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Heart Disease

Cardiac Disease

Heart diseases are one the leading causes of morbidity and mortality worldwide, because of increasing sedentary lifestyle. They could be congenital or acquired.


Presentation

Congenital disorder manifests in newborn, and characterized by poor feeding, blue discoloration, cough and breathing difficulty. Coronary diseases present as severe chest pain, palpitation, sweating, anxiety, fear, and syncope. Rheumatic diseases present with sore throat, pain in joints, chest pain, breathlessness and rash. Valvular heart diseases present with complaints such as dyspnea, leg swelling, cough, fever, dizziness and chest pain [6].

Lymphedema
  • KEYWORDS: Corynebacterium striatum; Endocarditis; Lymphedema; Rheumatic heart disease[ncbi.nlm.nih.gov]
Wound Infection
  • infection (11.3% of readmission cases), ischemic heart disease (10.3%), and heart failure (8.7%).[ncbi.nlm.nih.gov]
Dyspnea
  • The symptoms of heart disease range from dyspnea, chest pain and syncope to symptoms of cardiac shock like cold extremities, hypotension, confusion, and multiple organ failure.[symptoma.com]
Pelvic Mass
  • The patient had bilateral pelvic masses and elevated serum CA125 and an elevated urinary 5-hydroxyindoleacetic acid (5-HIAA).[ncbi.nlm.nih.gov]
Chest Pain
  • Coronary diseases present as severe chest pain, palpitation, sweating, anxiety, fear, and syncope. Rheumatic diseases present with sore throat, pain in joints, chest pain, breathlessness and rash.[symptoma.com]
  • The patient, who had a history of hypertension presented with chest pain and shortness of breath to the emergency department. She was diagnosed with ischaemic heart disease (IHD) and had hypertension as one of the coronary risk factor.[ncbi.nlm.nih.gov]
  • Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.[heartresearch.com.au]
  • This disease includes a variety of problems, including high blood pressure, hardening of the arteries, chest pain, heart attacks, and strokes. What Is Heart Disease? The heart is the center of the cardiovascular system.[kidshealth.org]
  • After her fifth angioplasty, she still had constant chest pain. She was on 10 different daily medications, suffered migraines, and, at the age of 60, could not walk even one block.[drfuhrman.com]
Tachycardia
  • CASE DESCRIPTION: We present the case of a girl without heart disease admitted at our PICU due to an influenza A acute respiratory distress syndrome, who suffered a paroxysmal supraventricular tachycardia (PSVT) twelve hours after DEX progressive withdrawal[ncbi.nlm.nih.gov]
  • We present a case of a 46-year-old man with nonischemic cardiomyopathy and ventricular tachycardia who underwent an echocardiogram suggestive of cardiac Chagas disease. A subsequent F-FDG PET demonstrated abnormal hypermetabolism.[ncbi.nlm.nih.gov]
  • Tachycardia may be managed by carotid massage or adenosine if origin is supraventricular or beta blockers, verepamil, digoxin or lidocaine if origin is ventricular or nodal.[symptoma.com]
  • Tachycardia, or a heart rate that’s too fast, refers to a heart rate of more than 100 beats per minute. An arrhythmia can affect how well your heart works.[heart.org]
  • These include: tachycardia, when the heart beats too fast bradycardia, when the heart beats too slowly premature ventricular contractions, or additional, abnormal beats fibrillation, when the heartbeat is irregular Arrhythmias occur when the electrical[medicalnewstoday.com]
Heart Murmur
  • Topics under Heart Disease Abnormal Electrocardiogram (0 drugs) Arrhythmia (198 drugs in 25 topics) Cardiomyopathy (9 drugs in 6 topics) Endocarditis (82 drugs in 3 topics) Heart Murmur (0 drugs) Hemopericardium (0 drugs in 2 topics) Ischemic Heart Disease[drugs.com]
  • murmurs ‎ (7 F) Heart rupture ‎ (11 F) I Inflammatory heart diseases ‎ (5 C, 1 F) Ischemic heart diseases ‎ (4 C, 2 F) N Nederlandse Hartstichting ‎ (12 F) Heart neoplasms ‎ (32 F) P Pathologic dilatation ‎ (5 F) Pulmonary heart disease ‎ (1 C, 5 F)[commons.wikimedia.org]

Workup

The diagnosis can be done by physical examination and investigations. In each and every case, ECG should be done. Echocardiography is important investigation which shows anatomical defects, valvular defects, and defects in pericardial space. It also asseses the pathophysiological condition of blood flow, valvular function, myocardial contraction and cardiac function like output and stoke volume.

Cardiac catheterization is important to diagnose diseases of valves and function of ventricles. Angiography detects stenoses in coronary circulation, and is also important to be done before angioplasty or stenting. It is also done to measure pulmonary artery pressure, and cardiac output. Blood pool imaging establishes left ventricular ejection fraction. Myocardial perfusion scans measure perfusion of myocardium at rest and at stress [7]. Laboratory investigations like biochemical markers, troponin or Anti-streptolysin O (ASO) titer could be advised as required.

Treatment

Blood pressure is kept under control by diet modification and antihypertensive drugs like diuretics and beta blockers. If there is suspected or diagnosed ischemia, it requires treatment with oxygen, sublingual nitroglycerine, centrally acting analgesics like morphine and platelet inhibitors like aspirin or clopidogrel.

If ECG shows abnormal rhythm, anti-arrhythmic drugs like lidocaine, amiodarone, are indicated. In worst situations, patient may need resuscitation with defibrillation.

Bradycardia is managed by atropine. Tachycardia may be managed by carotid massage or adenosine if origin is supraventricular or beta blockers, verepamil, digoxin or lidocaine if origin is ventricular or nodal [8].

Surgical interventions are required in certain conditions like internal pacemaker for heart block, angioplasty or stent placement for coronary diseases, valvuloplasty or valve replacement in valvular defects and septoplasty for septal defects.

Prognosis

Congenital and acquired valvular defects have poor prognosis, and require regular follow up to asses function, secondary infection and rejection. Prognosis of other conditions like coronary diseases and conduction disorders is good with pharmacological and surgical management. Further recurrence of underlying conditions like atherosclerosis and thromboembolism could be prevented by control of obesity, diet, diabetes, lipids and changing lifestyle [5].

Etiology

Diseases of conduction can be due to myocardial infarction, sick sinus syndrome, hypothermia or fever, hypothyroidism and hyperthyroidismpheochromocytoma and drugs like beta blocker and digoxin. Coronary heart diseases are due to atherosclerotic plaques in coronary vessels with superimposed changes, and increased workload to the heart like in case of exertion [2].

Valvular defects could be congenital or acquired secondary to conditions like rheumatic disease. The valvular condition could also be senile or due to calcification like in the case of aortic stenosis or may be due to infective endocarditis or due to trauma in the case of aortic regurgitation. Myocardial diseases are secondary to viral infection or other conditions. Pericardium can be infected by virus or mycobacterium.

Epidemiology

In 2008, 17.3 million people died from cardiovascular diseases, accounting for total of 30% deaths. Out of this 7.3 million died because of coronary heart disease. High blood pressure, obesity, tobacco use and diabetes are associated risk factors. 9.4 million cases are attributed to high blood pressure. It is expected that there will be increasing incidence and prevalence of heart diseases [3].

Sex distribution
Age distribution

Pathophysiology

In congenital conditions, there might be anatomical defect resulting in altered hemodynamics, either pressure overload or volume overload, altered oxygenation of blood and which might further lead to infections.

Coronary heart diseases are precipitated as a result of superimposed changes in established atheromatous plaques resulting in unfulfilled oxygen need to heart muscles resulting in ischemic changes or infarct. This can lead to death of cardiac muscle.

Diseases of conduction can be due to myocardial infarction, sick sinus syndrome, hypothyroidism and hyperthyroidismpheochromocytoma and drugs like beta blocker and digoxin. Myocarditis is secondary to viral or rarely bacterial infection.

Pericardium can be infected by virus or mycobacterium, and may result in fluid accumulation in pericardial space [4].

Prevention

Except congenital diseases, other diseases are preventable by control of risk factors like obesity, smoking, blood pressure, diet control, life style changes and infections [9].

Summary

The symptoms of heart disease range from dyspnea, chest pain and syncope to symptoms of cardiac shock like cold extremities, hypotension, confusion, and multiple organ failure. Heart diseases can be diagnosed by electrocardiography (ECG), echocardiography, X-ray, cardiac catheterization or myocardial perfusion imaging. Heart conditions are treated with medications and surgical interventions like pacemakers, percutaneous coronary intervention and coronary artery bypass graft [1].

Patient Information

  • Definition: Heart diseases can be congenital or acquired. Acquired heart diseases can due to hereditary predisposition, infection or due to risky life style.
  • Symptoms: Congenital disorder manifests in newborn and children characterized by poor feeding, blue discoloration, cough and breathing difficulty. Coronary diseases presents as severe chest pain, feeling of heart beats, sweating, anxiety, fear and dizziness. Rheumatic diseases present with sore throat, pain in the joint, chest pain, breathlessness and rash. Valvular heart diseases present with complaints such as breathlessness, leg swelling, cough, fever, dizziness and chest pain.
  • Diagnosis: The diagnosis can be made by clinical history, presenting complaints, various signs and symptoms, and investigations like ECG, echocardiography, angiography, angioplasty, myocardial perfusion scan and cardiac catheterization depending on specific cardiac condition.
  • Treatment: Congenital defects requires surgery most of the time. Acquired defects can be treated medically or surgically [10].

References

Article

  1. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341:650.
  2. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292:1433.
  3. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104:2746.
  4. Parikh NI, Gona P, Larson MG, et al. Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart study. Circulation 2009; 119:1203.
  5. Hennekens CH, Andreotti F. Leading avoidable cause of premature deaths worldwide: case for obesity. Am J Med 2013; 126:97
  6. Aronow WS, Kronzon I. Prevalence and severity of valvular aortic stenosis determined by Doppler echocardiography and its association with echocardiographic and electrocardiographic left ventricular hypertrophy and physical signs of aortic stenosis in elderly patients. Am J Cardiol 1991; 67:776.
  7. Lonn E, Bosch J, Teo KK, et al. The polypill in the prevention of cardiovascular diseases: key concepts, current status, challenges, and future directions. Circulation 2010; 122:2078.
  8. Franzen SF, Huljebrant IE, Konstantinov IE, et al. Aortic valve replacement for aortic stenosis in patients with small aortic root. J Heart Valve Dis 1996; 5 Suppl 3:S284.
  9. Freeman WK, Schaff HV, O'Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol 1991; 18:29.
  10. Castellano JM, Sanz G, Peñalvo JL, et al. A Polypill Strategy to Improve Adherence: Results From the FOCUS Project. J Am Coll Cardiol 2014.

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Last updated: 2018-06-22 11:50