CHAPTER 10 DISEASES AND CONDITIONS OF THE CIRCULATORY SYSTEM

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CHAPTER 10 DISEASES AND CONDITIONS OF THE
CIRCULATORY SYSTEM
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Disorders of Cardiac Rhythm

• Tachycardia or bradycardia
• Arrythmias or Dysrythmias
• Can be caused many different disorders
• See drawings on page 427
• Each complete cardiac cycle takes 1.2 seconds if
  the heart rate is 72 beats/min.
  

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Heart and Circulation Disorders

• Coronary Artery disease
• Hypertension
• Angina pectoris
• MI
• CHF
• Cardiac arrest
• Shock
• Cardiac Tamponade
• Rheumatic fever
• Pericarditis
• Myocarditis
• Endocarditis
• Thromboangitis obliterans
• Raynaud disease

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Presenting Symptoms

• Chest pain
• Dyspnea
• Tachypnea
• Palpitations
• Cyanosis
• Edema
• Fatigue
• Syncope

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Coronary Artery Disease

• CAD condition affecting the blood supply for
  the heart muscle. The arteries have become
  narrowed by fatty plaque over time. This causes
  ischema and eventually MI.
• SS angina pectoris, burning squeezing,
  crushing, radiates to arm neck and jaw. Nausea,
  vomiting and weakness. Changes in the EKG.

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Pathology

• Atherosclerosis hardening and narrowing of the
  arteries due to buildup of cholesterol. Ather/o
  (plaque or fatty substance).
  

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CAD

• Atherosclerosis-narrowing of the arteries from
  fatty plaque
  
• Arteriosclerosis loss of elasticity of the
  artery, they become hard and narrow.
  
• Risk factors
• older than 40 - urban society
• man - hypertension
• post menopausal women - diabetes
• Caucasians - obesity
• smoking - high serum cholesterol
• sedentary lifestyle - stress

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CAD

• Dx not usually any chest pain until the artery
  is 75 occluded.Body compensates by creating
  collateral circulation. EKG, treadmill testing,
  thallium scan, cardiac catheterization,
  angiograms.
• Tx Vasodilators, Angioplasty with stents,
  cholesterol lowering drugs, beta-blockers, and
  anticoagulants. When all else fails or the
  blockage is severe bypass graft will be done.

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CAD

• Prognosis Varies based on the effect of
  treatments and changes in lifestyle.
  
• Prevention low fat salt and cholesterol diet.
  Exercise. Reduce stress. Stop smoking.

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Myocardial Infarction

• Death of Myocardial tissue caused by ischemia.
• SS sudden severe substernal or left side chest
  pain. Crushing with a feeling of massive
  constriction. May radiate to left arm, back or
  jaw. Irregular heartbeat, dyspnea, diaphoresis,
  denial, severe anxiety.

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MI

• Etiology insufficient oxygen supply from an
  occluded artery. Cardiac muscle will die if
  correction not performed within 6 hours.
  
• Dx thorough history, EKG, chest x-rays, cardiac
  enzyme levels (CPK elevated in first 6-24 hours,
  LDH peaks at 48 hours after MI)
  
• Tx Oxygen, morphine, aspirin, TPA, lidocaine,
  vasodilators.

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MI

• Prognosis - 65 of deaths from MI are within 1
  hour. Later deaths depends on extent of damage
  and complications. Most late deaths are from an
  arrythmia.
• Prevention Same as for coronary artery
  disease.
  

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Hypertensive Heart Disease

• Essential Hypertension a condition of
  abnormally high blood pressure in the arterial
  system. It has an insidious onset with few if any
  symptoms.
• SS headaches, epistaxis, syncope,
  lightheadedness. Detected during physical exam.
  More common in all groups of patients as they
  age.

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Hypertension

• Etiology unknown, contributing factors include
  stress, age, heredity, smoking, hyperactivity,
  obesity.
  
• Dx elevated blood pressure readings. A reading
  of 140/90 indicates hypertension. There are
  reading considered to be borderline hypertension.
  Diagnosis requires a series of high readings.

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Hypertension

• Tx drug therapy diuretics, beta-blockers to
  slow the heart rate and dilate vessels, calcium
  channel blockers to slow the heart rate and
  reduce conduction irritability, ACE inhibitors to
  produce vasodilation and increase renal blood
  flow. May be used in combinations. Decreasing
  sodium intake, dietary management, weight loss,
  exercise, reduce stress, no smoking.

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Hypertension

• Prognosis depends on therapy and lifestyle
  changes.
  
• Prevention - since cause is unknown only can
  adjust the contributing factors.

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Congestive Heart Failure

• Acute or chronic inability of the heart to pump
  enough blood throughout the body to meet demands
  for homeostasis.
  
• SS insidious onset with the patient
  experiencing gradual dyspnea. Cardiac and
  respiratory rates increase, with anxiety. Neck
  veins distend, edema in lower extremities. Right
  side affects liver and peripheral circulation,
  Left side affects lungs and causes respiratory
  distress.

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CHF

• Etiology common cause is an MI, hypertension,
  CAD, COPD, valve damage, arrythmias, and
  cardiomyopathy.
  
• Dx History and PE, decreased breath sounds,
  fluid in lungs, EKG, echocardiogram, cardiac
  catheterization.
  
• Tx reduce workload of the heart. digitalis to
  strengthen and slow the heartbeat. Beta blockers
  and ACE inhibitors help increase the blood flow,
  diuretics to reduce fluid volume. Decrease intake
  of fluid and salt.

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CHF

• Prognosis
• Acute CHF-responds well to treatment positive
  outcome
  
• Chronic CHF-major organ impairment and
  complications.
  
• Prevention Control blood pressure and other
  contributors to heart disease. Early intervention
  prevents multiple organ complications
  

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Cor Pulmonale and Pulmonary Edema

• Result from CHF. Edema of peripheral circulation
  in right CHF Cor Pulmonale and Pulmonary edema
  in Left Side CHF

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Cardiomyopathy

• A noninflammatory disease of heart muscle causing
  inlargement and ventricle dysfunction.
  
• SS Same as CHF. May be syncope and cardiac
  murmurs.
  
• Etiology 3 groups
• Dilated-alcoholism, autoimmune, viral
• Hypertrophic-genetic idiopathic
• Restrictive-fibrosis and thickening of walls

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Cardiomyopathy

• Dx- cardiomegaly, murmurs, CXR, ECG,
  echocardiogram and catheterization help determine
  type.
  
• Tx- Varies based on type. Mainly reducing
  workload, blood pressure contractility.
  
• Prognosis some may be fatal, medications help.
• Prevention Depends on underlying cause.

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Pericarditis,Myocarditis,Enocarditis

• Inflammation of respective tissues.
• SS Fever, malaise, chest pain, chills.
  Detectable rub or grating sound. tachycardia.
  Palpitations, dyspnea, fatigue
  
• Etiology inflammation or infection elsewhere in
  the body. Trauma, rheumatic fever. Secondary to
  MI. Toxic agents-lithium, cocaine, alcohol,
  radiation, and chemicals.

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Inflammation of Heart Tissue

• Dx cultures, CBC, Cardiac enzymes,
  echocadiogram, ECG
  
• Tx-Antibiotics (often IV), antipyretics,
  anticoagulants, bed rest, surgical drainage,
  analgesics, antiinflammatories
  
• Prognosis all have favorable resolution
  complete recovery with early diagnosis.
  
• Prevention Prompt treatment of infections.

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Rheumatic Fever

• A systemic inflammatory autoimmune disease
  involving joints and heart tissue.
  
• SS follows sore throat infection from Strep.
  pyogenes. Fever, polyarthritis, edema, redness
  and limited range of motion. Carditis, murmurs,
  cardiomegaly, CHF. Weakness, malaise, anorexia,
  weight loss, rash on trunk, abdominal pain.

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Rheumatic Fever

• Etiology after the strep throat, antibodies
  against the bacteria cross-react with normal
  tissue. The antibodies migrate to the endocardium
  and mitral valve or aortic valve. Vegetations
  form.
• Dx-recent URI, presence of both carditis and
  polyarthritis, ASO, cardiac enzyme levels, CBC,
  ESR.

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Rheumatic Fever

• Tx- complete course of antibiotics, antipyretics,
  antiinfammatories, bed rest
  
• Prognosis - good with treatment
• Incomplete treatment may result in Rheumatic
  heart disease damaged valves.

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Valvular Heart Disease

• Can be an acquired or congenital disorder that
  can involve any of the 4 valves. Will be either
  
• Insufficiency failure of the valve to close
  completely resulting in backflow into previous
  chamber.
  
• Stenosis hardening of the cusps prevents
  complete opening impeding flow into next area.
  
• Mitral valve involved most often

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Valvular Heart Disease

• SS Dyspnea, fatigue, cyanosis, murmur
• Etiology - Rheumatic heart disease causes most of
  the cases.
  
• Dx history, echocardiogram, murmur, ECG, x-ray,
  cardiac catheterization.
  
• Tx Bed rest, diuretics, digoxin, surgery
• Prognosis - good

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Arrythmias

• Any deviation from the normal heartbeat.
• SS palpitations, rapid heartbeat, skipped
  heartbeats, slow heart rate,syncope,and fatigue.
  
• Etiology drugs, ischemia, failure of SA node.
• Dx EKG, echocardiography,Holter monitor.

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Arrythmias

• Tx depends on cause, anticoagulants oxygen,
  cardioversion.
  
• Prognosis - depends on type
• Prevention avoiding identified causative agent.

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Shock

• Collapse of the cardiac system vasodilation,
  fluid shift and insufficient cardiac output.
  
• SS pale, cold, clammy skin, rapid weak and
  thready pulse, rapid breathing, altered
  consciousness. Drop in blood pressure, anxious,
  irritable,and restless, dizziness, extreme thirst
  and profuse sweating

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Shock

• Etiology Anaphylaxis, hemorrhage, sepsis,
  respiratory distress, heart failure, neurologic
  failure, emotional catastrophe, severe metabolic
  insult. The effectively circulating amount of
  blood is reduced. The vital organs are not
  getting enough oxygen to sustain life.
  Hypovolemia, massive dilation or constriction of
  vessels, heart failure, insufficient oxygen to
  organs.

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Shock

• Dx clinical picture, history, altered level of
  consciousness, respiratory distress
  
• Tx Aggressive intervention, oxygen, control
  bleeding, supine position, warm, volume
  replacement.
  
• Prognosis immediate treatment recovery.
  Treatment delayed- unstoppable with irreversible
  consequences.
  
• Prevention most are not.

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Emboli

• Clots of aggregated material (usually blood).
  They lodge in a blood vessel cutting off flow.
  
• SS Severe pain in the area of the embolus.
  Pale, numb, cold, arterial pulses absent, nausea,
  fainting, shock
  
• Etiology Blood clot, air bubbles, fat globules,
  bbacterial clumps, pieces of tissue. Most common
  is venous thrombosis. Cardiac arrythmias.

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Emboli

• Dx Clinical picture, history of bed rest and
  physical inactivity, heart failure, arrythmias,
  and any condition restricting blood flow in the
  legs or pelvis.
• Tx treatment depends on the area of
  involvement. Re-establish blood flow, heparin,
  enoxaparin, antispasmotics, surgery,
  thrombolytics.

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Emboli

• Prognosis Varies with location.
• Prevention Preventing the formation of deep
  vein thrombosis during long periods of
  immobilization.

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Arteriosclerosis

• Group of diseases characterized by hardening of
  the arteries.
  
• Atherosclerosis hardening as the result of
  plaque from cholesterol and lipids.
  
• SS angina, dizziness, hypertension, SOB.
• Etiology Risk factors, hereditary, sedentary
  lifestyle, diet rich in lipids and cholesterol
  producing foods, smoking, diabetes, hypertension,
  obesity.

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Atherosclerosis

• Dx routine exam, blood tests, blood pressure
  check, doppler studies.
  
• Tx diet changes, treatment for diabetes and
  hypertension, cholesterol lowering meds.
  
• Prognosis varies based on compliance can
  prevent progression.

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Aneurysms

• Weakening of the wall of an artery.
• SS can be slow or acute, abdominal or back
  pain, pulsing mass in the abdomen, hemorrhagic
  shock, neurologic deficits.
  
• Etiology buildup of atherosclerotic plaque.
  Trauma, infections, inflammation, congenital
  defects.
  
• Dx pulsing mass in the abdomen, radiography,
  CAT scan, MRI, Sx of shock

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Aneurysms

• Tx Surgical repair before rupture, synthetic
  graft.
  
• Prognosis good if repaired before rupture, not
  as good after rupture and large amounts of blood
  are lost.

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Blood Dyscrasias

• Deviation or malfunction of the systems in the
  body that form and the ones that remove blood
  cells from circulation.
  
• If RBCs are involved it is anemia, polycythemia
• If platelets thrombocytopenia, thromboses
• If leukocytes leukemia, lymphoma, leukopenia

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Anemia

• A condition involving a reduction in the oxygen
  carrying capacity of the blood. The patient has
  too few RBCs or the RBCs have a smaller amount
  of hemoglobin than normal.
• Types of Anemia
• Iron deficiency
• Folic acid deficiency
• Pernicious
• Aplastic
• Sickle cell
• Hemorrhagic
• Hemolytic

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Anemia

• SS
• Fatigue
• Dyspnea
• Headache
• Loss of appetite
• Heartburn
• Edema
• Numbness and tingling
• Syncope
• Pallor

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Anemia

• Etiology
• Iron deficiency
• Folic acid deficiency
• Pernicious anemia decrease in production of
  intrinsic factor for absorption of B12
  
• Autoimmune hemolytic anemia
• Aplastic anemia-destruction or damage to
  hematopoietic cells from toxins, radiation,
  drugs, and insecticides.

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Anemias

• Dx CBC, bone marrow studies
• Tx Dietary supplements, removing causes of
  aplastic and hemolytic anemias, increase fluid
  intake, analgesic, oxygen, transfusions.
  
• Prognosis varies based on cause and response to
  treatment.
  
• Prevention Most are not, diet helps some.

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Neutropenia

• Decreased number of neutrophils
• SS severe fatigue and weakness, pharyngitis,
  oral ulcerations, dysphagia, fever, rapid weak
  pulse, chills.
  
• Etiology - hypersensitivity, drug toxicity, can
  be part of aplastic anemia, TB, uremia
  megaloblastic anemia, or malaria

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Neutropenia

• Dx CBC, bone marrow, history of exposure to
  causative agents, cultures
  
• Tx antimicrobial therapy, cultures to evaluate
  treatment. Aggressive treatment needed, could be
  fatal if left untreated.
  
• Prognosis varies based on etiology
• Prevention not always possible, avoid toxic
  substances.

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Polycythemia

• Increase in amount of hemoglobin, RBCs, or
  hematocrit.
  
• SS headaches, dyspnea, irratibility, mental
  sluggishness, dizziness, syncope, night sweats,
  weight loss, thrombus formation, splenomegaly,
  clubbing of fingers.
• Unknown why there is sustained priduction

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Polycythemia

• Dx abnormal RBC numbers, hemoglobin and
  hematocrit. Increased numbers of WBCs, and
  platelets. Clinical picture.
  
• Tx therapeutic phlebotomy, myelosuppressive
  drugs, radiation.
  
• Prognosis therapeutic phlebotomy lifelong
  required. Some resolve with cause eliminated.
  
• Prevention none known

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Leukemia

• Malignant neoplasm of blood forming organs.
  Abnormal, uncontrolled proliferation of one cell
  type. Results in bone marrow overcrowding, which
  results in reduced production of functional cells
  which will cause anemia, clotting problems and
  increased infections.

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Leukemia

• Types
• ALL most common childhood leukemia, 5yr
  survival kids 85, adults 63
  
• CLL slow progression most discovered in routine
  checks, overall 5 yr survival 73
  
• AML rapid progression, most common adult
  leukemia, 5yr survival- 10 adults, 46 kids
  
• CML Slow progression, overall survival 35

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Leukemias

• SS- pale, fatigue, bone pain, weight loss, night
  sweats, bleeding, weakness, sore throat,
  lymphadenopathy, splenomegaly, headache, blurred
  vision, nausea, swelling of lymph nodes,
  increased infections.
• Etiology varies
• Dx CBC, bone marrow, chromosomes
• Tx varies
• Prognosis - varies

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Lymphoma

• Malignant neoplasms of the cellular components of
  the lymph system.
  
• Hodgkin lymphoma the proliferation of cells
  interferes with normal functioning by collecting
  in masses in various places.
  
• SS enlargement of lymph nodes, fatigue,
  alcohol induced pain, pruritus. B symptoms,
  fever, night sweats, weight loss
  

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Hodgkin Lymphoma

• Etiology previous malignancy with chemo or
  radiation therapy, family history,
  immunosupression, infectious agents.
  
• Dx - history of painless lymphadenopathy, lymph
  node biopsy, presence of Reed-Sternberg cells,
  CBC, ESR, ALP, bone marrow biopsy, CT scans of
  chest, abdomen and pelvis, LFTs, RFTs.

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Hodgkins Lymphoma

• Tx radiation therapy, chemotherapy, bone marrow
  transplant - multiple relapses
  
• Prognosis most treatable of all cancers overall
  5 yr survival 83
  
• Prevention - none known

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Transfusion Incompatibility Reaction

• Caused by reaction of patient antibodies against
  donor blood cells, or donor antibodies reacting
  to patient blood cells.
  
• SS- range from mild to fatal. Tachycardia chills
  and fever, back pain, vomiting, diarrhea, hives
  or rash. Hypotensive, circulatory collapse,
  bleeding from puncture, hematuria, renal failure.
  Most frequent, febrile and short lived.

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Transfusion Reaction

• Etiology the antibody antigen reaction causes
  hemolysis or agglutination of RBCs that may
  block small capillaries. Release of histamine and
  serotonin from the platelets may trigger DIC.
• Dx chills, fever, hives, back pain, dyspnea
  during transfusion. Blood and urine specimens are
  evaluated.

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Transfusion Reactions

• Tx Monitoring during the transfusion, at first
  indication of symptoms the transfusion of
  stopped. Antihistimines for mild reaction
  
• Prognosis varies based on cause of reaction,
  amount transfused and, speed of intervention.
  
• Prevention careful crossmatching

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Clotting Disorders

• Classic Hemophilia bleeding disorder from
  deficiency of clotting factors.
  
• SS any unusually long bleeding time, easy
  bruising, hematomas, nosebleeds in male child,
  ecchymosis, joint swellin and pain.
  
• Etiology - an x-linked genetic disorder, missing
  factor VIII.

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Hemophilia

• Dx clinical picture and history, clotting
  studies, normal platelet count and function
  normal PT, elevated PTT and a low factor VIII
  assay.
• Tx- factor VIII infusions, whole blood
  transfusions.
  
• Prognosis infusions life-long, carry risk of
  blood borne diseases
  
• Prevention - none known

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Disseminated Intravascular Coagulation

• Condition of simultaneous hemorrhage and
  thrombosis. Occurs secondary to other diseases.
  
• SS oozing of blood from needle stick, mucous
  membranes, incisions, wound hematomas, petichiae.
  Hematemesis, hematuria and bloody stool. Weak,
  headaches, hunger, tachycardia.

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DIC

• Etiology follows a major event OB
  complications, septicemia, trauma, burns,
  hypothermia, and extensive tissue destruction.
  Hypotension, hypoxemia, acidosis, stasis of
  capillary blood.
• Dx clinical picture, precipitating event, lab
  tests, decreased platelets, increased PT, low
  fibrinogen levels.

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DIC

• Tx intravenous heparin, platelet and clotting
  factor replacement. Life threatening and often
  fatal.
  
• Prognosis guarded
• Prevention a major systemic insult cannot be
  prevented.