Cardiovascular Disorders: Introduction to terminologies

Common conditions of the cardiovascular system, which will present in all the cardio chapters, so we have put forth the terms and a short information.

 

Aortic Valve Disease

Aortic Valve is one of the valves that control the flow of the blood into and out of the heart. The flow of the oxygenated blood is pumped out of the heart from the left ventricle into the aorta which is the main artery and through it to the rest of the body. An abnormally narrow wall is called stenosis, so it’s but obvious that the heart has to work harder to pump the blood. The blood might regurgitate too. Later on a condition called hypertrophy may develop.

Image result for aortic valve disease

Who can get it?

A congenital condition or rheumatic fever are leading causes for aortic valve disease. Regurgitation in the aorta is also common in rheumatoid diseases such as ankylosing spondylitis, Reiter’s syndrome, SLE (Systemic Lupus Erythematosus), severe hypertension can also cause it.

What are the symptoms?

Usually does not cause any symptoms in early stages, but it will present as shortness of breath, angina, lightheadedness, dizziness, fainting, especially during exertion.

How is it diagnosed?

  • Chest Xray
  • Electrocardiogram
  • Echocardiogram

Treatment

  • Blood pressure should be kept normal
  • Limitation on strenuous physical activity
  • Surgery to replace the valve, plastic or metal prosthetics
  • Vasodilating drugs are can be used in aortic regurgitation but not in stenosis

 

Athletes’ Heart

An athlete’s heart is a physiological condition when the heart becomes enlarged due to regular physical exercise or strenuous conditioning over time. It would be an abnormal finding in a patient who is not an athlete, but a normal finding in an athlete. They usually have a pulse rate around 45-60 beats per minute, this is because the heart does not need to pump often to supply the blood. It becomes hypertrophied to meet these challenges and its walls are thickened, more on the left side.

Since this condition is because of regular physical activity, it does not need any treatment.

The recognizable character of this condition is bradycardia and slower than normal heartbeat usually around 45- 60 beats per minute, and an enlarged heart, and more recognizable is that these symptoms happen in the absence of symptoms such as shortness of breath, excessive fatigue or chest pain.

Treatment

Abnormalities which are only because of exercise need not be of much worry, but it has to be made sure that the problems are due to exercise and not because if any other disease.

Complications

Greatest complication is the misdiagnosis. It is important that the differential diagnosis is done and in particular, it has to be differentiated from other various conditions such as heart block or heart enlargement due to secondary to high blood pressure or valve defect.

An athlete’s heart is more capable of doing heavy duty work than a normal person’s heart because it has prepared itself like that.

Atrial Fibrillation

Its a type of tachycardia where the beats are very rapid, normal is 60 to 80 beats per minute at rest.

In atrial fibrillation, the atria ( the upper chambers) beat very rapidly and totally irregularly at more than 300 beats per minute, blood is not effectively pumped through the ventricles. The lower chamber and the upper chamber are totally uncoordinated. The ventricles do not get enough time to fill and the atrium doesn’t get enough time to push the blood with each beat.

Atrial fibrillation can be a chronic condition.

Who gets it?

Most commonly it happens in patients who already have underlying heart disease or hypertension or atherosclerosis or those with valvular disease. It may occur in patients who don’t have any underlying disorder.

Thyroid dysfunction or chronic obstructive lung disorders are also risk factors, but the statistical probability is lesser.

Most common symptom- Palpitations – awareness of rapid irregular heartbeat, it can be described as fluttering sensation in the chest. 

 

 

Image result for atrial fibrillation

 

 

Patient may feel nauseous, light headed, or may loose consciousness in unusual cases.

Methods of Diagnosis

 

  • Measuring the pulse  atrial fibrillation

 

 

 

 

 

 

 

 

  • Listening to the heartbeat with a stethoscope
  • Testing with electrocardiogram

 

What are the complications ?

Measures to prevent valvular and coronary heart diseases will decrease the chances of damages , in many situations little can be done to prevent it, but potential triggers should be avoided, these may vary from  patient to patient, but include cigarettes, caffeine, and the alcohol. Medication may be the only way to prevent recurrence if one episode has occurred. Individuals with atrial fibrillation should be under a physician’s care in order to receive optimum medication.

 

Bradycardia

Another term which will be very common the upcoming chapters, its the heart rate which is near to 55-60 beats per minute , considered slow and is called bradycardia, infants have much higher heart rate so in them heart rate below 100 is considered slow.

How can it be diagnosed? 

A normal measuring of pulse and ECG can be sufficient enough to measure it, ECG can definitely tell what other reasons can be present. In fact ECG is a very good tool to diagnose almost all heart conditions, and plays an essential role in establishing a firm diagnosis.

How is it treated ?

If there are no symptoms no medications are really necessary, however in many situations it may require medications, or may be a pacemaker. Certain medications can also cause slowing of the heartbeat, in those cases medications need to be removed.

Can there be complications- Definitely yes. A slower than normal hear beat an cause less oxygen or blood to the brain and thereby convulsions will soon follow, unless immediate measures can be taken.

The world of cardiovascular system is vast, and look at the irony for such a small organ which can beat throughout life without even stopping for a second.

We will discuss about the drugs later in a separate section.

 

Cardiac Arrest 

Happens most commonly in those have heart disease, or who develop severely abnormal heart rhythm , also called ventricular fibrillation, this arrhythmia may occur independently  or with or during a heart attack. Unlike heart attack, its an ELECTRICAL PROBLEM, and NOT A CIRCULATION PROBLEM

A cardiac arrest may be a final event leading to clinical death. It can happen in the situations of hypovolemia, lot of blood loss, in cases of major burns, severe allergic reactions, drug overdose, drowning.

What are the symptoms?

  • loss of consiousness
  • No pusle
  • no other signs such as breathing

Fewer than 1 in 5 people who suffer cardiac arrest receive proper treatment, also a cardiac arrest can happen to any person of any age, including infants.

The patient has very less time to react.

Treatment

Immediate resuscitation are most important to prevent death, if outside the hospital settings the layman has to give CPR (Cardio Pulmonary Resuscitation) , you can find a video tutorial here on the link https://youtu.be/hizBdM1Ob68 , copy paste the link, since its not a hyperlink.

CPR.jpg

 

In heart attack, there might be a blockage in the coronary artery or there can be narrowing of the vessels. This will cut off the supply of blood and there by leading to lack of oxygen , which can lead to difficulty in breathing, fatigue, or weakness. In general heart attack might give the patient some time but cardiac arrest will not.

Myocardial Infarction

Is a medical term for a heart attack. An infarct ( an area of dead or dying tissue) occurs in the myocardium (heart muscle) when there is a marked decrease in the oxygen supply to an area of the muscle. In 90% of the cases this decrease is caused by an obstruction or closure of one of the coronary arteries, caused by a blood clot blocking the artery , narrowed by atherosclerosis. Less commonly, the obstruction may be caused by an arterial spasm, which also closes off the blood flow.

Who gets it ?

Highest incidence- In the middle age or the elderly, the incidence in women rises about five to ten years after menopause. About 45 percent of all individuals who experience a heart attack are under age 65, 5 percent are under 40. Heart attacks are more common in those smoke , are obese, or have high blood cholesterol levels, high blood pressure, diabetes, or a family history of arteriosclerosis at an early age.  A small number of heart attacks occur in people who have none of these risk factors.

What are the symptoms?

  • feeling of pressure
  • tightness
  • squeezing pain in the center of the chest, lasting at least 5-15 minutes and less commonly for more than an hour. The discomfort may spread to shoulders, neck, jaw, or arms particularly to the left arm. 
  • It can be confused with indigestion
  • abut 20 % of the heart attacks there are no symptoms.

How is it diagnosed ? 

Heart attacks are usually diagnosed based on the patient’s symptoms and an evaluation of heart function by examination with a stethoscope, as well as measurements of blood pressure and pulse.

An ecg and blood test (for cardiac enzymes) will usually, but not invariably, confirm the diagnosis. Initial therapy is usually based on these evaluations. Follow up examinations can include- Nuclear scans, coronary angiography, echocardiography, stress tests. 

How is it treated ? 

An overall brief summary of treatments would be

  • immediate medical care
  • drugs such as tissue plasminogen activator
  • streptokinase
  • APSAC or urokinase
  • thrombolytic drugs should be given within two to four hours from onset of symptoms.
  • other treatments can include- stabilizing the abnormal heart rhythms, dilate blood vessels, to lower the heart’s workload, and to decrease the risk of further blood clot development.
  • angioplasty
  • cessation of smoking, regular exercise, diet modification
  • may be recommended as appropriate

 

What are the complications ?

Severe arrhythmias, heart failure, shock, and cardiac arrest are potentially life threatening complications of heart attack. With improved early treatment, these complications are becoming much less frequent.

Rarely, the heart muscle may rupture, requiring immediate surgery.

 

Peripheral Vascular Disease

Its a condition in which the blood supply to the legs or arms are impaired, when normal blood flow is limited, pain may occur, this pain, called intermittent claudication, occurs most often with walking or similar exercise of the legs and is akin to angina. It can be due to the build up of the fatty deposits or plaques on the interior surface of the large arteries of the extremities (especially the legs, thus narrowing the area through which the blood flows.

Who gets it ?

Occurs primarily in those who are middle-aged or elderly, at greater risk are individuals who already have atherosclerosis elsewhere, or who smoke, or if they have hypertension running in the family, and if you are overweight.

What are the symptoms?

Pain that occurs upon exercising and is relieved at rest is a classical symptom, the discomfort can range from mild aching to severe pain, pain is usually centered in the calf but also can arise in the thigh, hip, or buttocks.

Legs may feel cool to touch, and in some cases impotence can occur. In unusual cases, the person might feel pain in the arms too during workout.

How is it diagnosed ? 

Physicians diagnose it on the basis of symptoms, for example, no pulse or reduced symptoms on examining the artery of the leg. Arteriography may be useful in knowing the precise location of the narrowing of the artery.

 

 

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