Cardiovascular diseases

Chapter 2

Cardiovascular diseases

23 topics

  1. 14Diseases of the mitral valve: mitral stenosisA narrowed mitral valve, nearly always left by rheumatic fever, that dams blood back into the left atrium and the lungs; how it sounds, why atrial fibrillation tips it over, and when the valve is opened with a balloon.
  2. 15Diseases of the mitral valve: mitral regurgitationA mitral valve that leaks back into the left atrium in systole, from a diseased valve or a stretched ventricle; why the ventricle hides its damage, and when to repair the valve before it is too late.
  3. 16Diseases of the aortic valve: aortic stenosisA calcified aortic valve that slowly chokes the outflow of the left ventricle; the long silent years, the three symptoms that change everything, and how a valve is chosen, by surgery or by catheter.
  4. 17Diseases of the aortic valve: aortic insufficiencyAn aortic valve that lets blood fall back into the left ventricle in diastole, from a diseased valve or a widened aortic root; the bounding pulses it produces, and why the valve is replaced before the ventricle complains.
  5. 18EndocarditisInfection of the lining of the heart, usually a valve or something implanted, that grows vegetations, destroys the valve and throws emboli; how blood cultures and echocardiography find it, and why weeks of antibiotics and often surgery are needed to cure it.
  6. 19Pericardial diseases – classification. Pericarditis. Pericardiac tamponade.The diseases of the sac around the heart, inflammation, fluid and scarring; why most pericarditis settles with anti-inflammatory drugs and colchicine, how a pericardial effusion turns into tamponade, and how a stiff pericardium mimics heart failure.
  7. 20Myocardial diseases: myocarditisInflammation of the heart muscle, most often after a viral infection; how it mimics a heart attack, why cardiac MRI and sometimes a biopsy make the diagnosis, and which rare forms need immunosuppression.
  8. 21Myocardial diseases: cardiomyopathiesDiseases of the heart muscle itself, grouped by how the ventricle looks (thick, dilated, scarred, stiff or replaced by fat), their genes and acquired causes, the risk of sudden death, and why the whole family is examined.
  9. 22Acute heart failure – cardial asthma, pulmonary oedema, cardiogenic shock – etiology, pathogenesis, clinical manifestationsHeart failure that comes on or worsens over hours or days, from congested lungs and wheezing at night to flooded alveoli and shock; what drives it, how it presents, and the profiles that decide the treatment.
  10. 23Treatment of acute heart failureHow to treat a patient who arrives drowning in their own fluid or in shock, from oxygen, diuretics and nitrates to inotropes and mechanical support, and why the work is not done until the long-term drugs are started and the patient is seen again within two weeks.
  11. 24Chronic congestive heart failure – etiology, pathogenesis, clinical manifestationsThe common end of most heart disease, a heart that cannot pump or fill well enough; its causes, the neurohormonal responses that first help and then harm, how it presents, and how natriuretic peptides and echocardiography make the diagnosis.
  12. 25Treatment of chronic heart failureThe four foundational drugs that let people with a weak heart live longer, how they are started together and pushed to full doses, and the drugs, devices and procedures added for chosen patients, from iron and digitoxin to defibrillators, resynchronisation and transplantation.
  13. 26Ischemic heart disease: Stable Angina pectoris – clinical features, treatmentChest pain that comes with effort and goes with rest, the sign of a heart muscle that gets too little blood when it works harder; how the history and imaging make the diagnosis, and how drugs, lifestyle and sometimes a stent or bypass relieve the pain and prevent heart attacks.
  14. 27Acute coronary syndrome: Acute myocardial infarction with ST segment elevationA coronary artery blocked completely by a clot, and the heart muscle beyond it dying by the minute; how the ECG makes the diagnosis in minutes, why opening the artery fast decides the outcome, and what can go wrong in the days after.
  15. 28Acute coronary syndrome without ST segment elevation: unstable angina pectoris, myocardial infarction without ST segment elevationChest pain at rest from an unstable coronary plaque without ST elevation on the ECG; how high-sensitivity troponin separates infarction from unstable angina within an hour or two, how risk decides how soon the arteries are imaged, and why the long-term outlook is as serious as after STEMI.
  16. 29Conductive disturbances. Treatment of conductive disturbancesWhen the heart's wiring slows or fails, from a sinus node that pauses to an atrioventricular block that leaves the ventricles to a slow escape rhythm; how to read the blocks on the ECG, which are harmless and which cause sudden blackouts, and when a pacemaker is needed.
  17. 30Rhythm abnormalities: supraventricular arrhythmiasThe fast rhythms that start above the ventricles, from atrial fibrillation, the commonest arrhythmia and a major cause of stroke, to the sudden regular palpitations of young people that ablation cures; how to tell them apart on the ECG, what to do first, and how to prevent strokes.
  18. 31Rhythm abnormalities: ventricular arrhythmiasRhythms that start in the ventricles, from harmless extra beats to ventricular tachycardia and fibrillation, the main causes of sudden cardiac death; how to recognise them on the ECG, the inherited syndromes behind them in young people, the emergency treatment, and who needs an implantable defibrillator.
  19. 32Antiarrhythmic drugsThe drugs that slow a fast heart, restore sinus rhythm or prevent attacks, from flecainide and amiodarone to adenosine and digoxin; how each class changes the cardiac action potential, which drug suits which arrhythmia and which heart, and why every one of them can also cause arrhythmias.
  20. 33HypertensionA blood pressure that stays too high, the leading risk factor for death worldwide; how it is measured and confirmed, the secondary causes worth finding, the damage it does to the heart, brain, kidneys and eyes, and how lifestyle and a few well-chosen drugs bring it down, including in an emergency.
  21. 34Acute Rheumatic fever. RheumocarditisThe autoimmune illness that can follow a streptococcal sore throat, inflaming the heart, joints, brain and skin; how the Jones criteria make the diagnosis, and why years of penicillin protect the valves from the next attack.
  22. 35Chronic cor pulmonaleThe right ventricle worn down by lung disease; how chronic hypoxia and damaged lungs raise the pressure in the pulmonary arteries, how the right heart adapts and then fails, how it is found, and why oxygen, not vasodilators, is the treatment that prolongs life.
  23. 36Aortic diseases: aortic dissection, aortic aneurysmThe aorta that tears or balloons; how a weakened wall gives way, how to recognise a dissection that mimics a heart attack and an aneurysm that mimics renal colic, which emergencies need surgery within hours, and how screening and timely repair prevent rupture.