Cardiovascular Disorders

 Cardiovascular Disorders

Introduction

·       The cardiovascular system ensures circulation of blood, delivering oxygen and nutrients while removing waste products.

·       Disorders affecting the heart, blood vessels, and blood components can compromise oxygen delivery, leading to significant morbidity and mortality.

·       Cardiovascular disorders can involve:

·        Vascular pathology (e.g., hypertension, atherosclerosis, Raynaud’s).

·        Heart diseases (e.g., heart failure, arrhythmias, angina, MI, pericardial infections).

·        Blood disorders (e.g., anemia, polycythemia, leukocyte disorders, congenital blood disorders).

·        Circulatory disturbances (e.g., shock).

Hypertension

• Definition: Persistent elevation of blood pressure ≥140/90 mmHg.
• Types:
• Primary (essential): 90–95%, no identifiable cause.
• Secondary: Due to renal disease, endocrine disorders, medications, pregnancy.
• Risk factors: Family history, obesity, high salt intake, smoking, alcohol, sedentary lifestyle, stress, diabetes.
• Pathophysiology: Increased peripheral resistance → vascular remodeling → arterial stiffness → end-organ damage (heart, brain, kidney, retina).
• Clinical features: Often asymptomatic ("silent killer"), headache, dizziness, palpitations, visual disturbances.
• Complications: Stroke, MI, CHF, renal failure, retinopathy.
• Management: Lifestyle modification (diet, exercise, stress reduction), antihypertensives (diuretics, ACE inhibitors, ARBs, beta-blockers, calcium channel blockers).

Shock

• Definition: A life-threatening condition where tissue perfusion is inadequate to meet cellular needs.
• Types:
• Hypovolemic: Due to blood/fluid loss.
• Cardiogenic: Due to heart pump failure (MI, arrhythmia).
• Distributive: Septic, anaphylactic, neurogenic.
• Obstructive: Pulmonary embolism, cardiac tamponade.
• Pathophysiology: ↓Perfusion → anaerobic metabolism → lactic acidosis → cellular injury → multi-organ dysfunction.
• Stages:
• Compensated (tachycardia, vasoconstriction).
• Progressive (hypotension, confusion).
• Irreversible (organ failure).
• Clinical features: Hypotension, tachycardia, cold clammy skin (except warm in septic shock), oliguria, altered consciousness.
• Management: Oxygen, IV fluids, vasopressors, treat underlying cause (e.g., antibiotics for sepsis, epinephrine for anaphylaxis).

Anaemia

• Definition: Reduction in hemoglobin, hematocrit, or RBC count → reduced oxygen-carrying capacity.
• Types:
• Microcytic (iron deficiency, thalassemia).
• Macrocytic (B12/folate deficiency).
• Normocytic (chronic disease, acute blood loss, hemolysis).
• Causes: Nutritional deficiencies, chronic disease, blood loss, hemolysis, bone marrow failure.
• Clinical features: Fatigue, pallor, breathlessness, palpitations, dizziness, spoon nails, jaundice (in hemolytic anemia).
• Diagnosis: CBC, peripheral smear, iron studies, vitamin B12/folate levels, bone marrow exam.
• Management: Iron, folic acid, vitamin B12 supplementation, blood transfusion, erythropoietin, treat underlying cause.

Congestive Heart Failure (CHF)

• Definition: Inability of the heart to pump sufficient blood to meet body needs.
• Types:
• Left-sided: Pulmonary congestion, dyspnea, orthopnea.
• Right-sided: Peripheral edema, ascites, hepatomegaly.
• Causes: Hypertension, MI, valvular disease, cardiomyopathy.
• Pathophysiology: ↓Cardiac output → activation of RAAS & sympathetic nervous system → fluid retention → worsening overload.
• Clinical features: Fatigue, dyspnea, edema, nocturnal cough, jugular venous distension, weight gain.
• Management: Salt restriction, diuretics, ACE inhibitors, beta-blockers, digoxin, surgical options (valve repair, heart transplant).

Angina Pectoris

• Definition: Chest pain due to transient myocardial ischemia without infarction.
• Types:
• Stable: Predictable with exertion, relieved by rest/nitroglycerin.
• Unstable: New-onset, increasing frequency, may occur at rest.
• Variant (Prinzmetal’s): Due to coronary artery spasm.
• Clinical features: Substernal chest pain (constricting, radiating to left arm/jaw), triggered by exertion, relieved by rest/medication.
• Diagnosis: ECG (ST depression in stable angina), stress test, coronary angiography.
• Management: Nitrates, beta-blockers, calcium channel blockers, aspirin, lifestyle modification, revascularization (PCI, CABG).

Myocardial Infarction (MI)

• Definition: Irreversible myocardial necrosis due to prolonged ischemia, usually from coronary artery thrombosis.
• Risk factors: Atherosclerosis, smoking, diabetes, hypertension, dyslipidemia, obesity.
• Clinical features: Severe crushing chest pain >30 min, sweating, nausea, dyspnea, not relieved by rest/nitroglycerin.
• Complications: Arrhythmias, cardiogenic shock, pericarditis, CHF, ventricular rupture.
• Diagnosis: ECG (ST elevation in STEMI, ST depression in NSTEMI), elevated cardiac enzymes (Troponin, CK-MB).
• Management: MONA (Morphine, Oxygen, Nitrates, Aspirin), thrombolysis, PCI, anticoagulants, beta-blockers, ACE inhibitors.

Arrhythmia

• Definition: Abnormal rhythm of the heart due to disturbances in impulse generation or conduction.
• Types:
• Tachyarrhythmias: Atrial fibrillation, ventricular tachycardia.
• Bradyarrhythmias: Sinus bradycardia, AV block.
• Ectopic beats: PACs, PVCs.
• Clinical features: Palpitations, dizziness, syncope, chest discomfort, sudden cardiac death.
• Diagnosis: ECG, Holter monitoring, electrophysiological studies.
• Management: Antiarrhythmic drugs, pacemaker, cardioversion/defibrillation, ablation therapy.

Pericardial Infections (Pericarditis)

• Definition: Inflammation of pericardium due to infection (viral, bacterial, TB), trauma, autoimmune disease, post-MI.
• Clinical features: Sharp chest pain (worsens with inspiration, relieved by leaning forward), fever, pericardial friction rub, dyspnea.
• Complications: Pericardial effusion, cardiac tamponade, constrictive pericarditis.
• Diagnosis: ECG (diffuse ST elevation), echocardiography, pericardial fluid analysis.
• Management: NSAIDs, colchicine, steroids, antibiotics if bacterial, pericardiocentesis for tamponade.

Raynaud’s Disease

• Definition: Vasospastic disorder causing episodic ischemia of extremities (fingers/toes) in response to cold or stress.
• Types:
• Primary (Raynaud’s disease): Idiopathic.
• Secondary (Raynaud’s phenomenon): Associated with connective tissue diseases (scleroderma, lupus).
• Clinical features: Triphasic color change – pallor → cyanosis → redness, numbness, tingling, pain.
• Management: Avoid cold exposure, stress reduction, vasodilators (calcium channel blockers, nitrates).

Atherosclerosis

• Definition: Chronic arterial disease characterized by plaque formation in intima of large/medium arteries.
• Risk factors: Hyperlipidemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle.
• Pathophysiology: Endothelial injury → LDL infiltration → foam cell formation → fatty streaks → fibrous plaque → luminal narrowing → thrombosis.
• Clinical consequences: Coronary artery disease (angina, MI), stroke, peripheral arterial disease, aneurysm.
• Management: Lifestyle changes, statins, antihypertensives, antiplatelets, revascularization (angioplasty, bypass surgery).

Polycythemia

• Definition: Increased RBC mass and hemoglobin concentration.
• Types:
• Primary (Polycythemia vera): Myeloproliferative disorder.
• Secondary: Due to chronic hypoxia (COPD, high altitude), tumors secreting erythropoietin.
• Relative: Due to dehydration.
• Clinical features: Headache, dizziness, pruritus (especially after hot bath), ruddy complexion, splenomegaly, thrombosis risk.
• Diagnosis: CBC, erythropoietin levels, JAK2 mutation analysis.
• Management: Phlebotomy, hydroxyurea, aspirin, oxygen therapy (for hypoxic causes).

Leukocyte Disorders

• Types:
• Leukocytosis: Increased WBC count (infection, inflammation, leukemia).
• Leukopenia: Low WBC (viral infections, bone marrow suppression, chemotherapy).
• Leukemia: Malignant proliferation of WBCs.
• Acute lymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Chronic lymphocytic leukemia (CLL)
• Chronic myeloid leukemia (CML)
• Clinical features: Recurrent infections, fever, pallor, bleeding, lymphadenopathy, splenomegaly.
• Diagnosis: CBC, peripheral smear, bone marrow biopsy, cytogenetic tests.
• Management: Chemotherapy, radiation, stem cell transplantation, antibiotics for infections.

Congenital Blood Disorders

• Definition: Inherited abnormalities affecting RBCs, hemoglobin, or coagulation.
• Examples:
• Thalassemia: Defective hemoglobin synthesis → microcytic hypochromic anemia.
• Sickle cell anemia: Mutation in β-globin → HbS → sickling of RBCs → vaso-occlusive crises, hemolysis.
• Hemophilia: X-linked deficiency of clotting factors VIII (A) or IX (B) → bleeding tendency.
• Von Willebrand disease: Deficiency/dysfunction of vWF → platelet adhesion defect.
• Clinical features: Anemia, jaundice, bone deformities (thalassemia), painful crises (sickle cell), bleeding/bruising (hemophilia).
• Management: Blood transfusions, hydroxyurea (sickle cell), iron chelation, factor replacement therapy, bone marrow transplantation.

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