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... then give rise to further branching. Cardiologists refer to one, two or three vessel disease based on how many of these three arteries are significantly narrowed by atherosclerosis. However, patients can receive quadruple, quintuple etc, coronary bypasses if branches off of the three main arteries are bypassed as well. Coronary Artery Disease-Atherosclerosis affecting the coronary arteries. This may be asymptomatic, result in stable angina, unstable angina, acute myocardial infarction or cardiac arrest.
It can be diagnosed by stress testing, coronary angiography and a new test called ultrafast CT scanning. RETURN TO TOP -D- Deep Venous Thrombosis- This is more commonly known as phlebitis. It refers to a blood clot that forms in the deep veins of the calves, thigh or pelvis. This can occur with prolonged immobility, such as a long car or airplane ride or prolonged brest when ill. Trauma to the leg, cancer and inherited abnormalities of the body's blood coagulation system can also cause it. Patients with cancer and those recovering from recent surgery are also at increased risk.
It can produce symptoms of leg pain and swelling but may also be asymptomatic. The diagnosis is made most commonly by ultrasound evaluation of leg veins. The treatment involve immediate blood thinning with intravenous or subcutaneous heparin's, followed by long term therapy with oral warfarin. The most dreaded complication is a pulmonary embolus (see below).
Varicose veins with chronic leg swelling may also be a long term consequence. Sometimes, clot dissolving agents are given during the acute treatment to prevent this latter complication as well as lead to more rapid resolution of the acute symptoms. Diastole-The part of the cardiac cycle when the main pumping chambers of the heart, the ventricles, are filling with blood for the next heart beat. Diastolic Blood Pressure-The bottom number of the blood pressure.
It should be less than 90. Dyspnea-This means shortness of breath. This symptom typically occurs with physical exertion. When caused by heart failure, it can also occur lying down and will be relieved by elevating the head. This type of dyspnea is also known as orthop nea. Dyspnea can be the result of many processes including many diseases of the heart and lungs, anemia, metabolic disturbances, overweight and physical de conditioning.
Diagnostic tests to help sort out the cause for a person's dyspnea may include an X-ray of the chest, echocardiography, stress testing and pulmonary function tests. RETURN TO TOP -E- Edema-This means swelling. Swelling can be due to fluid retention, injury or inflammation or varicose veins. Varicose veins are the most common cause of swollen ankles. Fluid retention can be a manifestation of heart disease (heart failure), kidney disease or liver disease.
The best test to assess the likelihood of the heart as a cause is an echocardiogram. The liver and kidneys can be evaluated by blood and urine tests, as well as imaging techniques that take pictures of those organs. Fluid retention caused by varicose veins is often treated by leg elevation and elastic stockings. Diuretics can be used if those measures are not satisfactory. Edema from heart, lung and kidney disease is treated with diuretics as well. Restriction of salt and fluid intake by the patient is also often recommended.
Endocarditis-This refers to an infection of the lining of the interior of the heart. It most commonly occurs on the valves of the heart. Untreated, it can destroy the tissue of the valve, resulting in severe leakage of those valves, heart failure and death. The infecting organism is most often any one of a number of bacteria. In many cases, it is difficult or impossible to determine how the bacteria got into the blood stream to infect the heart. Prior dental work or medical procedures involving non sterile parts of the body (such as the rectum) may be responsible.
Established infections elsewhere in the body may spread to the blood stream and then the heart. Patients with preexisting valvular or congenital heart disease are at increased risk, as are people who inject recreational drugs. The potential for dramatic symptoms is noted above. However, patients with endocarditis may manifest only subtle symptoms such as muscle or joint aches, low grade fevers, weight loss or anemia. Some are entirely asymptomatic! In addition to heart failure, the other dreaded complication is that some of the infectious material may break off from the valve and travel through the blood stream and occlude an artery somewhere in the body.
The tissue supplied by this artery will die and may become secondarily infected. If the material travels to the brain, a stroke ensues. The mainstay of diagnosis in culturing the patient's blood to determine if any microorganisms are growing in it as well as echocardiography. Trans esophageal echocardiography is particularly helpful. None of these tests are perfect.
Blood cultures can be positive from infections other than endocarditis and are sometimes negative even in patients with endocarditis. Ditto for echocardiography. Treatment is intravenous antibiotics, which often have to be given for as long as six weeks. This can often be done with the help of home intravenous therapy services to avoid prolonged hospitalization. Open heart surgery to remove the infected valve and replace it with a prosthesis is done if antibiotics fail, heart failure from a leaky valve occurs, abscess formation occurs within the heart or material repeatedly breaks off from the valve and occludes blood vessels elsewhere in the body. Patients with certain types of valvular or congenital heart disease who are felt to be predisposed to endocarditis are advised to take antibiotics prophylactically prior to medical or dental procedures that may seed the blood stream with bacteria.
RETURN TO TOP -F- Fainting-see syncope. RETURN TO TOP -G- RETURN TO TOP -H- Hardening of the arteries-see atherosclerosis Heart Attack-this ill defined lay term usually refers to an acute myocardial infarction. Heart Block-A disturbance in th electrical conduction system of the heart which may occur in isolation or may accompany other coexisting heart problems. Some medications may cause this as a side effect.
It may also be the result of a metabolic disturbance. The heart has a well defined conduction system. The electrical impulse is generated at the top of the right atrium. It then spreads throught both atria and then converges at a small piece of tissue where the two atria meet the two ventricles, called the atrioventricular node or AV node. The impulse travels through the AV node to the ventricles. Below the AV node is the right bundle which brings the electrical signal to the right ventricle and the left bundle which brings the electrical signal to the left ventricle.
Conduction blocks may occur at the AV node, or one or both of the bundles. The diagnosis is made by recording the ECG. Sometimes, an electro physiologic study is needed as well. Treatment begins by correcting any metabolic disturbances and, if possible, stopping any medications that could conceivably cause this as a side effect. If these measures are not available or ineffective, consideration may be given towards implantation of a pacemaker. The decision whether a pacemaker is needed is based on (1) where in the conduction system the block has occured, (2) the resulting heart rate, and (3) whether or not the heart block is causing any symptoms.
Heart Failure-This is also known as congestive heart failure or CHF. It refers to an impairment in the ability of the heart to pump blood out to the body in the normal fashion. The organs of the body receive less blood than they need. In addition, the blood returning to the heart backs up into the veins because the heart is congested with the blood it fails to pump out normally. The veins draining the lungs become engorged and serum seeps out of them into the lung tissue. This causes symptoms of shortness of breath with exertion and when lying down flat.
This fluid build up in the lungs is often evident on chest X-rays. The veins draining the body also become engorged and serum seeps out-first to the ankles, then higher up in the legs. Eventually, the liver becomes congested and fluid builds up in the abdominal cavity. At the end stage, the entire body may be swollen. Failure to adequately pump blood to the body's organs may cause symptoms of weakness and lightheadedness and impair the functioning of the kidneys. Heart failure can be caused by myriad things.
It can be the end result of many other heart diseases including coronary artery disease, prior heart attacks, valvular heart disease, cardiomyopathies and arrhythmias. It can also be caused by non cardiac illnesses straining the heart. These include high blood pressure, lung disease, diabetes, cigarette smoking, anemia, and infections. The heart condition is exacerbated by overproduction of certain hormones and over activity of the sympathetic nervous system in a maladaptive attempt by the body to compensate for the weakened heart. Treatment first entails identifying and treating any cardiac or non cardiac illnesses that may be contributing to the heart failure. The first test used to evaluate the heart is usually the echocardiogram.
Some evaluation for coronary artery disease is also often carried out. The fluid build-up is treated with diuretics and restriction of salt and fluid intake. If the actual heart muscle is weakened (which is most often the case), other heart failure medications such as ACE inhibitors, angiotensin blockers, digoxin and beta blockers may be used. Spironolactone is a diuretic that has benefits to the failing heart in addition to its fluid removing action. ACE inhibitors, angiotensin blockers and spironolactone exert their beneficial effects by counteracting the actions of hormones deleterious to the failing heart. Beta blockers exert their beneficial effect by countering the over activity of the sympathetic nervous system that is deleterious to the failing heart.
Sometimes, mechanical support with an intra aortic balloon pump or left ventricular assist device is required. Should the aforementioned measures fail, consideration may be given towards cardiac transplantation or other experimental therapies such as left ventricular reduction surgery. In most cases, the cause of the heart failure can be resolved or at least controlled. The goal of therapy is return patients to their prior level of functioning. The prognosis is quite variable and difficult to predict with certainty in the majority of patients. It is quite possible to lead a long and relatively asymptomatic life.
Hypertrophic Cardiomyopathy-This is a genetic disease that runs in families. The genetic defect causes an overgrowth of the heart muscle. The abnormally thick heart muscle is quite stiff and unable to fill with blood properly. Sometimes, the thickened heart muscle actually obstructs the egress of blood out of the heart. Associated abnormalities of the mitral valve may further exacerbate the obstruction. A variety of arrhythmias may occur as well as leakage of the mitral valve (mitral regurgitation).
The diagnosis is made by echocardiography. It is recommended that first degree family members of the patient be screened with echocardiogram's as well. Patients with the obstructive form take prophylactic antibiotics to prevent endocarditis. Treatment modalities include calcium blockers, beta blockers, diisopyramide (an antiarrhythmic medicine that has additional properties that help hypertrophic cardiomyopathy), open heart surgery to remove some of the thickened heart muscle (septal myomectomy), and mitral valve replacement. Newer, experimental therapies include implantation of a pacemaker (which may aid the functioning of the heart in this condition by altering the electrical activation pattern of the heart) and injecting ethanol into an artery of the heart to thin some of the thickened muscle. The arrhythmias associated with this disease are treated with antiarrhythmic medications or a cardioverter / defibrillator .
RETURN TO TOP -I- Infarction-Death of tissue due to occlusion of the artery supplying that tissue. Insufficiency-see regurgitation Intermittent Claudication-Discomfort (pain, aching, cramping, weakness) in the calves or thighs due to atherosclerosis of the blood vessels supplying the leg muscles. Diagnosis is made by ultrasound studies or angiograms of the leg arteries. Treatment includes smoking cessation, walking exercises, pentoxifylline, and cilostazol. If the symptoms are debilitating, occur at rest or result in gangrene, angioplasty, stenting or a bypass operation can be performed on the leg arteries. Ischemia-Impairment of the functioning of tissue without tissue death due to a reduction in blood flow to that tissue.
RETURN TO TOP -J- RETURN TO TOP -K- RETURN TO TOP -L- RETURN TO TOP -M- Marfan's Syndrome- An inherited disorder of connective tissue that results in eye problems, excessive joint mobility, tall stature, long fingers, mitral valve prolapse with mitral regurgitation and aneurysmal dilatation of the aorta resulting in aortic dissection and aortic regurgitation. Please look up the specific cardiac problems on this page for more information on their diagnosis and management. Cardiac involvement is assessed by echocardiography as well as CT scans or MRI scans to assess the aorta. Beta blockers are administered prophylactically to prevent aortic dilatation and dissection. Mitral Valve-One of the four valves of the heart. It is composed of two leaflets.
It is called the bicuspid valve by some but was named the mitral valve because it is shaped like a bishop's mitre. It connects the left atrium to the left ventricle. When the ventricle is ejecting blood out to the body, the mitral valve is closed to prevent the blood from going backwards to the left atrium and the lungs. After the ventricle finishes ejecting the blood, the valve opens to allow the left ventricle to fill with blood for the next heart beat. Mitral Valve Prolapse-An excess of tissue in the mitral valve allows the valve to buckle or bow backwards into the left atrium when the valve closes. The valve may leak blood back into the left atrium (mitral regurgitation-see below).
Using improved diagnostic echocardiographic techniques, recent studies show the incidence of mitral valve prolapse is only 2. 4 % and most patients are asymptomatic and enjoy an excellent prognosis. Patients with abnormally thickened leaflets or significant mitral regurgitation require antibiotic prophylaxis before certain medical and dental procedure to prevent infections of the mitral valve. The management of mitral regurgitation is discussed below. Mitral Valve Regurgitation-In this condition, blood leaks back into the left atrium when the mitral valve closes and causes symptoms of heart failure.
The most common causes include mitral valve prolapse, diseases of the heart muscle (the mitral valve is attached to the heart muscle and may not closes properly if the muscle dilates or weakens), rheumatic heart disease, infections on the mitral valve, and hypertrophic cardiomyopathy. The diagnosis is made by echocardiography and cardiac catheterization. Surgery on the valve (repair or replacement) is recommended if symptoms develop and also in the absence of symtoms if the main pumping chamber of the heart is becoming weak or dilated. Mitral Valve Stenosis-An inability of the mitral valve to open fully.
This results in blood backing up in the left atrium and lungs, which in turn leads to symptoms of heart failure. The left atrium dilates, often resulting in atrial fibrillation. Blood clots may form in the left atrium. If they break off and travel to the brain, a stroke ensues. The most common cause is rheumatic heart disease.
The diagnosis is made by echocardiography. Symptoms are controlled by keeping the heart rate slow with medicines like beta blockers or digoxin which allows more time for the left atrium to empty. Blood clots are prevented by blood thinning medication such as warfarin. Mitral valve repair or replacement is carried out if they symptoms are severe or not adequately controlled with medical therapy. Balloon valvuloplasty is also an option for some. Murmur-One of the abnormal sounds from the heart a physician hears with a stethoscope.
The presence of a murmur may indicate valvular or congenital heart disease but murmurs are also commonly produced by the normal flow of blood through the heart. These latter types of murmurs are also called innocent murmurs, flow murmurs or physiologic murmurs. The various causes of murmurs can be differentiated based on how they sound and...
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Research essay sample on Coronary Artery Disease Sympathetic Nervous System
