Diseases and Conditions of the Circulatory System

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• Diseases and Conditions of the
  Circulatory System

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Most frequent symptoms

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

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Coronary Artery Disease

• Arteriosclerosis

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MECHANISM

• narrowing of the arterial lumen of the coronary
  arteries that supply the myocardium

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ETIOLOGY

• Atherosclerosis

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Predisposing Factors

• Smoking
• Genetic
• Older than 40
• Urban society
• HTN

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• Diabetes
• Obesity
• Decreased HDL
• Lack of Exercise
• Stress
• High Cholesterol

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SYMPTOMS AND SIGNS

• Initially asymptomatic
• 1st Symptoms
• Chest pain after exertion (Angina pectoris) due
  to decreased blood oxygen to heart muscle

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• Advanced S S
• severe constant pain as of MI
• Burning, squeezing, crushing, radiating to arm,
  neck, jaw
• Nausea / Vomiting
• Weakness

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DIAGNOSIS

• 75 occlusion of artery
• Collateral circulation
• EKG shows
• Ischemia
• Arrhythmias
• Angiogram
• Treadmill Test
• Thallium
• Cardiac catheterization

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TREATMENT

• Restoring adequate blood to myocardium
• Vasodilatation
• Angioplasty
• Bypass surgery
• Morphine - for pain
• Hypolipidemic drugs
• CPR (within 4-6 min) if required

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• Lidocaine- For antiarrythmic
• Epinephrine
• Nitroglycerin drip
• Defibrillation
• Atropine
• Anticoagulants
• Angioplasty
• Isoprotererol (antispasmodic)
• Bretylium
• all can lead to Cardiogenic shock

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• Hypertensive Heart Disease

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MECHANISM

• Elevated blood pressure that causes heart to work
  harder than normal

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ETIOLOGY

• Essential Unknown
• predisposing factors
• Stress
• Age
• Heredity,
• Smoking
• Obesity
• Type A personality are
• Malignant Unknown

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SYMPTOMS AND SIGNS

• Essential Insidious onset
• Usually symptomatic
• if symptomatic
• Headache
• Epistaxis
• Lightheadedness / syncope
• Malignant Life threatening
• Severe head ache
• Blurred vision
• Dyspnea

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• Essential
• Systole140 Diastole 90 on a constant basis
• Malignant
• Marked blood pressure elevation 200/100

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TREATMENT

• Essential
• Diuretics to decrease blood volume
• Beta-adregenic to slow heart rate
• Vasodilators
• Diet
• Ca channel blockers
• ACE inhibitors
• Exercise

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• Malignant
• Hospitalization
• IV Vasodilatation (hyperstat)
• BP meds for life
• Nitroprusside (Nipride)
• Na diet restriction

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COMPLICATIONS

• Malignant
• Cerebral vascular accident ( CVA )
• Irreversible renal damage

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• Congestive Heart Failure
• ( CHF )

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MECHANISM

• Constriction of myocardium with blood
• Failure of hear to pump
• Inadequate perfusion

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ETIOLOGY

• Hypertension ( HTN )
• Coronary artery disease ( CAD )
• Myocardial Infarction ( MI )
• Chronic Obstructive Pulmonary Disease ( COPD )
• Valve Disease
• Angina

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SYMPTOMS AND SIGNS

• Right Side Failure
• Gradual dyspnea
• Anxiety
• Neck vein distention
• Hepato/splenomegaly
• Peripheral edema

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• Left Side Failure
• Gradual dyspnea
• Anxiety
• increase pulmonary congestion
• Respiratory difficulties

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DIAGNOSIS

• History physical exam
• Auscultation
• Diminished breath sounds
• CXR
• fluid in lungs
• EKG
• Enlarged ventricles
• ECHO
• Large ventricles walls, septum

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TREATMENT

• Medications
• Digitalis
• strengthen slow hear rate
• Diuretics
• Reduce blood volume
• Vasodilatation
• Decrease blood pressure
• Decreased fluid sodium intake

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• Cor-Pulmonale

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MECHANISM

• Right sided heart failure due to pulmonary
  disease

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ETIOLOGY

• Emphysema
• Fibrosis
• Pulmonary Emboli

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SYMPTOMS AND SIGNS

• Severe dyspnea
• Hypoxia
• Neck vein distention
• Peripheral edema
• Hepatomegaly

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DIAGNOSIS

• Polycythemia
• increased RBC production to carry more oxygen
• physical exam
• x-ray
• ECHO
• right valve of heart
• ECG
• arrhythmia

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TREATMENT

• Treat underlying pulmonary disease
• Bronchodilators
• Oxygen supply
• Bed rest
• Digitalis
• Phlebotomy
• if Polycythemia is the problem

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• Cardiomyopathy

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MECHANISM

• Non-inflammatory disease of cardiac muscle
  hypertrophy
• 1. Congestive
• - severe hypertrophy
• decrease in contractile effort
• 2. Hypertrophic
• LVH / septum / A. V. obstruction
• 3. Restrictive
• Thickening of myocardium

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ETIOLOGY

• Congestive
• Alcoholism
• Autoimmune
• Viral
• Hypertrophic
• Genetic
• Idiopathic
• Restrictive
• infiltrate (fibrosis)

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SYMPTOMS AND SIGNS

• same as in Congestive Heart Failure

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DIAGNOSIS

• History physical exam
• Cardiac Murmur
• CXR
• EKG
• Catheterization
• Biopsy

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TREATMENT

• Congestive
• Treat congestion
• Hypertrophic
• Decrease the load on heart (conductivity
  contractility)
• Beta blockers (Inderal)
• Restrictive
• Decrease work load

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prognosis

• permanent damage

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• Rheumatic Heart Valve Disease

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MECHANISM

• Systemic inflammatory disease
• Antibodies attach endocardium, Mitral or Aortic
  valves (Vegetation)

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ETIOLOGY

• Autoimmune disease
• Group A - Beta hemolytic Streptococcus
• After a sore throat
• Dental procedure

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SYMPTOMS AND SIGNS

• Involves the joints and cardiac tissue
• Children 5-15 experience fever
• Joints pain, redness/swelling limited range of
  motion, nodules on joints
• ( polyarthritis )

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• Carditis
• Valve Disorders
• Mitral stenosis, insufficiency or prolapse
• Murmurs
• Cardiomegaly
• CHF

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• Abdominal pain
• Weakness / malaise / Anorexia / weight loss

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DIAGNOSIS

• History of URT infection
• Carditis / polyarthritis
• Culture
• Increase level of streptococcus normal flora
• Antistreptolysin o titer level elevated
• Elevated WBC and ESR

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TREATMENT

• Penicillin
• Antipyretics
• for pain
• Anti-inflammatory
• For joint inflammation
• Valve replacement if needed

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• Valve disorders
• Stenosis
• Insufficiency
• Prolapse

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MECHANISM

• Stenosis
• narrowing
• Insufficiency
• failure to close
• Prolapse
• Abnormally long or short chordae tendineae which
  is unable to close properly

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ETIOLOGY

• Stenosis
• Rheumatic heart disease (group A -Beta Hemolytic
  Strept.)
• Insufficiency
• Inflammation / vegetation / Rheumatic fever
• Prolapse
• congenital - can affect all age groups

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SYMPTOMS AND SIGNS

• Stenosis
• Exertional dyspnea , fatigue, cough,
  palpitation, hemoptysis
• Insufficiency
• Dyspnea, left atrium murmur (blood leaks back)
• Prolapse
• Most patients are asymptotic
• if symptomatic
• dyspnea, dizziness, chest pain, fatigue,
  syncope, anxiety

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DIAGNOSIS

• ECHO, EkG, CXR, Catheterization
• Stenosis
• Diastolic murmur
• Insufficiency
• history of rheumatic fever, murmur,
• Prolapse
• click, rushing, gurgling, murmur ( PVCs ).

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TREATMENT

• Stenosis
• Bed rest
• Na limitation
• Diuretics
• Anticoagulants
• Valve replacement

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• Insufficiency
• bed rest
• oxygen therapy
• antibiotics
• Complication
• Congestive Heart Failure)

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• Prolapse
• Surgery is not required if asymptomatic
• if symptomatic
• beta blockers
• avoid caffeine and large meals

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• Cardiac Tamponade

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MECHANISM

• Restriction of heart pumping due to blood in the
  pericardial sac due to hemorrhaging of heart
  vesicles

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ETIOLOGY

• Insult (outside)
• Cardiac rupture (inside)

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SYMPTOMS AND SIGNS

• Severe dyspnea
• rapid hypotension
• pulse weak, thready, and rapid
• Shock cyanosis
• low level of consciousness

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DIAGNOSIS

• History of heart trauma
• Muffled or distant heart sound breath sounds

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TREATMENT

• Aspiration of pericardial sac fluid
• surgery to repair leak

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• Aneurysms

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MECHANISM

• weakening and dilation of the wall of an artery

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ETIOLOGY

• buildup of atherosclerotic plaque
• trauma, infection inflammation, congenital

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SYMPTOMS AND SIGNS

• depends on location and size
• Most frequent type is abdominal aortic
• Can be asymptomatic
• abdominal or back pain if aortic
• pulsing mass visible on abdomen
• If ruptures S S of hemorrhagic shock

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DIAGNOSIS

• Bruit heard on auscultation
• X-ray, Ultrasound, CT, MRI

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TREATMENT

• Depends on the size
• Surgical repair before rupture
• If ruptured medical emergency - surgery

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COMPLICATIONS

• If rupture Internal hemorrhage shock
• Pressure -- CVA S S

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• Phlebitis
• Thrombophlebitis

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MECHANISM

• Inflammation of the vein
• Venous flow stasis

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ETIOLOGY

• Uncertain
• Hypercoagulation (clot)
• Injury
• Surgery
• Obesity
• Standing for extended period

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SYMPTOMS AND SIGNS

• Swelling, redness, pain, heat
• Tender on palpation

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DIAGNOSIS

• Clinical Picture (Edema tenderness)
• Compare both legs
• Venogram
• Ultrasound

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TREATMENT

• Immobilization
• Heparin
• Antibiotics
• Bypass
• Surgery if needed (Graft)

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COMPLICATION

• P. embolus
• MI
• Stroke

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• Varicose Veins

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MECHANISM

• Defective or absence of valves causes stasis of
  blood flow from lower extremities

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ETIOLOGY

• Unknown
• Pregnancy
• Long periods of standing or sitting

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SYMPTOMS AND SIGNS

• Gradual dull ache fatigue
• Leg cramps at night
• Swollen ankles
• veins-hard to touch

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DIAGNOSIS

• Knotted, swollen legs
• History of prolonged standing or sitting

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TREATMENT

• Rest / Elevate legs
• Exercise / warm soaks
• Stockings
• constant leg movement
• Vein ligation, stripping, bypass

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• Thromboangiitis Obliterans
• (Buergers Disease)

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MECHANISM

• Nicotine destroying blood vessels, veins,
  arteries
• Death of tissue gangrene due to lack of blood
  flow

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ETIOLOGY

• Smoking
• Jewish descent

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SYMPTOMS AND SIGNS

• Intense pain in extremities aggravated by
  exercise relieved by rest
• Atrophy / Ischemia
• Ulcers
• Gangrene

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DIAGNOSIS

• History of smoking
• Intense pain
• Arterio/venogram
• Ultrasound to ID site of clot

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TREATMENT

• Cessation of smoking
• Buerger - Allen exercise
• (elevate feet then lower)
• If unsuccessful - surgery

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• Raynauds Disease

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MECHANISM

• Vasospasm of peripheral arteries
• Follows exposure to cold

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ETIOLOGY

• Cold exposure
• Smoking can worsen condition
• Stress

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SYMPTOMS AND SIGNS

• Pain and Numbness
• Discoloration (blanching--blue- red)

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DIAGNOSIS

• History of numbness in cold weather
• Necrosis in severe situation

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TREATMENT

• Stop smoking
• Avoid exposure to the cold / stress
• vasodilators
• alpha- adrenergic blockers
• calcium channel blockers
• if necrosis - amputation

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COMPLICATIONS

• Necrosis

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• Leukemias
• Acute Lymphocytic
• Chronic Lymphocytic

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MECHANISM

• Acute or Chronic
• Erythro leukemia, megakaryocytic, plasma cells
• elevated WBC in bone marrow or lymph nodes

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ETIOLOGY

• Unknown
• Genetic
• Chemicals
• Radiation

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SYMPTOMS AND SIGNS

• Acute Lymphocytic leukemia A.L.L
• Rapid onset
• affects children older people
• Elevated lymphoblast in bone marrow, lymph
  nodes, spleen, liver
• Recent infection
• Paleness, fatigue, bone pain, sore throat,
  night sweats, weakness

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• Chronic Lymphocytic Leukemia C.L.L.
• slowly progressive lymphocytosis
• later age
• Anemia
• weight loss, fever, splenomegaly

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DIAGNOSIS

• Clinical picture
• Blood bone marrow studies
• A.L.L- elevated immature lymphocytes
• decreased RBC
• decreased Hb
• C.L.L.- Elevated mature lymphocytes
• decreased RBC
• decreased Hb

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TREATMENT

• A.L.L.
• -children 2-9 years old
• bone marrow transplant
• chemotherapy
• antibiotics
• C.L.L.
• - chemotherapy / radiation

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• Acute Myelocytic
• Chronic Myelocytic

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MECHANISM

• Acute
• elevated myeloblasts (myeloid precursors)
• Chronic
• leukocytosis thrombocytosis
• increased granulocyte production

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ETIOLOGY

• Acute unknown
• Chronic unknown

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SYMPTOMS AND SIGNS

• Acute
• fatigue, fever, anemia, headaches
• bone joint pain, abnormal bleeding
• Enlarged liver, spleen, lymph nodes
• Chronic
• loss of appetite, fatigue, weight loss, same S
  S as acute

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DIAGNOSIS

• Acute
• Blood and bone marrow
• elevated Megakaryocytes
• Chronic
• Blood bone marrow test
• elevated platelets WBC

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TREATMENT

• Acute
• antineoplastic drugs
• Chronic
• Chemo / bone marrow transplant.

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• Lymphoma
• Hodgkins (H)
• Non-Hodgkins (NH)

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MECHANISM

• H malignant lymphatic cells
• NH malignant lymphatic cells

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ETIOLOGY

• H
• unknown
• associated with viral infection (Epstein-Barr
  virus)
• NH
• unknown
• infectious,
• environmental,
• immunological,
• genetic

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SYMPTOMS AND SIGNS

• painless enlarged lymph nodes, tonsils,
  adenoids
• fatigue, night sweats, weight loss
• coughing, dyspnea, hepato/splenomegaly
• Non-Hodgkins Grades
• low grade Beta-Cells (mucosa)
• Centrocytic
• Malignant histocytic (Peripheral)
• Sclerosing large-cell mediastinal
• Large-cell anaplastic

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DIAGNOSIS

• H
• lymph node biopsy shows Reed-Sternberg Cells
  (large, multilobed nucleus)
• history of painless lymphadenopathy
• Blood normochronic, normocytic anemia,
  neutrophilic cyanosis, decreased lymphocytes
• elevated ESR, eosinophilia, alkaline
  phosphatase
• CT scan, lymphangiograms

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DIAGNOSIS

• NH
• Blood study to stage lymphoma,
• Rule out Hodgkins

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TREATMENT

• depends on stage for both
• chemotherapy, radiation therapy, surgery