Cardiovascular Pathologia: Capitulos 21 & 23

Chapter 21 & 23: Core Concepts

• Ischemic heart disease, arrhythmias, conduction abnormalities and structural/infectious heart disorders are key topics
• Coronary vascular pathology, angina, and myocardial infarction (MI) are important areas

Coronary Circulation and Angina Pectoris

• Angina indicates severe arterial narrowing
• Stable angina is relieved by nitroglycerin spray or pills after the first dose
• Unstable angina necessitates calling 911 after three sublingual nitroglycerin doses, five minutes apart
• Unstable angina requires immediate medical attention
• Vasospastic (Prinzmetal's) angina involves coronary artery spasms, often managed with sumatriptan
• Important to note that plaque ruptures grow

Myocardial Infarction (MI)

• Blockage in arteries due to fatty plaques diminishes oxygen supply to the heart
• Stress, stimulants, smoking, and cafes contribute to CAD
• Obesity over 25 BMI puts you at risk
• An African American heritage increases risk
• Avoid NSAIDs due to their thrombolytic effects in MI settings

Complications of Acutersclerosis

• Complications include, Pericarditis and Cardiac tamponade

Diagnostic tools & Test for MI and Angina?

• Electrocardiogram is helpful
• Cardiac catheterization
• Troponin and cardiac enzyme levels are essential diagnostic markers
• Elevated cardiac enzymes

Medical Interventions & Treatment for Heart Attacks

• Interventions includes balloon angioplasty, with or without stents
• Aspirin, clopidogrel, and cholesterol-lowering statins are key medications
• Nitroglycerin
• Beta-blockers
• Calcium channel blockers are essential
• Peripheral Vascular resistance in primary hypertension is related to sodium and obesity
• Primary Treatment for MI & Angina entails statins and patient education.

Gerontologic Considerations and Atherosclerosis

• The peripheral vascular resistance increases

Acute Coronary Syndrome

• Acute coronary syndrome includes UNSTABLE, Non-ST segment elevation and ST segment elevation

Coronary Artery Interventions

• Percutaneous transluminal coronary angioplasty (PCTA) improves blood flow by compressing atheroma
• Coronary artery stents reduce the risk of restenosis after PCTA; some are drug-coated
• Aspirin is taken indefinitely, with clopidogrel for one year after a stent placement Coronary artery bypass graft (CABG) is used when angina cannot be managed with medication or PCI

Atherosclerosis

• Atherosclerosis involves blood clots and fat build-up, which can rupture
• Factors contributing to atherosclerosis include stress and smoking

Coronary Artery Diagnostics and Interventions

• Stress tests, including exercise ECGs and cardiac catheterization, are used for diagnosis
• Interventions include PCI (angioplasty with or without stenting) and CABG
• The DASH diet is often recommended

Chapter 24: Valvular and Infectious Heart Disorders

• Chapter focuses on valvular disorders (prolapse, stenosis, regurgitation) and cardiomyopathies

Valvular Disorders

• Valvular disorders include prolapse, stenosis, and regurgitation
• Valvular regurgitation- Blood flows in the wrong direction
• The following are key risk factors: HTN, aging, high LDL, smoking, diabetes
• Disorders can also result from infective endocarditis and rheumatic fever that can cause murmurs
• Valve repair and replacement, including percutaneous balloon valvuloplasty are a part of the treatments
• Antibiotics are given for prosthetic valves

Aortic Stenosis

• Aortic stenosis involves narrowing of the aortic valve, obstructing left ventricular outflow
• Common causes are age-related calcification and bicuspid valves
• Diagnostic transthoracic echocardiography is used initially, followed by cardiac catheterization for accuracy
• Aortic valve replacement is the medical intervention

Mitral Valve Stenosis

• Mitral valve stenosis involves narrowed leaflets and thickening, leading to left atrial enlargement and potential blood clots
• Causes include rheumatic fever, age-related calcification, and congenital conditions
• Diagnostic tools available are ECGs and x-rays

Aortic Regurgitation

• Aortic regurgitation involves backflow from the aorta into the left ventricle due to endocarditis, aortic dissection, or chest trauma
• Findings include widened pulse pressure, Corrigan pulse, and a diastolic murmur
• Treatment options range from vasodilators to surgical repair or replacement

Mitral Regurgitation

• Mitral regurgitation involves backflow from the left ventricle to the left atrium, often due to ischemic or non-ischemic causes
• EMERGENCY Causes- cardiogenic shock, Rheumatic fever, Congenital Bicuspid Valve
• Chronic: Marfan or Rheumatic diseased

Mitral Valve Prolapse (MVP)

• Mitral valve prolapse (MVP) involves valve prolapse into the left atrium during systole
• Most patients are asymptomatic
• Secondary MVP can be associated with dilated cardiomyopathy
• Atypical angina
• Palpitations
• dyspea

Myocarditis

• Myocarditis- causes a swelling and inability to contract
• Caused By: Coxsackie & Lyme disease Dx- Enlarged heart-
• Treatment: Treat Heart failure, antibiotics

Pericarditis

• Pericarditis involves inflammation of the pericardium, leading to potential complications like cardiac tamponade
• Acute includes severe chest pain, and chronic (constrictive pericarditis) includes fibrous thickening
• Rick- Chest trauma Treatwment- NSAIDS PPL

Rheumatic Carditis

• Involves sequelae from strep throat infections and the development of rheumatic fever
• Antibiotics: valve repair
• Valve replacement

Infected Endocarditis

• Caused by bacteria or fungi. Can lead to necrosis
• Risks- Congenital Disease & Iv drug use- -Fever Petechial hemorrhages and-Blood Culture

Cardiomyopathy

• Disorder of Muscle
• 2 types- Restriticed
• Hypertonic

Dilated Cardiomyopathy

• Dilated cardiomyopathy common and effects the Contraction, systolic failure.
• Manage ACE-1, Betablock and Diretics