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CARDIOVASCULAR DISORDERS

Pkm/2011
REVIEW OF ANATOMY & PHYSIOLOGY

Class discussion
• Anatomy (structure)
• Physiology (function)
• Regulation
• Failure of Regulation
• Associated conditions
INVESTIGATIONS IN CARDIAC DISORDERS

1. Chesty X-ray
• Aids to determine heart size in relation to the
thorax. Maximum transverse diameter is compared
with the maximum transverse diameter of the
thorax measured from inside the ribs.
(cardiothoracic ratio)
• The transverse diameter of the heart should be less
that 50% of the thoracic diameter, except in
neonates infants, athletes and patients with funnel
chest.
INVESTIGATIONS IN CARDIAC DISORDERS

2. Electrocardiography (ECG)
A graphic record of the heart’s electrical
activities. (Normal electrocardiogram).
Electrocardiography
• Certain conditions result in abnormalities of
the ECG. Examples-
• Atrial fibrillations common in mitral stenosis,
rheumatic heart and infarction of atrial
myocardium- seen as depressed P wave
• Ventricular fibrillations due to ventricular
myocardial infarction, seen as complete
disruption of normal rhythm and depressed
QRS complex.
INVESTIGATIONS IN CARDIAC DISORDERS

3. Echocardiograpy
Non-invasive technique for evaluating the
internal structures and motion of the heart
and great vessels through ultra sound.
(ultrasound-imaging technique in which high
frequent sound waves are reflected off tissue
to form an image).
Echocardiograpy

• Echocardiography is used to diagnose vulvular


heart disease, congenital heart disease,
cardiomyopathy, congestive heart failure,
pericardial diseases, cardiac tumours and
intracardial thrombi
INVESTIGATIONS IN CARDIAC DISORDERS

4. Cardiac catheterization.
• Introduction of a thin radio-opague catheter into
circulation, used to measure pressure within the
heart chambers.
• Right heart is catheterized using a peripheral
vein eg femoral or internal jugular vein advancing
through the right atrium and ventricle.
• Left heart is catheterized via right femoral artery.
INVESTIGATIONS IN CARDIAC DISORDERS

5. Computed tomography scan (CT)-X-ray


technique that produces an image
representing a detailed cross-section of a body
structure eg the heart.
INVESTIGATIONS IN CARDIAC DISORDERS

• Cardiac magnetic resonance (CMR). Similar to


CT but does magnetic field instead of X-rays to
emit radio-frequency waves that are constructed
as sectional images on the computer.
• Produces sharper images compared to other
imaging techniques.
• Can be used to diagnose several heart
conditions such as congenital heart disease,
diseases of the aorta, valvular diseases etc.
INVESTIGATIONS IN HEAMATOLOGICAL
DISORDERS
• Bone marrow biopsy
• Full blood count
• Haemoglobin estimation
• Peripheral blood smear
COMMON CARDIAC SIGNS & SYMPTOMS

• Pain- usually due to ischemic heart disease or


pericarditis- the quality, severity and location
of pain usually determines the underlying
cause.
• Dyspnoea-experienced as uncomfortable or
shortness of breath. Takes different forms
– dyspnoea associated with activity= dyspnoea on
exertion, early symptom of heart failure
COMMON CARDIAC SIGNS & SYMPTOMS

– Orthopnoea= dyspnoea when lying flat relieved –


due to advanced heart failure=severity of
orthopnoea is measure by the number of pillows
– Paroxysmal nocturnal dyspnoea = occur after pt
has been lying flat after several hour. Client
awaken abruptly with a feeling of suffocation and
panic.
COMMON CARDIAC SIGNS & SYMPTOMS

• Fatigue = feeling of tiredness after an activity,


can be due to many causes, however fatigue
due to decreased cardiac output is worse in
the evening.
• Palpitations=unpleasant awareness of heart
beat or feeling of fluttering in the chest,
usually due to changes in heart rate or rhythm
(sinus tachycardia=SA node discharge exceed
100 per minute).
COMMON CARDIAC SIGNS & SYMPTOMS

• Sudden weight gain , best indicator of fluid


retention (oedema)
• Syncope= transient loss of consciousness due
to decreased brain perfusion, secondary to
decreased cardiac output, usually due to
ventricular dysrhythmias.
• Increased blood pressure
• Cyanosis
COMMON CARDIAC SIGNS & SYMPTOMS

• Skin temperature= reduced usually due to


heart failure or peripheral vascular disease.
• Clubbing of the finger due to chronic oxygen
deprivation, secondary to congenital haert
diseases (angle of normal nail bed is 160
degrees with clubbing it straightens to 180
degrees.
COMMON CARDIAC SIGNS & SYMPTOMS

• Hypokinetic arterial pulses


• Increased jugular venous pressure evidenced
by distended jugular veins.
• Apical impulse appearing in more than one
intercostal space or shifting laterally indicates
left ventricular hypertrophy. ( Apical impulse or
Point of Maximum Impulse is located in the left
fifth intercostal space in the mid clavicular line.
HYPERTENSION
HEART FAILURE