Cardiovascular Disease Complications

Complications of Heart Disease

• Congestive heart failure
• Sudden cardiac death
  • Unexpected cardiac death within 1 hour of symptom onset
  • About ½ of all cardiac deaths
  • Most are caused by lethal arrhythmias
  • 80-90% of patients have atherosclerotic stenosis
  • Arrhythmias are caused by scarring, damage, and electrical instability in the conduction system

Hypertensive Cardiovascular Disease

• Cardiac disease occurring because of longstanding hypertension
• Gross morphology:
  • Cardiac hypertrophy: Increase in the weight of the heart and thickness of the left ventricle (concentric hypertrophy)
  • Accompanied by significant coronary artery atherosclerosis
• Complications of hypertensive cardiovascular disease:
  • CHF
  • Lethal cardiac arrhythmias
  • Atrial fibrillation secondary to left atrial dilation

Valvular Heart Disease

• Degeneration
• Inflammation
• Infection
• 2dary involvement after myocardial disease

Degenerative Valvular Diseases

• Calcific aortic stenosis
  • Age-related calcification of valves in elderly or in people with congenital valvular malformations
• Mitral valve prolapse
  • Enlarged, oedematous floppy valves due to valve matrix damage
  • Associated with Marfan syndrome
  • Complications: mitral regurgitation, infective endocarditis, thrombosis

Rheumatic Fever

• Acute inflammatory disease in children, due to infection by group A streptococcal infection (pharyngitis)
• Cross-reaction of antibodies against bacterial antigens cross-react with cardiac tissue components causing inflammation
• 70% of patients have mitral valve disease
• Any cardiac component may be affected

Rheumatic Heart Disease

• Acute:
  • Acute valvulitis or pancarditis
  • Other clinical features of rheumatic fever: Sydenham chorea, skin rash, and arthritis
• Chronic:
  • Distortion, thickening, and fibrosis of valves
  • Mitral valve: fish mouth, button-hole deformities

Infective Endocarditis (IE)

• Microbial colonization of valves
• Blood-borne organisms
• IV drug users, dental procedures, sepsis
• Acute IE:
  • Highly virulent organisms attack normal valve causing necrosis, ulcers, vegetations, and thrombi which may embolize
  • Rapid fever, chills, and flow complications
• Subacute IE:
  • Low virulent organisms colonize damaged valves
  • Smaller vegetations
  • Nonspecific clinical symptoms

Cardiomyopathy (CM)

• Primary heart disease, not caused by a known systemic disease
• 3 main types:
  • Dilated CM
  • Hypertrophic CM
  • Restrictive CM

Pericardial Disease

• Effusion:
  • Accumulation of fluid within pericardial cavity
  • Serous: CHF, renal failure
  • Exudate: acute and chronic inflammatory states
• Haemo-pericardium:
  • Accumulation of blood within pericardial space
• The amount and rapidity of accumulation is important:
  • Slow: over 500ml fluid may be tolerated
  • Rapid: >200ml fluid causes cardiac tamponade

Chest Pain

• Smothering, pressing, aching, or heaviness
• May radiate to jaw, shoulder, arms, or upper abdomen
• May have dyspnea and sweating
• Unstable angina:
  • Chest pain that falls into one of several patterns
  • Chest pain that is more severe, prolonged, or frequent in a patient with previous stable angina
  • Chest pain of new onset associated with minimal exertion