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Cardiovascular system: Heart diseases

Notes

Transcript

Content Reviewers:

Lisa Miklush, PhD, RNC, CNS

Heart diseases can affect both children and adults. In children, they’re usually congenital, or present from birth, and they can result from abnormal development of the heart during pregnancy.

In adults, heart diseases are acquired, which means that they develop later in life, and they’re often caused by the person’s lifestyle choices.

Okay, let’s start with congenital heart diseases, which can affect the atria, the ventricles, the heart valves, and vessels. They can cause blood flow to slow down, stop completely, or change direction.

There’s no clear cause that’s been identified, but there are a number of risk factors that seem to be associated with congenital heart disease.

The most well-known factors include a family history of a congenital heart disease, certain viral infections of the mother during pregnancy, maternal diabetes, and exposure to medications and illicit drugs.

Children with congenital heart diseases could be asymptomatic or present with difficulty breathing; cyanosis, which is when the skin turns blue due to decreased oxygen in the blood; poor feeding; and failure to thrive, which means that the child is not growing as fast as they should.

Diagnosis is usually made during pregnancy or soon after birth. However, some cases are diagnosed when the child is older.

Treatment usually requires medications or surgery to correct the defect, and afterwards, children can often grow up to live a normal life without complications.

Okay, now, let’s switch our focus to acquired heart diseases that are more common in adults. The most common are coronary artery disease; heart failure; and arrhythmia, which is abnormal heart rhythm.

Risk factors for an acquired heart disease can be divided into non-modifiable, meaning they can’t be changed, and modifiable, which means they can be.

Non-modifiable risk factors include age, with biological males greater than 45 years and biological females greater than 55 years being more at risk; sex, with biological males being at a greater risk; and family history of heart disease.

Modifiable risk factors include eating a diet high in saturated fats, obesity, sedentary lifestyle, hypertension, diabetes, hyperlipidemia, smoking, and chronic alcohol use.

Okay, let’s take a closer look at the acquired heart diseases starting with coronary artery disease, where the coronary arteries that supply the heart with blood become harder and less elastic than normal.

This is usually caused by atherosclerosis, or buildup of cholesterol plaques, in the innermost wall of the blood vessel, and it can affect one or more coronary arteries.

As a result, the heart receives less blood, oxygen, and nutrients. Coronary artery disease can often be treated with lifestyle changes, like stopping smoking and improving diet and exercise.

In some cases, medications may be required to slow down atherosclerosis, open up the blocked arteries, reduce symptoms, and prevent complications.

With severe atherosclerosis, angioplasty can be used to open a blocked artery with a balloon, followed by the placement of a stent to keep the artery open.

Also, a blood vessel from another part of the body can be grafted in and used to bypass, or go around, a blocked artery.

Coronary artery disease can lead to various complications including angina pectoris, or chest pain; a myocardial infarction, or heart attack; arrhythmias; and sudden death.

At first, the heart may receive enough blood during rest, but if the body demands more oxygen and nutrients, like during exercise or stressful situations, the heart has to work harder and, therefore, needs more blood itself.

It’s during these times of exertion or emotional stress that clients with coronary artery disease can experience chest pain, which is usually described as feeling pressure or squeezing.

This pain can radiate to the left arm, jaw, shoulders, and back and is sometimes accompanied by difficulty breathing, shortness of breath, fatigue, and sweating.

Usually the pain and symptoms last less than 20 minutes and subside after the exertion or stress is taken away, when the heart muscle isn’t demanding as much blood.

Many clients experience angina pectoris quite often, and they can take nitroglycerin pills that increase blood vessel diameter to allow more blood flow to the heart.

Now, chest pain and the associated symptoms that last longer and are not relieved by rest and nitroglycerin can be a heart attack.

A heart attack occurs when the coronary arteries remain blocked long enough that the heart tissue starts to die from the lack of oxygen.

The most important risk factor in addition to coronary artery disease is a previous history of heart attack.

Now, the first few minutes after a heart attack are extremely important because the damage to the heart is potentially reversible.

That’s why quickly identifying and treating a heart attack is super important. This is focused on re-establishing blood flow to the dying heart cells, relieving symptoms, and preventing life-threatening complications.

A potentially life-saving treatment that can be performed is fibrinolytic therapy, which uses medications to destroy the clots that are causing the blockage.

An angioplasty might also be done, where a thin tube is inserted into the blocked artery to open it up.

If the client has a very severe blockage or blockage of multiple arteries, a surgery may be indicated to bypass the blocked area of the coronary artery.