Module 4: Cardiovascular

Congenital Heart Defects

 Definition: Structural issues of the heart present at birth.
 Examples: Septal defects, patent ductus arteriosus, valvular
disorders, transposition of the great arteries, and tetralogy of Fallot.
 Risk Factors:
o Heredity and genetics.
o Fetal substance exposure (e.g., tobacco, certain medications).
o Maternal health status (e.g., diabetes, obesity).
 Manifestations:
o Heart murmurs.
o Dyspnea (shortness of breath).
o Tachypnea (rapid breathing).
o Cyanosis (bluish discoloration of skin).
o Fatigue.
o Chest pain/discomfort.
o Difficulty gaining weight.
Pericarditis
 Definition: Inflammation of the pericardium, the sac surrounding the
heart.
 Causes:
o Viral infection.
o Thoracic trauma.
o Myocardial infarction.
o Tuberculosis.
o Malignancy.
o Autoimmune conditions.
 Explanation: Pericarditis can lead to pericardial effusion, a
condition where fluid accumulates between the pericardial sac and the
heart, causing friction due to swollen tissue.
 Complications:
o Cardiac tamponade: A life-threatening compression of the
heart due to fluid accumulation (pleural effusion).
  Manifestations: Falling arterial pressures, rising venous
pressures, narrowing pulse pressure, and muffled heart sounds.
 Other Manifestations:
o Constrictive pericarditis: Loss of elasticity in the pericardium
due to chronic inflammation.
 Manifestations:
 Pericardial friction rub (grating sound).
 Sharp, sudden, severe chest pain that worsens with deep
inspiration and improves when sitting up or leaning
forward.
 Dyspnea, tachycardia, palpitations, edema, and flu-like
symptoms.
Infective Endocarditis
 Definition: An infection of the endocardium (inner lining of the heart)
and heart valves.
 Previous Name: Bacterial endocarditis.
 Common Causes: Streptococcus and Staphylococcus bacteria.
 Explanation: This infection leads to the formation of thrombi (blood
clots) that can travel as emboli, causing microemboli and
microhemorrhage.
 Manifestations:
o Flu-like symptoms.
o Embolization.
o New-onset heart murmur.
o Petechiae (small, red or purple spots on the skin).
o Splinter hemorrhages under the nails.
o Hematuria (blood in the urine).
o Swollen lymph nodes.
o Edema.
 Risk Factors:
o IV drug use.
o Preexisting valvular disorders.
o Prosthetic heart valves or implanted devices.
o Rheumatic heart disease.
o Aortic coarctation (narrowing of the aorta).
 o Congenital heart defects.
o Marfan Syndrome.
 Life-Threatening Complications:
o Myocardial infarction (heart attack).
o Stroke.
o Pulmonary embolism (blockage of an artery in the lungs).
Infective Myocarditis
 Definition: Inflammation of the myocardium (heart muscle), a
relatively uncommon and not fully understood condition.
 Causes: Organisms, blood cells, toxins, and immune substances can
cause damage to the heart muscle.
 Complications:
o Heart failure.
o Cardiomyopathy.
o Dysrhythmia (irregular heartbeat).
o Thrombus formation.
 Manifestations:
o Flu-like symptoms.
o Dyspnea.
o Dysrhythmia, palpitations, tachycardia.
o Heart murmurs.
o Chest discomfort.
o Cardiomegaly (enlarged heart).
o Pale and cool extremities.
o Syncope (fainting).
o Decreased urine output.
o Joint pain/swelling.
Valvular Disorders
 Definition: Conditions involving stenosis (narrowing) and/or
regurgitation (leakage) of one or more heart valves.
 Explanation: These disorders disrupt the normal flow of blood through
the heart.
 Types:
o Valve Stenosis: Narrowing of the valve, restricting blood flow.
  Consequences: Decreased cardiac output, increased
workload on the heart, and hypertrophy (thickening of the
heart muscle).
 Atresia: A complete failure of the valve to open, often
accompanying stenosis.
o Valve Regurgitation: Insufficient closure of the valve, allowing
blood to flow backward.
 Consequences: Decreased cardiac output, increased
workload on the heart, leading to hypertrophy and dilation
of the ventricles.
 Causes:
o Congenital defects.
o Infective endocarditis.
o Rheumatic fever.
o Myocardial infarction.
o Cardiomyopathy.
o Heart failure.
 Manifestations: Vary depending on the specific valve affected but
generally reflect the altered blood flow through the heart.
Cardiomyopathy
 Definition: Acquired or inherited conditions that weaken and enlarge
the myocardium (heart muscle).
 Explanation: It makes it harder for the heart to pump blood
effectively, potentially leading to heart failure.
 Main Types: Dilated, hypertrophic, and restrictive cardiomyopathy.
Dilated Cardiomyopathy
 Explanation: The most common type, characterized by cardiomegaly
(enlarged heart) and ventricular dilation, which damage myocardial
muscle fibers, reducing cardiac output and causing blood stagnation.
 Risk Factors: Higher risk in African American men and with increasing
age.
 Causes:
o Chemotherapy.
o Alcoholism.
o Cocaine abuse.
 o Pregnancy.
o Infection.
o Thyrotoxicosis (overactive thyroid).
o Diabetes mellitus.
o Neuromuscular diseases.
o Hypertension.
o Coronary artery disease.
o Hypersensitivity to certain medications.
 Manifestations: Develop as the heart's compensatory mechanisms
begin to fail, including:
o Breathing changes (e.g., shortness of breath) and a
nonproductive cough.
o Fatigue.
o Dysrhythmias, cardiac pain, and abnormalities in heart function.
o Dizziness and activity intolerance.
o Abnormal lung sounds.
o Peripheral edema (swelling in the extremities).
o Ascites (fluid accumulation in the abdomen).
o Hepatomegaly (enlarged liver).
o Weak pedal pulses (pulses in the feet).
o Cool/pale extremities.
o Poor capillary refill.
Hypertrophic Cardiomyopathy
 Explanation: Primarily affects systolic function, mainly in men and
sedentary individuals. The ventricle wall stiffens, becoming unable to
relax properly.
 Risk Factors:
o Hypertension.
o Obstructive valvular disease.
o Thyroid disease.
o Dominant genes (genetic predisposition).
 Manifestations:
o Dyspnea, particularly with exertion.
o Fatigue.
o Syncope.
 o Orthopnea (difficulty breathing when lying down).
o Angina (chest pain).
o Dysrhythmias.
o Left ventricular failure.
o Myocardial infarction.
Restrictive Cardiomyopathy
 Explanation: Characterized by rigidity of the ventricles, affecting
diastolic function, and often carrying a poor prognosis. More common
in South and Central America, India, Asia, and Africa.
 Causes:
o Amyloidosis (abnormal protein buildup).
o Hemochromatosis (iron overload disorder).
o Radiation exposure.
o Connective tissue diseases.
o Myocardial infarction.
o Sarcoidosis (inflammatory disease).
o Cardiac neoplasms (heart tumors).
 Manifestations:
o Fatigue.
o Breathing difficulties and lung changes.
o Angina.
o Hepatomegaly.
o Jugular vein distention.
o Ascites.
o Heart murmurs.
o Peripheral cyanosis (bluish discoloration of extremities).
o Pallor (paleness).
Electrical Alterations: Dysrhythmias
 Definition: Abnormal or irregular heartbeats, affecting both rate and
rhythm.
 Classification: Dysrhythmias are classified based on their origin.
 Impact: They can significantly affect cardiac output (CO) and blood
pressure (BP).
 Causes:
o Acid-base imbalances.
 o Hypoxia (low oxygen levels).
o Congenital heart defects.
o Connective tissue disorders.
o Degeneration of conductive tissue in the heart.
o Drug toxicity.
o Electrolyte imbalances.
o Stress.
o Myocardial hypertrophy, ischemia, or infarction.
 Manifestations: Vary widely depending on the specific type of
dysrhythmia; common symptoms include palpitations, fluttering
sensations in the chest, and skipped beats.
Heart Failure
 Alternative Name: Congestive heart failure (CHF).
 Definition: A condition caused by inadequate pumping of the heart,
leading to decreased cardiac output (CO) and increased preload (the
volume of blood in the ventricles at the end of diastole) and afterload
(the pressure the heart must overcome to eject blood).
 Causes:
o Congenital heart defects.
o Myocardial infarction.
o Valvular diseases.
o Dysrhythmias.
o Thyroid disease.
 Explanation:
o The body initially employs compensatory mechanisms
(sympathetic nervous system activation, renin-angiotensin-
aldosterone system activation, and hypertrophy), but these
eventually contribute to the worsening of heart failure.
o Heart failure can involve:
 Systolic dysfunction: Reduced contractility (the heart's
ability to pump effectively) during systole (the contraction
phase of the heartbeat).
 Diastolic dysfunction: Impaired filling of the ventricles
with blood during diastole (the relaxation phase of the
heartbeat).
  Mixed dysfunction: A combination of both systolic and
diastolic dysfunction.
 Types:
o Left-Sided Failure:
 Explanation: Cardiac output falls, leading to blood backing
up into the pulmonary circulation (lungs), causing
pulmonary congestion, dyspnea, and activity intolerance.
 Causes: Left ventricular infarction, hypertension, and aortic
or mitral valve stenosis.
o Right-Sided Failure:
 Explanation: Blood backs up into the peripheral circulation,
causing edema and weight gain.
 Causes: Pulmonary disease, left-sided heart failure, and
pulmonic or tricuspid valve stenosis.
 Additional Notes:
o Heart failure can be acute or chronic, depending on the
underlying cause.
o Manifestations depend on the type and severity of heart failure.
It is graded on a scale of I to IV.
o Symptoms often become apparent as the heart's compensatory
mechanisms start to fail.
o Manifestations typically indicate systemic or pulmonary fluid
congestion.
Aneurysms
 Definition: A bulge or ballooning in the wall of an artery caused by
weakening of the arterial wall.
 Common Locations: Abdominal aorta, thoracic aorta, cerebral
arteries, femoral arteries, and popliteal arteries.
 Serious Complication: Rupture of an aneurysm can lead to
exsanguination (severe blood loss).
 Risk Factors:
o Congenital defects.
o Atherosclerosis.
o Hypertension.
o Dyslipidemia (abnormal blood lipid levels).
 o Diabetes mellitus.
o Tobacco use.
o Advanced age.
o Trauma.
o Infection.
 Types:
o True Aneurysms: Involve all three layers of the blood vessel
wall.
 Saccular Aneurysm: A bulge on one side of the artery
(asymmetrical).
 Fusiform Aneurysm: Affects the entire circumference of
the artery (symmetrical).
o Dissecting Aneurysm: Occurs within the inner layers of the
arterial wall and is not considered a true aneurysm.
 Manifestations:
o Depend on the location and size of the aneurysm.
o Possible symptoms:
 Pulsating mass.
 Pain.
 Respiratory difficulty.
 Neurological deficits (if the aneurysm affects arteries
supplying the brain).
Dyslipidemia
 Definition: High levels of lipids (fats) in the blood.
 Source of Lipids: Lipids enter the bloodstream from dietary sources
and are also produced by the liver.
 Classification: Based on density, with triglycerides contributing to low
density and protein contributing to high density.
o Types:
 Very-low-density lipoproteins (VLDLs).
 Low-density lipoproteins (LDLs) ("bad" cholesterol).
 High-density lipoproteins (HDLs) ("good" cholesterol).
 Impact: Increases the risk for various chronic diseases, particularly
cardiovascular disease.
  Manifestations: Often asymptomatic until it leads to complications or
other diseases.
Atherosclerosis
 Definition: A chronic inflammatory disease of the arteries
characterized by thickening and hardening of the arterial walls due to
plaque buildup. These plaques often calcify.
 Trigger: Vessel wall injury.
 Consequences:
o Obstruction of blood flow through the affected vessel.
o Platelet aggregation (clumping).
o Vasoconstriction (narrowing of the blood vessels).
 Complications:
o Peripheral vascular disease.
o Coronary artery disease.
o Thrombus formation.
o Hypertension.
o Stroke.
 Manifestations: Typically asymptomatic until complications develop.
Peripheral Vascular Disease (PVD)
 Definition: Narrowing of the peripheral blood vessels, affecting both
arteries and veins.
 Common Cause: Atherosclerosis in the arteries.
 Other Causes: Thrombi (blood clots), inflammation, and vasospasms.
 Specific Types:
o Thromboangiitis Obliterans (Buerger Disease):
 A chronic inflammatory condition of the arteries, primarily
affecting small and medium-sized arteries in the
extremities.
 Can lead to thrombosis (blood clot formation) and
eventually complete occlusion (blockage) of these arteries.
 Most commonly affects men between 20 and 40 years old
who smoke cigarettes.
 The exact cause is unknown.
o Raynaud Phenomenon:
  Characterized by vasospasms of the arteries in response to
sympathetic nervous system stimulation.
 These vasospasms are often associated with autoimmune
conditions like lupus and scleroderma.
 Most frequently affects women between 18 and 30 years
old.
 Increased vessel occlusion can lead to ischemia (reduced
blood flow) in the affected tissues.
Coronary Artery Disease (CAD)
 Definition: Narrowing or blockage of the coronary arteries, the blood
vessels that supply the myocardium (heart muscle) with oxygenated
blood.
 Common Cause: Atherosclerosis.
 Other Causes: Vasospasms, cardiomyopathy, and thrombus
occlusion.
 Significance:
o It is the most common type of heart disease in the United States.
o A leading cause of myocardial infarction.
 Risk Factors:
o Nonmodifiable Risk Factors:
 Age: Males over 45 years; females over 55 years or those
who have experienced premature menopause.
 Family history: Premature CAD in first-degree male
relatives.
o Modifiable Risk Factors:
 Tobacco use.
 Obesity.
 Physical inactivity.
 Stress.
 Diabetes mellitus.
 Hyperlipidemia.
 Hypertension.
 Main Types:
o Obstructive CAD.
o Nonobstructive CAD.
 o Coronary Microvascular Disease.
 Obstructive CAD:
o Plaque accumulates in the large coronary arteries, causing
narrowing and reduced blood supply to the myocardium.
o The coronary artery is typically occluded by more than 50%.
o Blood flow may become completely blocked.
 Nonobstructive CAD:
o Large arteries are occluded by less than 50%.
o Can also be caused by damage or injury to the inner lining of the
coronary arteries, impairing their ability to dilate (widen) in
response to increased myocardial oxygen demand.
 Coronary Microvascular Disease:
o Affects the smallest arteries of the myocardium.
o Caused by molecular changes in these small vessels, which can
occur as part of the normal aging process or as a result of
damage from conditions like inflammation, diabetes, and
hypertension.
o These arteries do not respond appropriately to signals to
vasodilate (widen) when the myocardium's oxygen demand
increases.
 Angina:
o Stable Angina: Chest pain or discomfort caused by myocardial
ischemia (reduced blood flow) that occurs when oxygen demand
increases (e.g., during physical activity) and is relieved with rest
or when oxygen demand decreases.
 The reduced blood flow may or may not cause permanent
damage to the heart muscle.
o Unstable Angina: Chest pain that becomes unpredictable and
may occur even at rest. It often increases in frequency and
intensity.
 Considered a pre-infarction state, meaning it is a warning
sign of a potential heart attack.
 Clinical Manifestations of CAD:
o Angina that may radiate to the neck, jaw, arm, or back.
o A sensation similar to indigestion.
 o Nausea and vomiting.
o Cold, clammy extremities (hands and feet).
o Diaphoresis (excessive sweating).
o Dyspnea.
o Fatigue.
o Weakness.
Thrombi and Emboli
 Thrombus: A blood clot that forms within a blood vessel anywhere in
the circulatory system.
 Conditions Promoting Thrombus Formation:
o Endothelial injury (damage to the inner lining of the blood
vessel).
o Sluggish blood flow.
o Hypercoagulability (increased tendency for blood to clot).
 Frequency: Venous thrombi (blood clots in the veins) are more
common than arterial thrombi due to the lower blood pressure in the
veins and the effects of gravity.
 Embolus: A piece of a thrombus (or other material) that breaks loose
and travels through the circulatory system.
 Composition of Emboli: Besides thrombi, emboli can also consist of
air, fat, tissue fragments, bacteria, amniotic fluid, tumor cells, or
foreign substances.
 Destinations and Consequences:
o Right Side of Heart Origin: Venous emboli travel to the
pulmonary circulation, potentially causing a pulmonary embolism
(blockage of an artery in the lungs).
o Left Side of Heart Origin: Arterial emboli can travel to various
organs, including the brain and heart, where they can cause an
infarction (tissue death due to blocked blood supply).
 Clinical Manifestations: Depend on the location of the embolus in
the body and whether it is venous or arterial.
Deep Vein Thrombosis (DVT)
 Definition: A blood clot that forms in a deep vein, most commonly in
the legs.
  Risk Factors: Similar to those for thrombus formation in general
(endothelial injury, sluggish blood flow, hypercoagulability).
Pulmonary Embolism (PE)
 Definition: Occurs when a thrombus (often originating from a DVT)
travels to the pulmonary artery or its branches, disrupting blood flow
to the lungs.
Varicose Veins
 Definition: Dilated, engorged (swollen) veins due to incompetent or
damaged venous valves.
 Common Location: Legs.
 Other Locations: Esophagus (esophageal varices), rectum
(hemorrhoids), and testicles (varicoceles).
 Mechanism: Increased venous pressure and blood pooling lead to the
enlargement of the veins.
 Consequences: Edema and increased pressure can cause decreased
circulation, venous stasis ulcers (sores on the skin), and necrosis
(tissue death).
 Risk Factors:
o Genetic predisposition.
o Pregnancy.
o Obesity.
o Prolonged sitting or standing.
o Alcohol use and liver disorders (particularly for esophageal
varices).
o Constipation (especially for hemorrhoids).
 Clinical Manifestations:
o Irregular, purplish, bulging veins.
o Pedal edema (swelling in the feet).
o Fatigue.
o Aching in the legs.
o Shiny, hairless, pigmented skin on the legs and feet.
o Skin ulcer formation.
Lymphedema
 Definition: Abnormal swelling in the extremities due to an obstruction
of the lymphatic system.
  Types:
o Primary Lymphedema: Rare, caused by a congenital absence
or reduction in the number of lymphatic vessels.
o Secondary Lymphedema: More common, resulting from
various factors that damage or block lymphatic vessels.
 Causes:
 Surgical removal of lymph nodes (e.g., after a
mastectomy).
 Scarring from radiation therapy.
 Occlusion (blockage) related to cancerous tumors.
 Obstructions caused by infection.
 Severity: A staging system is used to classify the severity of
lymphedema.
 Laterality: May affect one side of the body (unilateral) or both sides
(bilateral).
 Clinical Manifestations:
o Edema.
o Skin changes, including hyperpigmentation (darkening of the
skin), ulceration, and thickening.
o Thick and rough skin texture.
Myocardial Infarction (MI)
 Alternative Names: Heart attack, acute coronary syndrome.
 Definition: Death of myocardial tissue (heart muscle) due to a sudden
blockage of coronary blood flow.
 Mechanism: The blockage deprives the heart muscle of oxygen,
leading to cell death and tissue necrosis.
 Underlying Cause: Often related to atherosclerosis, thrombus
formation, or vasospasms in the coronary arteries.
 Significance: Cardiovascular disease, including the damage that
occurs after an MI, is the leading cause of death in the United States.
 Risk Factors: Largely the same as those for coronary artery disease
(CAD), including dyslipidemia, diabetes mellitus, hypertension, stress,
and tobacco use.
 Clinical Manifestations:
o Unstable angina.
 o Fatigue.
o Nausea and vomiting.
o Coughing and shortness of breath.
o Diaphoresis (excessive sweating).
o A sensation like indigestion.
o Elevation in cardiac biomarkers (substances released into the
blood when the heart muscle is damaged).
o Dysrhythmias (irregular heartbeats).
o Anxiety.
o Syncope (fainting).
o Dizziness.
o Sleep disturbances.
Hypertension
 Definition: Prolonged elevation of blood pressure.
 Mechanism and Impact: Elevated blood pressure puts a strain on the
heart, increasing its workload due to vasoconstriction (narrowing of
blood vessels), which increases afterload.
o Decreased renal blood flow can inappropriately activate the
renin-angiotensin-aldosterone system (RAAS), further
contributing to hypertension.
 Prevalence: One of the most common chronic health conditions in the
United States.
 Risk Factors:
o Age: Blood vessel compliance decreases with age, and women
have an increased risk after menopause.
o Ethnicity: More prevalent in African Americans.
o Family History: A family history of hypertension increases risk.
o Weight: Excessive weight and obesity increase oxygen demands
and put more pressure on arterial walls.
o Physical Inactivity: A sedentary lifestyle is a risk factor.
o Tobacco Use: Nicotine raises blood pressure, and tobacco use
damages arteries over time.
o High-Sodium Diet: Leads to fluid retention, increasing blood
volume and pressure.
 o Low Potassium, Calcium, and Magnesium Diet: May
contribute to blood pressure regulation issues.
o High Vitamin D Intake: While the exact mechanism is
unknown, high vitamin D intake is thought to affect the RAAS.
o Excessive Alcohol Consumption: Causes cardiovascular
damage over time.
o Stress: Can lead to temporary increases in blood pressure and
may contribute to long-term hypertension.
 Types:
o Primary (Essential) Hypertension:
 Most common type.
 Develops gradually over time.
 No identifiable cause.
 Accounts for 95% of adult hypertension cases.
o Secondary Hypertension:
 More sudden onset and often more severe.
 Caused by underlying medical conditions or certain
medications.
 Causes: Renal disease, diabetes, adrenal gland tumors,
some medications (e.g., birth control pills, decongestants),
and illicit drugs like cocaine and amphetamines.
o Pregnancy-Induced Hypertension:
 Includes preeclampsia, a serious condition that can
progress to eclampsia (seizures).
 Characterized by elevated blood pressure during
pregnancy.
o Malignant Hypertension (Hypertensive Crisis):
 A severe and life-threatening form of hypertension that
does not respond well to treatment.
 Blood pressure is extremely high (at least 180/120 mm Hg)
and the individual is typically experiencing symptoms
related to organ damage.
Orthostatic (Postural) Hypotension
 Definition: A decrease in both systolic and diastolic blood pressure
upon standing.
 Diagnostic Criteria: A drop in systolic blood pressure of at least 20
mm Hg or a decrease in diastolic blood pressure of at least 10 mm Hg
within 3 minutes of moving from a lying or sitting position to a standing
position.
 Explanation: The body fails to compensate for the effects of gravity
on blood circulation when moving to an upright position.
 Types:
o Acute Orthostatic Hypotension: Sudden and temporary, often
triggered by dehydration, medication side effects, or prolonged
bed rest.
o Chronic Orthostatic Hypotension: Persists over time and may
indicate an underlying medical condition affecting the autonomic
nervous system, such as Parkinson's disease or diabetes.