Heart

progressive

when heart cant match metabolic demands of tiss.

result from systolic or dyastolic dysfunction

Ischemic heart disease

systemic hypertension

mitral/aortic vlave disease

primary myocardial disease

-> results mostly in rigth heart failure

Pressure overload state

Hypertension

Aortic stenosis or coartaction

Volume overload states

Aortic insufficiency

Anemia (decreased oxygen carrying capacity)

Thyreotoxicosis (increased tissue demands)

Decreased myocardial contractility

MI

Cardiomyopathy

Disorders of cardiac conduction

dyspnea

cough (bc of fluid transudation)

orthopnea (dyspnea in supine position)

paroxysmal nocturnal dypnea (dramatic breathlessness)

hypocic encephalopathy

hypoxic injury of bowl

decreased renal perfusion

parenchimal lung disease

1.pul. hypertension

recurrent pul. thromboembolism

pul. vasoconstriciton (schlaf apnö)

=> pressure, volume overload

low myocardial contractiliy

fatigue

dependent edema

cyanosis

anorexia

liver enlargement

multifactorial, 90% the cause is unknown

arises from faulty embryogenesis during gestational weeks

3 through 8

Enviromental exposures

viruses (congenital rubella infection)

teratogens:talidomid,litium-> depression therapy

maternal diabetes, fetal alcohol sy

Genetic factors

familial forms of CHD

chromosomal abnormalities (Down, Turner)

1. Malformation R-L shunt (early cyanosis)

2. MAlformation L-R shunt (late cyanosis)

3. malformation with obstructive lesion -> aortic coartation, aortic and pul. stenosis

MOST COMMON ANOMALY

opening between ventricles (90% membranous, 10% muscular)

50% spontaneous closure

most common anomalie in adults

asymptomatic

blood flows between aorta and pulmonary aorta

didnt close in fetal development

Cyanotic R-L shunt

severe symptoms

VSD

boot shaped heart

functually seperated systemic and pul. circulation

=> emergency surgery after birth

constriction of aorta

r/L v hypertophy

infantile (hypertophy of aortic arch)

adult (folding of aorta)

50% + bicuspid aortic valve

Reduced coronary blood flow

coronary atherosclerosis (>90%)

thrombosis

coronary vasospam emotional stages

arteritis

Diminished oxygenation or oxygen-carrying capacity

anemia,COPD, CO poisining

Diminished blood volume

hypotension, shock

Increased myocardialdemand

hypertrophy, tachycardia, hyperthyreosis , fever

Angina pectoris

Myocardial infarction

Chronic IHD with CHF

Sudden cardiac death

nirtoglycerin

necrosis of myocytes from abolute ischemia

major underlying cause = arterosclerosis

transmural

subendocardial

microscopic

caused by epicardial vessel occlusion, due to acute plaque

change with thrombosis

within the distribution of a single coronary artery

involve full thickness of the ventriclular wall

ST-segment elevated MIs

MOST COMMON

intraplaque hemorrhage or plaque rupture

superimposed thrombosis and coronary occlusion

myocardial ischemia and dysfunstion

• severe ischemia leads to ATP depletion and loss of contractile function within 60 sec

• complete deprivation of blood flow for 20 to 30 min leads to irreversible injury

cinical symptoms of MI >80% pts ->

ECG abnormalities, cardiomyocyte-specific proteins without

MIs limited to the inner third of the myocardium

non-ST-segment elevated MIs

 systemically diminished supply - hypoperfusion or hypoxia

 lysis of a thrombotic occlusion before full- thickness infarction

 chronic atherosclerotic disease in the setting of increased myocardial demand - tachycardia

Small vessels occlusion

Non-diagnostic ECG

 vasculitis

 embolization (valve vegetation or mural thrombi)

 vessel spasm (catecholamines)

 extreme emotional stress

 tumors (pheochromocytoma)

 cocaine

coronary artery disease

• conduction system scaring

• acute ischemic injury

• electrical irritability of myocardium distant from the conduction system

➢ congenital(bicuspidaorticvalve)

➢ acquired

➢ degeneration

➢ inflammatory processes (postinflammatory scaring)

➢ immune diseases

➢ changes secondary to myocardial disease

stenosis

insufficiency

changes that affect the integrity of valvular extracellular matrix

➢ calcification (cuspal or annular)

➢ alterations in the ECM (myxomatous

degeneration)

➢ changes in the production of MMP or their inhibitors

➢ aging – repetitive mechanical stresses

calcification

age-related lesions Asymptomatic / symptomatic / congenital bicuspid aortic valve

Cardiac output is maintained

Concentric left ventricular hypertrophy

High left ventricular pressure

Exhaustion of compensatory mechanisms:

Syncope, angina, CHF

Surgical intervention

most common disease in women

Myxomatous degeneration of the mitral valve

One or both mitral leaflets prolapse into the left atrium during systole

0,5-2,4% adults, women 7-fold more

Primary

➢ defect of conective tissue synthesis, Marfan sy, systemic structural abnormalities in connective tissue..

Secondary

➢ injury of the valve myofibroblasts (chronic hemodynamic forces)

Acute, immunologically mediated multisystem inflammatory disease

Atributed to host anti-streptococcal antibodies and/or T cells that cross-reacts with cardiac antigenes

Occuring in children 5-15 yrs after group A streptococcal infection (pharyngitis)

Rheumatic heart disease

progressive valve damage with fibrosis – most important clinical

feature (mitral valve 70% cases)

• ➢  migratory polyarthritis of large joints

• ➢  carditis

• ➢  subcutaneous nodules

• ➢  erythema marginatum

• ➢  Sydenham chorea („St. Vitus dance”)

➢ fever

1. ➢ arthralgias

   ➢ elevated CRP

   ➢ ECG changes

microbial colonization or invasion of valves, leading to friable, infected vegetations, often with valve damage and destruction of the underlying cardiac tissue

• ➢  Host factors

  • ➢  neutropenia, immunodeficiency

  • ➢  diabetes

  • ➢  malignancy

  • ➢  alcohol

  • ➢  chronic infections (gut, oral cavity, urinary tract)

  • ➢  trivial injuries

  • ➢  cardiac abnormalities

• ➢  Congenital heart diseases

• ➢  Prosthetic heart valves

• ➢  IV drug abuse

• ➢  Dental or surgical procedure antibiotic prophylaxis

• rapid onset

• fever, rigor , malaise, wakness

• staph aureus !!!

• embolic complications

• splenomegaly

• high mortality

no normal valve

Strep Viridans!!!!

small vegettaions lower mortality

• ➢  Valvular and myocardial damage ➢ ring abscess

  ➢ calcification ➢ mycotic aneurisms ➢ arrhythmias

• ➢  Septicaemia, embolic complication

• ➢  Renal injury (septic infarcts, glomerulonephritis) ➢ Vasculitis

• ➢  Marantic endocarditis

• ➢  Underlying malignancy (mucinous adenocarcinoma)

• ➢  Prolonged debilitating illness ➢ Renal feilure

  ➢ Chronic sepsis

• ➢  Underlying hypercoagulable states ➢ DIC

  ➢ Hyperestrogenic states

• ➢  Marantic endocarditis

• ➢  Underlying malignancy (mucinous adenocarcinoma)

• ➢  Prolonged debilitating illness ➢ Renal feilure

  ➢ Chronic sepsis

• ➢  Underlying hypercoagulable states ➢ DIC

  ➢ Hyperestrogenic states

1. Dilated

2. hypertophic

3. restrictes

90% of all myopathys

gradual 4 chambers hypertophy and dilatation

systolic dysfunction with hypocontraction

progessive CHF

Idiopathic

myocarditis

toxic (alcohol)

peripartum

iron overload

genetic

➢ AD disorder characterized by predominantly right- sided failure and arrhythmia

➢ consider in young male with arrhythmia

➢ Mutation:

➢ genes encoding desmosomal junctional proteins

➢ Protein that interact with the desmosomes

➢ Death: secondary to progressive CHF or sudden death (fatal arrhythmia)

myocardial hypertrophy

dyastolic dysfunction (defective diastolic felling)

ventricular outflow obstruction (1/3) due to systolic

anterior motion of the mitral valve

AD mutation of sarcomeric proteins, with variable expression

➢ Β-myosin heavy chain mutations

➢ Primary disease in ventricular compliance

➢ Restriction of ventricular filling leading to reduced cardiac output (relaxation also problem)

➢ Idiopathic

➢ Associated with systemic diseases

➢ radiation fibrosis, amyloidosis, sarkoidosis, hemochromatosis...

disease of children and teens

africa, tropical

nutritional deficiency

helmintic infection

inflammatory

caused by infections/immune reactions

Infections

➢ Coxsackieviruses A and B, other enteroviruses, Influenza virus, HIV, CMV

➢ Protozoan Trypanosoma cruzi - Chagas disease (South America)

➢ Spirochete Borrelia burgdorferi – Lyma disease ➢ Trichinela spiralis (trichinosis) ➢ Toxoplasma gondii (cats) ➢ Corynebacterium diptheriae

➢ Noninfectiousvcauses

➢ Systemic disease of immune origin (SLE, poymyositis) ➢ drug hypersensitivity reaction

➢ Unknown cause: sarcoidosis, giant cell myocarditis

CHF hypoalbunminemia

trauma

malignancy

ruptures MI

aortic dissection

mediastinal lymphatic obsruction

➢ acute primary pericarditis

viral infection

bacterial viral fungal

➢ secondary

➢ disorders involving the heart or mediastinal structures

➢ systemic abnormalities

➢ chronic pericarditis

➢ delicate adhesions

➢ fibrotic scars that obliterate the pericardial space

➢ constrictive pericarditis

➢ MI

➢ cardiac surgery

➢ Trauma

➢ Radiation

➢ Tumors

➢ Uremia

➢ autoimmune diseases