Ms Hassen Zabala, RN, MAN
July 22, 2013

• Heart failure is a condition in which
the heart can no longer pump
enough blood to the rest of the

Causes, incidence, and risk factors
• Heart failure is present when:
– Your heart muscle cannot pump (eject) the blood out of the heart
very well. This is called systolic heart failure.
– Your heart muscles are stiff and do not fill up with blood easily. This
is called diastolic heart failure.

• As the heart's pumping action is lost, blood may back up in
other areas of the body.
• The most common cause of heart failure is coronary artery
disease (CAD), a narrowing of the small blood vessels that
supply blood and oxygen to the heart.
• Heart failure can also occur when an infection weakens the
heart muscle. This condition is called cardiomyopathy.

• Other heart problems
that may cause heart
failure are:

• Other diseases that can
cause or contribute to
heart failure:

– Congenital heart disease

– Emphysema

– Heart attack

– Overactive thyroid

– Heart valve disease

– Severe anemia

– Some types of abnormal
heart rhythms

– Underactive thyroid

Structure of the Heart .

Circulation of the Heart .

weakness.Symptoms • Cough • Fatigue. or palpitations • Weight gain . faintness • Shortness of breath when active or after lying down • Loss of appetite • Swollen (enlarged) liver or abdomen • Need to urinate at night • Swollen feet and ankles • Pulse that feels fast or irregular.

heard through a stethoscope – Swelling of the liver or abdomen .Signs and tests • Signs of heart failure: – Fast or difficult breathing – Irregular or fast heartbeat and abnormal heart sounds – Leg swelling (edema) – Neck veins that stick out (are distended) – Sounds ("crackles") from fluid buildup in the lungs.

• An echocardiogram (echo) is often the best test to diagnose. and monitor heart failure. learn the cause of. • Other imaging tests are: – Cardiac stress tests – Heart catheterization – MRI of the heart – Nuclear heart scans .

Echocardiogram Cardiac stress test .

Cardiac catheterization MRI of heart .

Nuclear heart scans .

complete blood count (CBC) – Test for brain natriuretic peptide (BNP) – Watch sodium and potassium levels in blood . creatinine clearance. creatinine. urinalysis) – Look for a low blood count or anemia -.• Lab tests: – Check how well kidneys are working (BUN.

Treatment • These medicines: – Help the heart muscle pump better – Keep blood from clotting – Lower cholesterol levels – Open up blood vessels or slow heart rate – Replace potassium – Rid body of excess fluid and salt (sodium) .

– A pacemaker can help treat slow heart rates or help both sides of your heart contract at the same time. – A defibrillator sends an electrical pulse to stop lifethreatening abnormal heart rhythms. . – Heart valve surgery may be done if changes in a heart valve are causing your heart failure.• The following surgeries and devices may be recommended for certain patients with heart failure: – Coronary bypass surgery (CABG) and angioplasty may help improve blood flow to the damaged or weakened heart muscle.

• END-STAGE HEART FAILURE • Severe heart failure occurs when treatments no longer work. – Intra-aortic balloon pump (IABP) – Left ventricular assist device (LVAD) .

.VALVULAR HEART DISEASE Definition • Heart valve disease occurs when your heart's valves do not work the way they should.


This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. All four valves can be stenotic (hardened.What Are the Types of Valve Disease? • Valvular stenosis. mitral stenosis or aortic stenosis . This can lead to heart failure and other symptoms (see below). The narrowed opening may make the heart work very hard to pump blood through it. pulmonic stenosis. restricting blood flow). the conditions are called tricuspid stenosis.

Also called regurgitation. Depending on which valve is affected. mitral regurgitation or aortic regurgitation. If the valves do not seal. and less blood may flow to the rest of the body. this occurs when a valve does not close tightly.• Valvular insufficiency. the conditioned is called tricuspid regurgitation. some blood will leak backwards across the valve. As the leak worsens. pulmonary regurgitation. the heart has to work harder to make up for the leaky valve. . incompetence or "leaky valve".


• Congenital valve disease.What Causes Valvular Heart Disease? • Valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. the bicuspid aortic valve has only two. . Most often affects the aortic or pulmonic valve. Instead of the normal three leaflets or cusps. • Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve.

– Endocarditis occurs when germs. This leads to mitral regurgitation. throat).• Acquired valve disease. the leaflets stick together and become scarred. and connective tissue diseases. thickened and shortened. syphilis (a sexually transmitted disease). This can lead to leaky valves. rigid. causing growths and holes in the valves and scarring. • Mitral valve prolapse (MVP) is a very common condition. heart attack. aortic aneurysms. causes the leaflets of the mitral valve to flop back into the left atrium during the heart's contraction. cardiomyopathy (heart muscle disease). especially bacteria. • Other causes of valve disease include: coronary artery disease. – Rheumatic fever is caused by an untreated bacterial infection (usually strep. The heart valves become inflamed. hypertension. . enter the bloodstream and attack the heart valves.

• Palpitations. You may feel a pressure or weight in your chest with activity or when going out in cold air. • Swelling of your ankles.What Are the Symptoms of Valve Disease? • Shortness of breath and/or difficulty catching your breath. • Rapid weight gain. • Discomfort in your chest. • Weakness or dizziness. . A weight gain of two or three pounds in one day is possible. feet or abdomen.

These may include: – Echocardiography – Transesophageal echocardiography – Cardiac catheterization (also called an angiogram) – Radionuclide scans – Magnetic resonance imaging (MRI) . the doctor may order diagnostic tests.How Are Valve Diseases Diagnosed? • After the physical exam.

• ACE inhibitors.How Is Heart Valve Disease Treated? Medications • Diuretics ("water pills") • Antiarrhythmic medications. rather than backwards through a leaky valve. A type of vasodilator used to treat high blood pressure and heart failure • Beta blockers. Treat high blood pressure and lessen the heart's work by helping the heart beat slower and less forcefully. encourages blood to flow in a forward direction. Used to decrease palpitations in some patients. • Anticoagulants ("blood thinners") . Lessen the heart's work. Control the heart's rhythm • Vasodilators.

• percutaneous balloon valvotomy.Surgeries • heart valve repair or replacement. .

There are three main types of cardiomyopathy — dilated. Cardiomyopathy can lead to heart failure.CARDIOMYOPATHY Definition • A disease that weakens and enlarges heart muscle. Cardiomyopathy makes it harder for your heart to pump blood and deliver it to the rest of your body. . hypertrophic and restrictive.

Dilated cardiomyopathy .

Hypertrophic cardiomyopathy .

Symptoms • Some people who develop cardiomyopathy have no signs and symptoms during the early stages of the disease. Cardiomyopathy symptoms may include: – Breathlessness with exertion or even at rest – Swelling of the legs. pounding or fluttering – Dizziness. ankles and feet – Bloating of the abdomen due to fluid buildup – Fatigue – Irregular heartbeats that feel rapid. lightheadedness and fainting .

selenium. such as tricyclic antidepressants • Use of some chemotherapy drugs to treat cancer • Certain viral infections. calcium and magnesium • Pregnancy • Excessive use of alcohol over many years • Abuse of cocaine or antidepressant medications. such as thiamin (vitamin B-1).Causes • Long-term high blood pressure • Heart valve problems • Heart tissue damage from a previous heart attack • Chronic rapid heart rate • Metabolic disorders • Nutritional deficiencies of essential vitamins or minerals. which may injure the heart and trigger cardiomyopathy • Iron buildup in your heart muscle (hemochromatosis) • Genetic conditions .

Dilated cardiomyopathy. becomes enlarged (dilated) and can't effectively pump blood out of the heart • occurs most often in middle-aged people and is more likely to affect men . • This is the most common type of cardiomyopathy • the pumping ability of your heart's main pumping chamber — the left ventricle — becomes less forceful.Types of cardiomyopathy 1.

2. interfering with your heart's ability to deliver blood to your body. • the heart tends to stiffen and the size of the pumping chamber may shrink. • tends to be more severe during childhood. . Hypertrophic cardiomyopathy. • involves abnormal growth or thickening of your heart muscle. particularly affecting the muscle of your heart's main pumping chamber.

meaning the heart can't properly expand and fill with blood between heartbeats. Restrictive cardiomyopathy • heart muscle becomes rigid and less elastic. . • most often tends to affect older people. The condition may also be caused by diseases elsewhere in the body that affect the heart.3. • least common type and can occur for no known reason (idiopathic).

• Blood clots. • Valve problems.Complications • Heart failure. . • Cardiac arrest and sudden death.

One blood test can measure Btype natriuretic peptide (BNP). a protein produced in your heart. Cardiac magnetic resonance imaging (MRI).Tests and Diagnosis • • • • • • Chest X-ray Echocardiogram. Cardiac catheterization and biopsy. Blood tests. . Electrocardiogram (ECG).

ramipril (Altace) and captopril (Capoten). Toprol-XL). . such as enalapril (Vasotec). such as losartan (Cozaar) and valsartan (Diovan). • Angiotensin receptor blockers (ARBs) for those who can't take ACE inhibitors. • Beta blockers to improve heart function. such as carvedilol (Coreg) and metoprolol (Lopressor.Treatment Dilated cardiomyopathy • ACE inhibitors to improve your heart's pumping capability.

One diuretic. Commonly prescribed diuretics for heart failure include bumetanide (Bumex) and furosemide (Lasix). may also be helpful in treating scarring of your heart tissue. Make you urinate more frequently and keep fluid from collecting in your body. • ICD . • Diuretics. Increases the strength of heart muscle contractions.• Digoxin (Lanoxin). tends to slow the heartbeat. spironolactone (Aldactone).

Isoptin.Hypertrophic cardiomyopathy • Beta blockers. others). . such as verapamil (Calan. overgrown heart muscle wall (septum) that separates the two bottom heart chambers (ventricles). These medications include Lopressor or calcium channel blockers. • Septal myectomy. This is an open-heart operation in which the surgeon removes part of the thickened.

. this is a treatment in which a small portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter into the artery supplying blood to it. Also called septal alcohol ablation.• Septal ablation.

Pacemaker implantation ICD .

Restrictive cardiomyopathy Treatment focuses on improving symptoms. . • salt and water intake monitoring and weight monitoring • diuretics for sodium and water retention • medications to lower blood pressure and control fast or irregular heart rhythms.

Heart transplant & Ventricular assistive devices (VADs) .


Stress Cardiomyopathy • Broken heart syndrome • S/sx: • • • • Chest pain Shortness of breath An irregular heartbeat A generalized weakness • • • • Death Disruptions in your heartbeat A fast or slow heartbeat Backup of fluid into your lungs (pulmonary edema) • Cx: .

• Test & diagnosis: • Personal history and physical exam • Electrocardiogram (ECG) • Chest X-ray • Echocardiogram • Blood tests • Treatment • angiotensin-converting enzyme (ACE) inhibitors • beta blockers • diuretics .

Inflammation of these tissue layers surrounding the heart is referred to as pericarditis. one that fits tightly onto the heart muscle and another looser layer surrounding the inner layer. .What is pericarditis? Definition • The hearts sits in the center of the chest and is surrounded by a sac called the pericardium. This sac has two layers.

hydralazine (Apresoline) and procainamide (Pronestyl. Procan-SR. .What causes pericarditis? • Idiopathic • Mechanical injury to the heart – Heart attack and Dressler's syndrome – Heart surgery and post pericardiotomy syndrome • Infection – – – – Bacterial Viral Fungal HIV • Tumors or cancer • Connective Tissue Disease – Rheumatoid arthritis – SLE – Sarcoidosis • Metabolic diseases – Uremia (kidney failure) – Hypothyroidism • Medication Reactions – Side effects of phenytoin (Dilantin). Procanbid).

– The pain can be made worse with deep breaths (pleuritic). • Infections may present with fever. to the neck or to the arm. – It can arise slowly or suddenly and can radiate directly to the back. – Pain may occur with swallowing if the inflammation is near the esophagus. chills and other nonspecific symptoms such as muscle aches and general malaise. – If there is associated irritation of the diaphragm.What are the symptoms? • Chest pain – The pain is usually sharp and stabbing. . – The pain is frequently positional and made worse when lying flat and better when leaning forward. the pain can radiate to the shoulder blade.

How is pericarditis diagnosed? • Physical Evaluation • Diagnostic Testing –Electrocardiogram –Chest x-ray –Echocardiography –Blood testing .

Roxicodone)] – Corticosteroids • Surgery – Pericardiocentesis (a thin needle is inserted through the chest wall into the pericardial sac) . hydrocodone (Vicodin) or oxycodone (OxyContin.What is the treatment for pericarditis? • Medicines – Nonsteroidal antiinflammatory drugs (ibuprofen) – Narcotic pain medication [codeine.

Pericardotomy (cutting a hole in the pericardial sac) Pericardectomy (removing the sac completely) .

etc.) • Pregnancy • Others . Causes • Viruses • Sarcoidosis • immune diseases (such as systemic lupus.Myocarditis Definition • inflammation of heart muscle.

.Symptoms • pain in the chest • weakening of the heart muscle • heart failure symptoms – shortness of breath – Fatigue – fluid accumulation in the lungs – Etc • heart rhythm irregularities from inflammation and/or scarring of the electrical system of the heart.

.Diagnosis • Blood tests for heart muscle enzymes (CPK levels) can be elevated • Electrical testing (EKG) can suggest irritation of heart muscle and demonstrate irregular beating of the heart • Nuclear heart scan testing can show irregular areas of heart muscle.

. etc. water pills.Treatment • Treatment measures mainly involves alleviating heart failure (salt restriction. beta blockers. ACE inhibitors.) and treating as well as monitoring heart rhythm abnormalities.

Endocarditis Definition • Endocarditis is a serious infection of one of the four heart valves. leading to an infected mass called a "vegetation". . Cause • Endocarditis is caused by a growth of bacteria on one of the heart valves.

foot (feet). chills. . blood in urine. weakness aching joints and muscles. edema in the leg(s). and occasionally. night sweats.What are the symptoms? • • • • • • • • • • • fever. fatigue. malaise. and a new heart murmur. and abdomen. scattered small skin lesions. elevated white blood cell count. anemia. shortness of breath.

mitral stenosis. etc.Who is at risk for endocarditis? • People with existing diseases of the heart valves (aortic stenosis.) and people who have undergone heart valve replacements . mitral regurgitation.

How is endocarditis diagnosed? • Transesophageal echocardiography .

– Amoxicillin – Ampicillin – Erythromycin – Gentamicin – Vancomycin • surgical replacement of the valve . generally given intravenously.How is endocarditis treated? • Aggressive antibiotics. usually for 4-6 weeks.

but below 140/90. . it is called pre-hypertension. and the bottom number is called the diastolic blood pressure. • High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.HYPERTENSION • Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. • If your blood pressure numbers are 120/80 or higher. • The top number is called the systolic blood pressure.

Essential HPN • no cause of high blood pressure is found Secondary HPN • Chronic kidney disease • Disorders of the adrenal gland (pheochromocytoma or Cushing syndrome) • Pregnancy • Medications such as birth control pills. and migraine medications • Renal artery stenosis • Hyperparathyroidism . diet pills. some cold medications.

changes in your vision.Symptoms • If you have a severe headache. nausea or vomiting. . bad headache. or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension. confusion.

Diagnosis .

Complications .

which helps the blood vessels relax and open up – ARBs block the receptors so the angiotensin fails to constrict the blood vessel – Calcium channel blockers relax and open up narrowed blood vessels .Treatment • Lifestyle modification • Medications – Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure – Beta-blockers reduce the heart rate. the heart's workload and the heart's output of blood – ACE inhibitors help the body produce less angiotensin.

relaxing the muscle tone of the vascular walls – Alpha 2 receptor agonist decreases the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system – Combined alpha and beta-blockers areused as an IV drip for those patients experiencing a hypertensive crisis – Central agonists also help decrease the blood vessels' ability to tense up or contract – Peripheral adrenergic inhibitors reduce blood pressure by blocking neurotransmitters in the brain.– Alpha blockers reduce the arteries' resistance. allowing the vessel to dilate (widen) . can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax. – Blood vessel dilators. This blocks the smooth muscles from getting the "message" to constrict. or vasodilators.

.ANEURYSM Definition • An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.

• Common locations for aneurysms include: – The major artery from the heart (the aorta) – The brain (cerebral aneurysm) – In the leg behind the knee (popliteal artery aneurysm) – Intestine (mesenteric artery aneurysm) – An artery in the spleen (splenic artery aneurysm) • • • • Risks High blood pressure Atherosclerotic disease Pregnancy .

• If an aneurysm ruptures.Symptoms • The symptoms depend on the location of the aneurysm. pain and swelling with a throbbing mass is often seen. If the aneurysm occurs near the body's surface. low blood pressure. The risk of death after a rupture is high. and lightheadedness may occur. a rapid heart rate. pain. . • Aneurysms within the body or brain often cause no symptoms.

• Signs and tests –physical exam. –CT scan –Ultrasound • Treatment –Surgery • endovascular stent repair • Endovascular embolization. .

Endovascular stent repair .

Cause • Caused by vasculitis (inflammation of the blood vessels). • very uncommon in children unless if with autoimmune diseases. Raynaud's disease.) Definition • blood vessels of the hands and feet become blocked. • average age when symptoms begin is around 35 years • history of heavy smoking/chewing tobacco. .THROMBOANGITIS OBLITERANS (BUERGER’S DSS.


ankles.Symptoms • Hands or feet may be pale. two or more limbs are affected. or feet when walking (intermittent claudication) – Often located in the arch of the foot • Skin changes or ulcers on hands or feet Note: Symptoms may worsen with exposure to cold or with emotional stress. severe – Burning or tingling – Often occurring at rest • Pain in the legs. red. . or bluish • Hands or feet may feel cold • Pain in the hands and feet – Acute. Usually.

Signs & Tests Angiography/arteriography of the extremity Doppler ultrasound of the extremity .

• Applying warmth and exercising gently may help increase circulation. • Cutting the nerves to the area (surgical sympathectomy) may help control pain. Aspirin and vasodilators may also used.Treatment • There is no cure for thromboangiitis obliterans. • The patient must stop using tobacco and should avoid cold temperatures and other conditions that reduce circulation to the hands and feet. . It may be necessary to amputate the hand or foot if infection or widespread tissue death occurs. The goal of treatment is to control symptoms.

it is referred to as "Raynaud's disease" or primary Raynaud's phenomenon.RAYNAUD’S PHENOMENON • Raynaud's phenomenon (RP) is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. it is called secondary Raynaud's phenomenon. When it accompanies other diseases. . • White---blue---red • Affects women between 20-40 • When it occurs alone. Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues.

What causes Raynaud's phenomenon? • The causes of primary and secondary RP are unknown. .

What are Raynaud's phenomenon
symptoms and signs?
• skin discoloration upon cold exposure
• mild tingling and numbness of the involved
digit(s) that will disappear once the color
returns to normal.
• Ulcerated digits can become infected
• Less common areas of the body that can be
affected by RP include the nose, ears, and
tongue. While these areas rarely develop
ulcers, they can be associated with a sensation
of numbness and pain.

How is Raynaud's phenomenon
• Physical exam
• No single blood test to help the doctor to confirm
the diagnosis. The doctor can order certain blood
tests (for example, sedimentation rate,
rheumatoid factor, antinuclear antibody, thyroid
hormone levels, and protein levels) to exclude
associated rheumatic diseases and thyroid
• Certain maneuvers with the patient's extremities
to exclude pinched blood vessels that can
produce symptoms that mimic RP, such as in
thoracic outlet syndrome.

What is the treatment for Raynaud's
• Management of Raynaud's phenomenon involves protecting the
fingers and the toes from cold, trauma, and infection.
– Avoiding direct and indirect (passive or secondhand smoke) smoking

• Medications that can aggravate blood vessel spasm should be
• Medications that dilate the blood vessels can be administered.
– Calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine
(Cardene), nifedipine (Procardia), and other medicines used in blood
pressure treatment, such as methyldopa (Aldomet) and prazosin
– Low doses of aspirin or dipyridamole (Persantine)
– Some patients with persistent symptoms can benefit by adding a
medication called pentoxifylline (Trental), which makes the red blood
cells more pliable and thereby improving circulation.

• Sympathectomy is
sometimes considered.
In this procedure, to
prevent blood-vessel
spasm, the nerves that
stimulate the
constriction of the
vessels (sympathetic
nerves) are surgically
interrupted. the tiny
nerves around the
blood vessels are
stripped away.

embolism.Acute peripheral arterial occlusion Definition • A sudden blockage of a peripheral artery. Symptoms • Severe pain • Coldness • Paresthesias • Loss of sensation • Paleness in an extremity • Lack of pulse in an extremity • Blue skin in affect limb . The blockage may result from a blood clot. Symptoms usually start suddenly. dissection or trauma.

Tests • Blood Pressure Hypertension Tests • Blood Pressure Monitors • Heart Tests Treatment • Embolectomy • Thrombolysis • Bypass surgery .