fatigue Anorexia Weight gain Pericardial knock Edema Management: Treatment of underlying condition Heart transplant Heart failure meds may be necessary