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 possibilityCoronarography – therapeutical possibility

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

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

• 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

• 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

• 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– 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– Forward – hypoperfusio– Backward – congestion, pressure elevation

• Subtypes– Left heart failure– Right heart failure– Combined (global) heart failure

Heart failure

• Left heart failure– Forward: systemic hypoperfusion– Backward: pulmonary congestion

• Complaints:– Dyspnea– Orthopnea– Coughing– Weakness

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

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)

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:– Weakness– Decreased loadibility

• Signs– Tachycardia (on res)– Soft heart sounds– Sometimes arrhythmia, heart failure

Pericarditis

• 1.Pericarditis sicca– Pericardial friction rub– Chest pain

• 2.Exsudative pericarditis– Enlarged heart– Soft heart sounds

Hypertension

• Functional phase• 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

– Symptomless– Pain– Dissection– Rupture– Signs due to compression– Thrombosis - Embolism

• Physical examination– Sometimes palpable (abdominal)– Systolic murmur

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

Venous thrombosis

• Superficial vein - thrombophlebitis– Painful, inflamed, palpable vein

• Deep vein thrombosis– Unilateral swelling – Pain– Signs of inflammation