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 Isufficiency – regurgitation 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 S1 Opening snap Protomesodiastolic and praesystolic murmur Pulmonal S2 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 Physical examination 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 Physical examination 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 Physical examination 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 Pulmonal 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 Subtypes Forward – hypoperfusio Backward – congestion, pressure elevation Subtypes Left heart failure Right heart failure Combined (global) heart failure

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

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

Heart failure Right heart failure Complaints: 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: Signs Weakness Decreased loadibility Tachycardia (on res) Soft heart sounds Sometimes arrhythmia, heart failure

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

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

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!

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

Arterial embolism Complaint Sign Source of embolism 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