Cardiovascular Conditions and Diseases

Ischemic heart diseases

Atherosclerosis and ischemic heart disease

Ischemic heart diseases result from inadequate oxygenation of myocardial tissue.

• angina
• acute coronary syndromes (including heart attack)

Hypertension

• hypertension
• hypertensive emergency

Arrhythmias

• atrial fibrillation
• ventricular fibrillation
• other arrhythmias

• cardiac arrest
• sudden cardiac death

Heart Failure and Cardiomyopathies

• congestive heart failure
• cor pulmonale (right heart failure from pulmonary hypertension)
• myocarditis

Valvular heart diseases

Valvular heart diseases are either stenosis or regurgitation back across the valve.

• aortic stenosis
• aortic regurgitation
• pulmonary stenosis
• pulmonary regurgitation
• mitral regurgitation
• tricuspid regurgitation
• infective endocarditis

The heart valves are indespensible structures in the heart, and their involvement by disease can range from unimportant to fatal, depending on degree, rate of development, and compensatory mechanisms.

 

Stenosis is a failure to completely open the valve, reducing flow.

Regurgitation, or insufficiency, is failure of a valve to close completely allowing backward flow. Functional regurgitation results from dilation of the heart or arteries, rather than direct problems with the valves.

Both can occur together as well.

 

Valvular problems can impact organs both proximally and distally. The most important are cardiac hypertrophy and the accompanying pulmonary and systemic changes.

 

The most common valvular problems are acquired aortic and mitral stenoses, accounting for almost 2/3 of all valve disease.

 

Calcification

Heart valves experience high repetitive mechanical stresses, particularly at hinge points, due to the over 40 million cardiac cycles they experience each year, the substantial deformations they undergo, and the pressure gradients when closed. This can lead to damage complicated by calcium phosphate deposits.

congenital heart diseases

Congenital heart diseases can range from asymptomatic to life-threatening

• atrial septal defect
• patent ductus arteriosus
• ventricular septal defect
• coarctation of the aorta
• tertalogy of Fallot
• transposition of the great vessels
• eisenmenger syndrome
• congenital aortic stenosis
• congenital pulmonic stenosis

Congenital heart disease is the most common problem in development, occurring in 8 in 1,000 live births, or close to 1:100. If a child has a heart problem at birth, future siblings have a chance of 3-5%.

Some problems can have minimal consequences, while others can be severe and require immediate medical attention.

 

Genetic mutations, environmental factors, maternal illness, or toxins can lead to cardiac malformations. However, in most cases, the cause is unknown.

 

Signs and Symptoms

Congenital heart problems generally do not cause substantial problems during pregnancy, as blood can shunt through the foramen ovale and the ductus arteriosus. It is usally only after birth, when the baby cannot depend on maternal oxygenation of the blood anymore, that symptoms arise.

 

Problems can be categorized as cyanotic or acyanotic.

Acyanotic problems include intracardiac and vascular stenosis, valve regurgitation, and problems resulting in left-to-right shunts.

Large left-to-right shunts cause pulmonary artery volume and pressure to increase, leading to pulmonary arteriolar hypertrophy and increased resistance to flow. Over time, this resistance can increase right heart pressure, resulting in a right-to-left shunt. This delayed development of hypoxemia and cyanosis is called Eisenmenger syndrome.

Increased pulmonary vascular resistance and heart dysfunction (ie a big VSD) can cause heart failure

 

Signs and Symptoms in Infants and Children

• failure to thrive
• cyanosis, especially during feeding, crying, or exertion, in some conditions
• increased rate of breathing or trouble breathing
  • due to fluid buildup
• hepatomegaly, likely due to hyperinflation
• decreased energy or lethargy (ie more sleepiness)

NO pitting edema or orthopnea

 

 

Some problems are apparent at birth, while others are picked up weeks, months, or years later.

• blue neonate: transposition of great vessels
• blue baby: tetrology of Fallot
• 1-4 weeks:
• older children: aortic stenosis, coarctation, myocardial obstruction

Peripheral Diseases

• peripheral artery disease
• venous insufficiency

other cardiovascular conditions and diseases

• pericarditis