PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF CARDIOVASCULAR/LYMPHATICCARDIOVASCULAR/LYMPHATIC

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Med PrepMed Prep

J.J. Nelson RN,CMAJ.J. Nelson RN,CMA

Ventricular Septal Ventricular Septal DefectDefect

• Septal defects are sometimes called a "hole" in Septal defects are sometimes called a "hole" in the heart. the heart.

• A defect between the heart's two the ventricles is A defect between the heart's two the ventricles is called a ventricular septal defect (VSD). called a ventricular septal defect (VSD).

• When there is a large opening between the When there is a large opening between the ventricles, a large amount of oxygen-rich (red) ventricles, a large amount of oxygen-rich (red) blood from the heart's left side is forced through blood from the heart's left side is forced through the defect into the right side. the defect into the right side.

• Ventricular septal defects are among the most Ventricular septal defects are among the most common congenital heart defects, occurring in 0.1 common congenital heart defects, occurring in 0.1 to 0.4 percent of all live births and making up to 0.4 percent of all live births and making up about 20 to 30 percent of congenital heart lesions. about 20 to 30 percent of congenital heart lesions.

VSDVSD

Atrial Septal DefectAtrial Septal Defect

•When an atrial septal defect is present, blood flows through the hole primarily from the left atrium to the right atrium.

•This shunting increases the blood volume in the right atrium which means more blood flows through the lungs than would normally.

•If left untreated, atrial septal defect may cause problems in adulthood.

ASDASD

What is cyanosis?What is cyanosis?

Coarctation of the Coarctation of the AortaAorta• Coarctation of the aorta — or aortic coarctation Coarctation of the aorta — or aortic coarctation

— is a narrowing of the aorta. When this — is a narrowing of the aorta. When this vascular defect occurs, the heart must pump vascular defect occurs, the heart must pump harder to force blood through the constricted harder to force blood through the constricted segment of your aorta.segment of your aorta.

• Coarctation of the aorta is a condition that's Coarctation of the aorta is a condition that's generally present at birth (congenital). It's generally present at birth (congenital). It's relatively common, accounting for 5 percent to relatively common, accounting for 5 percent to 10 percent of all congenital heart conditions.10 percent of all congenital heart conditions.

• Coarctation of the aorta may range from mild Coarctation of the aorta may range from mild to severe. It usually requires surgical treatment to severe. It usually requires surgical treatment and requires careful follow-up through infancy and requires careful follow-up through infancy and into adulthood.and into adulthood.

Coarctation of the Coarctation of the AortaAorta

PericarditisPericarditis• Pericarditis occurs when the Pericarditis occurs when the

pericardium, becomes inflamed pericardium, becomes inflamed (damaged from infection or irritation).(damaged from infection or irritation).

• Fluid from the inflammation can increase Fluid from the inflammation can increase pressure on the heart, squeezing it and pressure on the heart, squeezing it and making it harder to pump blood to the body.making it harder to pump blood to the body.

• Pericarditis often causes chest pain and Pericarditis often causes chest pain and sometimes other symptoms. Pericarditis may sometimes other symptoms. Pericarditis may be acute or chronic. The sharp chest pain be acute or chronic. The sharp chest pain associated with acute pericarditis occurs associated with acute pericarditis occurs when the pericardium rubs against the when the pericardium rubs against the heart's outer layer.heart's outer layer.

PericarditisPericarditis

Note the excessive pericardial fluid.

Rheumatic FeverRheumatic Fever• Rheumatic Fever is an inflammatory Rheumatic Fever is an inflammatory

disease, which occurs as a delayed sequel disease, which occurs as a delayed sequel to pharyngeal infection with streptococcal to pharyngeal infection with streptococcal bacteria. It involves principally the heart, bacteria. It involves principally the heart, joints, central nervous system and skin.joints, central nervous system and skin.

• Symptoms of rheumatic fever generally Symptoms of rheumatic fever generally appear within five weeks after an appear within five weeks after an untreated streptococcal (strep) throat untreated streptococcal (strep) throat infection. infection.

• There's no cure for rheumatic fever. But it There's no cure for rheumatic fever. But it can be prevented by prompt and thorough can be prevented by prompt and thorough treatment of a strep throat infection with treatment of a strep throat infection with antibiotics.antibiotics.

Rheumatic Heart Rheumatic Heart DiseaseDisease

• In more than half of all cases, rheumatic In more than half of all cases, rheumatic fever scars the valves of the heart fever scars the valves of the heart (rheumatic heart disease) forcing this (rheumatic heart disease) forcing this vital organ to work harder to pump blood.vital organ to work harder to pump blood.

• In rare cases the inflammation causes so In rare cases the inflammation causes so much damage to the heart muscle that it much damage to the heart muscle that it leads to heart failure. leads to heart failure.

• In other cases, a scarred heart valve may In other cases, a scarred heart valve may require surgery to repair or replace the require surgery to repair or replace the damaged valve or valves.damaged valve or valves.

Valvular Heart DiseaseValvular Heart Disease• Valvular heart disease occurs when the heart's Valvular heart disease occurs when the heart's

valves do not work correctly. Valvular heart valves do not work correctly. Valvular heart disease can be caused by disease can be caused by valvular stenosis valvular stenosis or or valvular insufficiencyvalvular insufficiency..

• In In valvular stenosisvalvular stenosis,, the tissues forming the the tissues forming the valve leaflets become stiffer, narrowing the valve valve leaflets become stiffer, narrowing the valve opening and reducing the amount of blood that opening and reducing the amount of blood that can flow through it. can flow through it.

• If the narrowing is mild, the overall functioning of If the narrowing is mild, the overall functioning of the heart may not be reduced. However, the the heart may not be reduced. However, the valve can become so narrow (stenotic) that heart valve can become so narrow (stenotic) that heart function is reduced, and the rest of the body may function is reduced, and the rest of the body may not receive adequate blood flow.not receive adequate blood flow.

Valvular StenosisValvular Stenosis

• A narrowed or A narrowed or “stenotic” valve“stenotic” valve requires the heart requires the heart to pump harder, to pump harder, which can strain which can strain the heart and the heart and reduce blood flow reduce blood flow to the body.to the body.

Valvular InsufficiencyValvular Insufficiency• Another valvular heart Another valvular heart

disease condition, disease condition, calledcalled valvular valvular insufficiencyinsufficiency (or (or regurgitation, regurgitation, incompetence, "leaky incompetence, "leaky valve"), occurs when valve"), occurs when the leaflets do not close the leaflets do not close completely, letting completely, letting blood leak backward blood leak backward across the valve. across the valve.

Valvular Heart DiseaseValvular Heart Disease

• Valvular disease is acquired or Valvular disease is acquired or congenital and can involve any of congenital and can involve any of the four heart valves. the four heart valves.

• Heart murmurs are most Heart murmurs are most often caused by defective heart often caused by defective heart valves. Valvular stenosis and valves. Valvular stenosis and insufficiency may be heard as a insufficiency may be heard as a heart murmurheart murmur

• The Auscultation Assistant - Hear Heart Murmurs, Heart Sounds, and Breath Sounds

Hypertension (HTN)Hypertension (HTN)• HTN is defined as a BP over 140/90 mm/HgHTN is defined as a BP over 140/90 mm/Hg• Most often the disease is idiopathic and Most often the disease is idiopathic and

asymptomatic (occasional epistaxis or asymptomatic (occasional epistaxis or vertigo).vertigo).

• In 90 percent to 95 percent of high blood In 90 percent to 95 percent of high blood pressure cases, the American Heart pressure cases, the American Heart Association says there's no identifiable Association says there's no identifiable cause. This type of high blood pressure, cause. This type of high blood pressure, called called essential hypertension essential hypertension or or primary hypertensionprimary hypertension, tends to develop , tends to develop gradually over many years.gradually over many years.

HTN: “Silent Killer”HTN: “Silent Killer”• The other 5 The other 5

percent to 10 percent to 10 percent of high percent of high blood pressure blood pressure cases are cases are caused by an caused by an underlying underlying condition. This condition. This type of high type of high blood pressure, blood pressure, called called secondary secondary hypertensionhypertension..

Coronary Artery Coronary Artery DiseaseDisease

• Coronary artery Coronary artery disease (CAD) is the disease (CAD) is the most common type of most common type of heart disease. It is the heart disease. It is the leading cause of death leading cause of death in the United States in in the United States in both men and women.both men and women.

• Cholesterol builds up in the coronary arteries causing hardening and narrowing. Without adequate oxygen the heart muscle sends messages via angina pectoris or a heart attack (myocardial infarction)

Myocardial InfarctionMyocardial Infarction• The term The term infarction infarction describes necrosis or describes necrosis or

death of myocardial cells. Atherosclerotic death of myocardial cells. Atherosclerotic heart disease is the most common underlying heart disease is the most common underlying cause of myocardial infarction. cause of myocardial infarction.

• During acute myocardial infarction, the During acute myocardial infarction, the central area of necrosis is generally central area of necrosis is generally surrounded by an area of injury, which in turn surrounded by an area of injury, which in turn is surrounded by an area of ischemia. Thus, is surrounded by an area of ischemia. Thus, various stages of myocardial damage can various stages of myocardial damage can coexist. The distinction between ischemia and coexist. The distinction between ischemia and necrosis is whether the phenomenon is necrosis is whether the phenomenon is reversible.reversible.

MIMI• Blockage may be Blockage may be caused by spasm of caused by spasm of the artery or by the artery or by atherosclerosis with atherosclerosis with acute clot formation. acute clot formation.

• The area affected The area affected (size and location) (size and location) along with the along with the patients health patients health status plays an status plays an important part in the important part in the prognosis.prognosis.

VENTRICULAR FIBRILLATION

• http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=745

CARDIAC CATHETERIZATION

• http://videomd.com/cardiaccatheterization-fv-744.aspx

Congestive Heart Congestive Heart FailureFailure

• Congestive heart failure (CHF), or heart Congestive heart failure (CHF), or heart failure, is a condition in which the heart can't failure, is a condition in which the heart can't pump enough blood to the body's other pump enough blood to the body's other organs. organs.

• The "failing" heart keeps working but not as The "failing" heart keeps working but not as efficiently as it should. People with heart efficiently as it should. People with heart failure can't exert themselves because they failure can't exert themselves because they become short of breath and tired.become short of breath and tired.

• As blood flow out of the heart slows, blood As blood flow out of the heart slows, blood returning to the heart through the veins backs returning to the heart through the veins backs up, causing congestion in the tissues. This up, causing congestion in the tissues. This results in edema and dyspnea.results in edema and dyspnea.

PITTING EDEMA

CHFCHF

NORMAL HEART HEART WITH CHF

CONCLUSIONCONCLUSION

Heart disease may be congenital, or Heart disease may be congenital, or acquired from our life style. Health care acquired from our life style. Health care workers must educate the patient to prevent workers must educate the patient to prevent disease and recognize the symptoms of disease and recognize the symptoms of disease.disease.

•http://www.webmd.com/heart-disease/slideshow-visual-guide-to-heart-disease