An overview of Cardiovascular disease

1
An overview ofCardiovascular disease

• Pairoj Pinjeesekikul,MD,MRCP,MTHA

2
PROTECTION Across the Cardio-Renal-Metabolic
Continuum
Reduces microalbuminuria
Reduces stroke
Reduces triglycerides
Reduces atrial fibrillation
CV Continuum
Myocardial infarctionStroke
Reduces proteinuria
Reduces risk of new onset diabetes
Coronary thrombosis
Reduces endothelial cell activation
Reduces CHF hospitalization
Remodeling
Renal Continuum
Microalbumiuria
Reduces LV mass index
Reduces CV mortality
Athero-sclerosis LVH
Diabetes Continuum
CHF
New Onset Diabetes
Endothelial dysfunction
Proteinuria
Pre-diabetes
Diabetes
Risk factors
Risk factors
Risk factors
Diabetic Complication (Nephropathy Neuropathy Reti
nopathy)
End stage renal disease (ESRD)
Hypertension Dyslipidemia Diabetes ObesitySmoking
Hypertension Dyslipidemia Diabetes ObesitySmoking
Hypertension Dyslipidemia ObesityEndothelialdys
function
End-stage heart disease
Adapted from Dzau et al. Circulation
2006 1142850-2870
1.Thurmann Circulation 1998 2.Nomura Throm Res
2006 3.Julius Lancet 2004 4.Maggioni AHJ 2005
5.Viberti Circulation 2002 6.Mochizuki Lancet
2007 7.Saiki Diab Resear 2006 8.Hollenberg J
Hyper 2007 9.Weber Lancet 2004 10.Julius
Hypertension 2006
3
Heart as a pump

• Anatomy
• Physiology

4
(No Transcript)
5
Factor interfering heart pump

• Abnormal filling
• Abnormal pumping
• Abnormal rhythm

6
normal Heart function

• Cardiac output
• Stroke volume x heart rate
• Blood pressure
• CO x total periperal resistance

7
Abnormal structure

• Endocardial disease
• Valvular heart disease
• Myocardial disease
• Pericardial disease
• Coronary disease
• Others eg Congenital disease

8
Abnormal filling

• Right sided heart failure
• RV infarction
• Pericarial effusion
• Mitral stenosis

9
Abnormal rhythm

• Tachycardia
• Supraventricular arrhythmia
• Atrial fibrillation,paroxysmal supraventricular
  tachycardia,atrial tachycardia
• Ventricular arrhythmia
• Ventricular tachycardia
• Ventricular fibrillation
• PVCs
• Bradycardia type
• AV block
• Completed AV block
• Bundle branch block

10
Abnormal pumping

• Myocardial infarction
• Cardiomyopathy
• Myocarditis
• chemotherapy

11
Symptoms and signs

• Sudden death , palpitation, syncope
• Shock,dyspnea,angina,fatique
• Abnormal heart rate,pulse
• Abnormal blood pressure
• Pumping failure systolic failure
• Pulmonary edema,crepitation
• Filling failure diastolic failure neck vein
  engorged hepatomegaly leg edema

12
Investigation

• Blood chemistries
• General CBC BS Cr electrolyte thyroid function
• Cardiac markers troponin T, NT pro BNP
• CXR , Echocardiography , CTA coronary
• Exercise stress test , 6 min walk test

13
ECG Wave and Its Origin
QRS
T
SA node
AV node
P
PR
14
Echocardiography
15
Common disorders in OPD

• Chest pain
• Coronary or non coronary
• Typical anginal pain?
• EKG, cardiac marker, CXR

16
Common non coronary chest pain

• Psychosomatic disorder
• Musculoskeletal pain
• dyspepsia
• Mitral valve prolapse

17
Uncommon but severe

• Aortic dissection
• Pulmonary embolism

18
palpitation

• Non cardiogenic, GAD generalized anxiety
  disorder
• True tachyarrhythmia, AF atrial fibrillation
• PSVT paroxysmal supraventricular tachycardia
• PVC premature ventricular contraction
• PAC premature atrial contraction

19
Syncope dizziness

• Non cardiogenic TIA,CVA,fainting,postural
  hypotension
• Cardiac syncope low CO
• Structural defect, AS aortic stenosis, HCOM
  hypertrophic cardiomyopathy
• Arrhythmia esp bradyarrhythmia heartblock 3 AV
  block, sick sinus syndrome

20
Dyspnea

• Non cardiogenic , aging, anxiety, pulmonary
  disease,anemia
• Cardiogenic dyspnea