Cardiovascular System Disorders_ (STUDENT VERSION.1.pptx

Cardiovascular System Disorders PHYT 7017: Cells, Systems & Disease UT Health San Antonio Bobby Belarmino, PT, DPT, PhD, CCS Learning Goals: At the end of this lecture, students will: 1. Be able to recite the different cardiac diseases. 2. Describe the prevalence rates of different heart diseases...

Cardiovascular System Disorders PHYT 7017: Cells, Systems & Disease UT Health San Antonio Bobby Belarmino, PT, DPT, PhD, CCS Learning Goals: At the end of this lecture, students will: 1. Be able to recite the different cardiac diseases. 2. Describe the prevalence rates of different heart diseases. 3. Identify risk factors that contributes to many heart diseases. 4. Explain the pathophysiology of different heart diseases. 5. Be able to understand the different surgical techniques to correct or to improve quality of life in person with heart disease. 3 Prevalence of CV •Disease “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.” • “One person dies every 36 seconds in the United States from cardiovascular disease.” • “About 655,000 Americans die from heart disease each year—that’s 1 in every 4 deaths.” • “Heart disease costs the United States about $219 billion each year from 2014 to 2015. This includes the cost of health care services, medicines, and lost productivity due to death.” - Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Heart Disease Deaths Vary by Sex, Race, and Ethnicity Major risk factors for heart disease 1. High blood pressure** 2. High blood cholesterol 3. Smoking** Modifiable risk 4. Diabetes factors 5. Overweight and obesity** 6. Physical inactivity** 7. Increasing age Non-modifiable 8. Hereditary and Race risk factors 9. Male gender 10. Stress Contributory 11. Excessive alcohol use 12. Poor diet and nutrition risk factors **= environmental risk Risk Factors: Life’s Simple 7 1. 2. 3. 4. 5. 6. 7. Manage blood pressure Control cholesterol Reduce blood sugar Get active Eat better Loose weight Stop smoking 12 Atherosclerosis • Obstruct blood flow and weaken vessel 13 CVD 14 Atherosclerosis – Risk Factors • Age: 40-60 years of age • Gender: affects more males than females • Genetics: familial predisposition • Hyperlipidemia: overeating especially diets rich in unsaturated fats or coconut oil • Obesity: tissue fat is in equilibrium with circulating lipids • Hypertension: by 60% increases risk • Cigarette smoking • Diabetes Mellitus 15 Myocardial ischemia (MI) -occurs when there is an imbalance between myocardial oxygen supply and demand 16 17 Myocardial Infarction (MI) • Heart attack occurs when blood flow to part of your heart is blocked which causes the heart muscle to sustain damage or die 18 19 Myocardial Infarction (MI) • Plaque formation causes cracks or tears in coronary arteries • Most common cause of MI • If MI is severe the individual will go into cardiac arrest and eventually to a cardiogenic shock. 20 Angina • Vascular heart disease inside the • chest pain/tightness and/or shortness of breath • Stable angina – angina with exertion • Unstable angina – angina at rest and exertion • Treatment: dietary and lifestyle changes, surgery, aspirin (inhibit thrombosis formation) 21 Classic signs of Myocardial Infarction (MI) 22 Location of chest pain in Myocardial Infarction 23 Silent MI -A patient with no symptoms or has atypical presentation of MI. - In some cases, silent MI may be later identified and referred to as “unrecognized MI.” - 20-40% of all MIs are unrecognized - Presence of abnormal Q waves on ECG - Has poor prognosis than recognized MI - Based on Framingham Heart Study, 58% male & 48% female had died within 10 years after detection of unrecognized MI - A more recent study from Cardiovascular Health Study, a 7-year mortality was seen with unrecognized MI (21% male & 25% 24 female). 25 Heart disease and Women  Heart disease is the leading cause of death for women in the United States, killing 299,578 women in 2017—or about 1 in every 5 female deaths.  Heart disease is the leading cause of death for African American and white women in the United States.  Among American Indian and Alaska Native women, heart disease and cancer cause roughly the same number of deaths each year.  For Hispanic and Asian or Pacific Islander women, heart disease is second only to cancer as a cause of death.  About 1 in 16 women age 20 and older (6.2%) have coronary heart disease, the most common type of heart disease:  About 1 in 16 white women (6.1%), black women (6.5%), and Hispanic women (6%)  About 1 in 30 Asian women (3.2%) 26 27 Cardiac enzymes: 71010 14 28 29 Coronary artery bypass graft surgery (CABG) 30 Percutaneous coronary • Drug-eluting (PCI) stents (DES) interventions Balloon angioplast y 31 32 33 34 35 36 37 HEART VALVE DISEASE 38 39 40 41 HEART FAILURE 42 Heart Failure  Based on AACF and AHA, “HF is a complex clinical syndrome that results from a structural or functional impairment of ventricular filling or ejection of blood.”  Cardinal signs:  Dyspnea and fatigue  Limited exercise tolerance  Fluid retention  Acute Decompensated Heart Failure (ADHF) “sudden onset of the signs and symptoms of congestive heart failure” requiring urgent medical attention.  Congestive Heart Failure (CHF) - presence of fluid 43 overload causing reduced ability to perform aerobic 44 Epidemiology of HF 45 46 HF Classification 47 48 49 Types of HF by Left Ejection Fraction HF HF with preserved EF (HFpEF) ≥ 50% (diastolic HF) HF with reduced EF (HFrEF) < 40% EF (systolic HF) HFpEF, borderline 41-49% HFpEF, Improved >40% Patient with previous HFrEF 50 Types of Left sided heart failure 51 P: An important new cardiac blood test ≥ 200 pg/mL = most accurate dx of CHF • 100% = sensitivity • 97% = specificity Villacorta et al, 2002 52 Other symptoms:  Breathing difficulty  Coughing  Fatigue/ exercise intolerance 53 • Orthopnea & Paroxysmal Nocturnal Dyspnea Individual develops dyspnea upon lying down • What changes when the patient is lying down? • Paroxysmal nocturnal dyspnea 54 Symptoms of Heart Failure 55 ymptoms of Acute Heart Failure ↑ shortness of breath with physical activity or while lying flat    42.8 % sensitivity; 87.5% specificity Am J Cardiol. 2009 July 15; 104(2): 259–264 Weight gain due to excess fluid in the body; this also may cause swelling of the abdomen, feet and ankles   Wt. gain ≥ 2kg (over 48-72 hrs)- 97% specificity (6): 953-957)  - 9% sensitivity (Eur J Heart Fail (2005) 7 Paroxysmal Nocturnal Dyspnea (PND) 37.6% sensitivity; 89.8% specificity Am J Cardiol. 2009 July 15; 104(2):56 259–264  mptoms of Acute Heart Failure..cont •Irregular or rapid heartbeat or pulse •Coughing and wheezing, especially at night •Kidney problems, which can lead to retention of fluid •Difficulty concentrating or decreased alertness •Decreased exercise tolerance due to tiredness, weakness and feeling dizzy or faint 57 igns of Acute Heart Failure Tiredness and weakness Edema (ankles, feet, and abdomen) - 72% specificity Health Technol Assess, 2009 Jul;13(32) Elevated JVD-> 55% - 65% sensitivity; ->74- 80% specificity JAMA 1997 Jun 4;277:1712 Hepato jugular reflex (signs of right sided failure)33% sensitivity and 94% specificity Chest 1990 Apr; 97(4):772 & BMJ 2004 Jul 24:329(7459): 209  Dyspnea on Exertion (DOE)/ Resting dyspnea-> 92% sensitivity; 19% specificity 58 Clinical Findings: have relatively high specificity, but low sensitivity (11%-53%) - edema (72% specificity) - elevated jugular venous pressure (70% specificity) - cardiomegaly (85% specificity) - lung crepitations (81% specificity) - added heart sounds (99% specificity) - hepatomegaly (97% specificity) Health Technol Assess 2009 Jul;13(32):1 59 Causes of Heart Failure  Coronary artery disease — narrowing of the arteries that supply blood to the heart; this can cause heart attacks and permanently damage heart muscle  Hypertension (high blood pressure)  Diseases of the heart valves — valves can leak or be overly stiff  Heart muscle disease from unknown causes  Damage to the heart from alcohol or other drugs  Defects in the heart present from birth 60 61 62 63 Left-sided heart failure • The dysfunction of the left ventricle would decrease the flow of blood from the aorta to the body • Blood will backup in the pulmonary vasculature • Backup of blood increases pressure in the pulmonary veins causing transudation of fluid into the lungs and results in pulmonary edema • Pulmonary edema causes dyspnea (shortness of breath) 64 Left-sided heart failure • Paroxysmal dyspnea nocturnal • Elevated pulmonary capillary wedge pressure • Pulmonary congestion • Orthopnea – dyspnea when lying flat 65 Right Ventricle • Not as strong as the left ventricle • Ventricular walls are thinner than the left ventricular walls since it pushes blood into low pressure pulmonary system 66 Right-sided heart failure • Any disease process that increases resistance in the pulmonary vasculature will increase the work load on the right ventricle • Left-sided heart failure will result in pulmonary hypertension and subsequent right-sided heart failure 67 Consequences of RIGHT-sided heart failure • Blood will back up in the superior and inferior vena cava • If venous pressure backs up then patient will have an elevated jugular venous pressure (JVP) • Blood will also back up into the liver and abdomen 68 Cor Pulmonale • Right-sided heart failure • Causes: long-term pulmonary hypertension and/or systemic hypertension • Clinical Manifestation: fainting with activity, chest pain, swelling of feet or ankles, swelling of neck veins (sign of right-sided heart disease) 69 Hypertrophic cardiomyopathy Cor pulmonale 70 Dilated cardiomyopathy 71 Heart Failure 72 Pulmonary Hypertension sure s e r p ↑ 73 Spiral effect of deconditioning 74 Cardiorenal syndrome of heart failure RAA • Renin –Angiotensin – Aldosterone System (RAA) • Aldosterone Chitturi C and Novak JE. Diuretics in the management of cardiorenal syndrome. Adv Chronic Kidney Dis.2018;25(5):425-433. 75 CKD and Heart Failure Mortality (PRIME-II) eGF R Hillege HL, Circulation. 2000;102: 203-210 76 Neurohumoral adaptation in CHF 77 Cardiac Muscle Cardiac Amyloidosis Disease Amyloidosis Hypertrophic Cardiomyopathy 78 Endocarditis • Inflammation endocardium of the • Causes: hypercoagulable states, Streptococcus viridians or Staphylococcus aureus • CM: fever and new heart murmur • Infections emboli tend to form • Treatment: antibiotic therapy and surgical replacement of the heart valves if the damage is extensive 79 Myocarditis • Inflammation of the myocardium • Causes: infection (coxsackie B virus), inflammatory disease, toxins • CM – varies but congestive heart failure is common • Treatment: eliminate underlying cause 80 Pericarditis •Inflammation of the pericardium •Infectious causes: coxsachie B virus, tuberculosis, streptococcus bacteria, staph aureus •Individual has pain in the chest that gets worse with deep inspiration (pain better when patient leans forward and worse when patient lies down) •Treatment: antibiotics for infectious causes, surgery drainage and pharmacological intervention (aspirin – decrease inflammation) 81 Cardiac Tamponade • Occurs in 2 out of 10,000 people in USA • Ventricles cannot fully expand due to blood or fluid collection in the pericardium • Causes: dissecting aortic aneurysm, end-stage lung cancer, MI, pericarditis, trauma, kidney failure, radiation therapy, heart surgery, SLE (systemic lupus erythematosus) 82 Cardiac Tamponade • anxiety, chest pain, dyspnea, fainting, cyanosis, rapid breathing, swelling of abdominal area • Treatment: drainage of fluid, pharmacological intervention • Tamponade is lifethreatening if untreated 83 Aortic Dissection • Tear in the intima of the aorta • Causes: trauma, hypertension, syphilis • CM: feeling of tearing/ripping in the chest, back pain, loss of pulses, stroke, MI • Treatment: surgery 84 Aneurysm 85 Open surgery Thoracic Endovascular Aneurysm Repair (TEVAR) 86 Aortic aneurysm Normal chest Xray 87 Descending Aortic Aneurysm 88 Peripheral Vascular Diseases 89 90 Varicose veins 91 THROMBOEMBOL ISM (VTE) 92 NEXT: Pulmonary Diseases 93 

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