Friday, July 9, 2021 6:35 PM
Cardiomyopathies but, without chest pain
Pericarditis Can produce chest pain But, this chest pain is not related to physical But, this chest pain will not be relieved by
exercise nitroglycerine
Calcific aortic stenosis • Leads to left-sided heart failure Here the angina pectoris will be due to extra But, if we are not having congenital bicuspid aortic
• Mainly causes by aging workload of left ventricle valve === > then it will Calcific aortic stenosis will
not occur
Viral Myocarditis • Lasts for weeks Pain will also exist at rest
• Will not last for 1 year
Left ventricular hypertrophy • can be caused by hypertension In hypertensive patient , there will be renal
diseases KIDNEY
Alcoholism Leads to dilated cardiomyopathy in both ventricular areas
Hypertrophic cardiomyopathy Low ejection fraction of left ventricle
Atherosclerosis • Leads to ischemic heart Major risk factors: • Doesn't affect valves
• Leads to myocardial inf. • Hypertension •
• Diabetes mellitus • Inflammation plays an essential role at all
• Hyperlipidemia stages of atherosclerosis
• smoking
Right-left shunt characteristics: No coarctation
• Early age cyanosis
• Truncus arteriosus
• Tetralogy of fallot
• Transposition of great arteries
What leads to Left-right shunt • Atrial septal defect Leads to pulmonary hypertension No coarctation
• patent ductus arteriosus, We have
• ventricular septal defect right ventricle is hypertrophied and often
dilated.
Acute myocardial infarction Kreatine kinase Troponin Lactate dehydrogenase
(Lab values)
unstable angina pectoris >70% obstruction of coronary artery Induced by : acute coronary syndrome
NOTE!! Critical stenosis = occlusion > 70 % 1. disruption of an atherosclerotic
plaque
2. mural thrombus
fibrinous pericarditis. most common cause = UREMIA We have renal failure
Systemic lupus erythematosus Rarely make valve diseases
syphilis, Dilation of aortic roots Result= Aortic insufficiency
Atrioventricular septal defect Congenital heart defect With Trisomy 21 Problem during feeding+breathing
AVSD
Congenital heart defect • Ventricular septal defect 90% cause is unknown
• Atrial septal defect Develop during gestation period 3 through 8 weeks
• Pulmonary stenosis
• Patent ductus arteriosus
• Tetralogy of Fallot
• Coarctation of aorta
• Atrioventricular septal defect
• Aortic stenosis
• Transposition of great arteries
• Truncus arteriosus
• Total anomalous pulmonary
venous connection
• Tricuspid atresia
Necrosis begins in the
subendocardial region
viral myocarditis. • Focal myocardial necrosis + lymphocytic infiltrate
Right coronary artery Found in right dominant heart Occlusion leads to
Left ventricular ischemic injury
left main coronary artery Found in left dominant heart Occlusion affect Widow maker
Entire left ventricle+ septum Fatal
Transmural infarctions caused by epicardial vessel occlusion • ST segment elevations STEMI
through a combination of chronic atherosclerosis and • negative Q waves
acute thrombosis; • loss of R wave amplitude Entire wall thickness involve
Subendocardial infarctions BECAUSE OF :
• Hypoperfusion
• hypoxia
Microscopic infarcts No ECG changes Occur in :
• vasculitis,
• embolization
of valve vegetations or mural thrombi,
• vessel spasm due to elevated
catecholamines—either endogenous
(e.g.,
pheochromocytoma or extreme
stress), or exogenous
(e.g., cocaine).
Pulmonary circulation Consist:
• right side of the heart
• the pulmonary arteries,
• the pulmonary capillaries,
• the pulmonary veins.
Systemic circulation Consists:
• left side of the heart,
• the aorta and its branches,
• the capillaries that supply the brain and peripheral
tissues,
• the systemic venous system
• the vena cava
Frank-Starling mechanism
increased
cardiac myofiber stretching
, • the pulmonary capillaries,
• the pulmonary veins.
Systemic circulation Consists:
• left side of the heart,
• the aorta and its branches,
• the capillaries that supply the brain and peripheral
tissues,
• the systemic venous system
• the vena cava
Frank-Starling mechanism
increased
cardiac myofiber stretching
compensated heart failure If dilated ventricle is able to maintain cardiac output
If the dilated ventricle no longer able to propel sufficient
decompensated heart failure.
blood to meet the needs of the body,
Left ventricular failure • Ischemic heart disease
• Myocarditis
• Valvular heart disease
• Restrictive Pericarditis
Right Ventricular Failure • Cor pulmonale
• Right-sided valvular disease
• Right-sided myocardial disease
• Pulmonary hypertension
systolic dysfunction inadequate myocardial contractile function Because of
ischemic heart disease.
Diastolic dysfunction inability of the heart to adequately relax and fill, Occurs in :
• massive left ventricular hypertrophy,
• myocardial fibrosis,
• amyloid deposition,
• pericarditis,
• valve dysfunction
Left-Sided Heart Failure • lungs are heavy and boggy • transudates, alveolar septal edema
accumulation of edema fluid in the alveolar
• Fatigue, tiredness • atrial fibrillation
spaces.
• Decrease urine production
• azotemia
• Dyspnea
• Crackles
• Cough
• hypoxic encephalopathy
• orthopnea),
• Paroxysmal nocturnal dyspnea
• Enlarged heart
Right-Sided Heart Failure • cor pulmonale • Hepatic and splenic enlargement, substantial pericardial
• primary pulmonic or tricuspid valve disease. • Peripheral edema
• systemic and portal venous systems effusions (greater than 500 mL) can limit cardiac
• Pleural effusion
filling and
• Ascites
cause cardiac failure (due to tamponade
• anasarca
atresia
malformation characterized by complete obstruction
Eisenmenger Syndrome 1. Left-right shunt + No Cyanosis
2. Shift to Right-left shunt+ Cyanosis
Tetralogy of Fallot Depends on degree of pulmonary stenosis 4 abnormalities : • Sabot shape
• Aortic Displacement • Cyanosis + clubbing digits
• Ventricular septal defect • bluish skin during crying or feeding
• Thickening wall of RV
• Narrow pulmonary valve
Obstructive Lesions Pulmonic valve stenosis,
Aortic valve stenosis or atresia, Coarctation of the aorta.
Coarctation • Preductule Coarctation : • Postductal Coarctation: We have Bicuspid aortic valve
• infant type • Adult type
• Remember ( hypoplastic) • adjacent to ligamentum art.
• Right Ventricular hypertrophy • Left Ventricular Hypertrophy
○ Because dilat pulm trun • upper extremity hypertension
• Cyanosis in lower body • Weak pulse
• Lower extremity hypertension
• Claudication + coldness
• Visible notch ribs
• Systolic murmur
• Palpable thrill
Ischemic heart an imbalance between cardiac blood supply (perfusion)
and myocardial oxygen and nutritional requirements.
Result from :
• Increase demand
disease (IHD) • Diminish blood volume
• Diminish oxygenation
• Diminish oxygen-carrying capacity
(CO poisoning)
Sudden cardiac lethal arrhythmia without myocyte necrosis Can also be caused by :
• Congenital coronary arterial
death Reason abnormalities
• Mitral valve prolapse
• Myocarditis
• Dilated or hypertrophic cardiomyopathy
• Pulmonary hypertension
Myocardial hypertrophy
• hereditary
Prinzmetal angina Caused by vessel spasm
Stable angina Pectoris Relieved at rest crushing or squeezing substernal sensation, 60-70% obstruction of Coron arter.
that can radiate down the left arm or to
the left jaw
Sinus Tachycardia HR>100
Bradyarrythmia+ Tachyarrythmia SSS syndrome
Acute viral pericarditis exudate => fibrinous uremia
Acute Bacterial pericarditis Exudate => purulent ( suppurative )
Chronic Pericarditis Scarring occur
Pericarditis ( clinical feature ) • Atypical chest pain
Cardiomyopathies but, without chest pain
Pericarditis Can produce chest pain But, this chest pain is not related to physical But, this chest pain will not be relieved by
exercise nitroglycerine
Calcific aortic stenosis • Leads to left-sided heart failure Here the angina pectoris will be due to extra But, if we are not having congenital bicuspid aortic
• Mainly causes by aging workload of left ventricle valve === > then it will Calcific aortic stenosis will
not occur
Viral Myocarditis • Lasts for weeks Pain will also exist at rest
• Will not last for 1 year
Left ventricular hypertrophy • can be caused by hypertension In hypertensive patient , there will be renal
diseases KIDNEY
Alcoholism Leads to dilated cardiomyopathy in both ventricular areas
Hypertrophic cardiomyopathy Low ejection fraction of left ventricle
Atherosclerosis • Leads to ischemic heart Major risk factors: • Doesn't affect valves
• Leads to myocardial inf. • Hypertension •
• Diabetes mellitus • Inflammation plays an essential role at all
• Hyperlipidemia stages of atherosclerosis
• smoking
Right-left shunt characteristics: No coarctation
• Early age cyanosis
• Truncus arteriosus
• Tetralogy of fallot
• Transposition of great arteries
What leads to Left-right shunt • Atrial septal defect Leads to pulmonary hypertension No coarctation
• patent ductus arteriosus, We have
• ventricular septal defect right ventricle is hypertrophied and often
dilated.
Acute myocardial infarction Kreatine kinase Troponin Lactate dehydrogenase
(Lab values)
unstable angina pectoris >70% obstruction of coronary artery Induced by : acute coronary syndrome
NOTE!! Critical stenosis = occlusion > 70 % 1. disruption of an atherosclerotic
plaque
2. mural thrombus
fibrinous pericarditis. most common cause = UREMIA We have renal failure
Systemic lupus erythematosus Rarely make valve diseases
syphilis, Dilation of aortic roots Result= Aortic insufficiency
Atrioventricular septal defect Congenital heart defect With Trisomy 21 Problem during feeding+breathing
AVSD
Congenital heart defect • Ventricular septal defect 90% cause is unknown
• Atrial septal defect Develop during gestation period 3 through 8 weeks
• Pulmonary stenosis
• Patent ductus arteriosus
• Tetralogy of Fallot
• Coarctation of aorta
• Atrioventricular septal defect
• Aortic stenosis
• Transposition of great arteries
• Truncus arteriosus
• Total anomalous pulmonary
venous connection
• Tricuspid atresia
Necrosis begins in the
subendocardial region
viral myocarditis. • Focal myocardial necrosis + lymphocytic infiltrate
Right coronary artery Found in right dominant heart Occlusion leads to
Left ventricular ischemic injury
left main coronary artery Found in left dominant heart Occlusion affect Widow maker
Entire left ventricle+ septum Fatal
Transmural infarctions caused by epicardial vessel occlusion • ST segment elevations STEMI
through a combination of chronic atherosclerosis and • negative Q waves
acute thrombosis; • loss of R wave amplitude Entire wall thickness involve
Subendocardial infarctions BECAUSE OF :
• Hypoperfusion
• hypoxia
Microscopic infarcts No ECG changes Occur in :
• vasculitis,
• embolization
of valve vegetations or mural thrombi,
• vessel spasm due to elevated
catecholamines—either endogenous
(e.g.,
pheochromocytoma or extreme
stress), or exogenous
(e.g., cocaine).
Pulmonary circulation Consist:
• right side of the heart
• the pulmonary arteries,
• the pulmonary capillaries,
• the pulmonary veins.
Systemic circulation Consists:
• left side of the heart,
• the aorta and its branches,
• the capillaries that supply the brain and peripheral
tissues,
• the systemic venous system
• the vena cava
Frank-Starling mechanism
increased
cardiac myofiber stretching
, • the pulmonary capillaries,
• the pulmonary veins.
Systemic circulation Consists:
• left side of the heart,
• the aorta and its branches,
• the capillaries that supply the brain and peripheral
tissues,
• the systemic venous system
• the vena cava
Frank-Starling mechanism
increased
cardiac myofiber stretching
compensated heart failure If dilated ventricle is able to maintain cardiac output
If the dilated ventricle no longer able to propel sufficient
decompensated heart failure.
blood to meet the needs of the body,
Left ventricular failure • Ischemic heart disease
• Myocarditis
• Valvular heart disease
• Restrictive Pericarditis
Right Ventricular Failure • Cor pulmonale
• Right-sided valvular disease
• Right-sided myocardial disease
• Pulmonary hypertension
systolic dysfunction inadequate myocardial contractile function Because of
ischemic heart disease.
Diastolic dysfunction inability of the heart to adequately relax and fill, Occurs in :
• massive left ventricular hypertrophy,
• myocardial fibrosis,
• amyloid deposition,
• pericarditis,
• valve dysfunction
Left-Sided Heart Failure • lungs are heavy and boggy • transudates, alveolar septal edema
accumulation of edema fluid in the alveolar
• Fatigue, tiredness • atrial fibrillation
spaces.
• Decrease urine production
• azotemia
• Dyspnea
• Crackles
• Cough
• hypoxic encephalopathy
• orthopnea),
• Paroxysmal nocturnal dyspnea
• Enlarged heart
Right-Sided Heart Failure • cor pulmonale • Hepatic and splenic enlargement, substantial pericardial
• primary pulmonic or tricuspid valve disease. • Peripheral edema
• systemic and portal venous systems effusions (greater than 500 mL) can limit cardiac
• Pleural effusion
filling and
• Ascites
cause cardiac failure (due to tamponade
• anasarca
atresia
malformation characterized by complete obstruction
Eisenmenger Syndrome 1. Left-right shunt + No Cyanosis
2. Shift to Right-left shunt+ Cyanosis
Tetralogy of Fallot Depends on degree of pulmonary stenosis 4 abnormalities : • Sabot shape
• Aortic Displacement • Cyanosis + clubbing digits
• Ventricular septal defect • bluish skin during crying or feeding
• Thickening wall of RV
• Narrow pulmonary valve
Obstructive Lesions Pulmonic valve stenosis,
Aortic valve stenosis or atresia, Coarctation of the aorta.
Coarctation • Preductule Coarctation : • Postductal Coarctation: We have Bicuspid aortic valve
• infant type • Adult type
• Remember ( hypoplastic) • adjacent to ligamentum art.
• Right Ventricular hypertrophy • Left Ventricular Hypertrophy
○ Because dilat pulm trun • upper extremity hypertension
• Cyanosis in lower body • Weak pulse
• Lower extremity hypertension
• Claudication + coldness
• Visible notch ribs
• Systolic murmur
• Palpable thrill
Ischemic heart an imbalance between cardiac blood supply (perfusion)
and myocardial oxygen and nutritional requirements.
Result from :
• Increase demand
disease (IHD) • Diminish blood volume
• Diminish oxygenation
• Diminish oxygen-carrying capacity
(CO poisoning)
Sudden cardiac lethal arrhythmia without myocyte necrosis Can also be caused by :
• Congenital coronary arterial
death Reason abnormalities
• Mitral valve prolapse
• Myocarditis
• Dilated or hypertrophic cardiomyopathy
• Pulmonary hypertension
Myocardial hypertrophy
• hereditary
Prinzmetal angina Caused by vessel spasm
Stable angina Pectoris Relieved at rest crushing or squeezing substernal sensation, 60-70% obstruction of Coron arter.
that can radiate down the left arm or to
the left jaw
Sinus Tachycardia HR>100
Bradyarrythmia+ Tachyarrythmia SSS syndrome
Acute viral pericarditis exudate => fibrinous uremia
Acute Bacterial pericarditis Exudate => purulent ( suppurative )
Chronic Pericarditis Scarring occur
Pericarditis ( clinical feature ) • Atypical chest pain
