Pathology: Cardiovascular System

Coronary Artery Calcium Score

0-99 low risk 100-399 intermediate risk A calcium score >400 is associated with a nearly 25% chance of a heart attack or stroke occurring within 10 years.

transposition of the great arteries (TGA)

A congenital condition in which the pulmonary artery arises from the left ventricle and the aorta from the right ventricle; can cause cyanosis and hypoxia. Surgical correction of TGA involves an arterial switch procedure *(pulmonary artery and aorta are reconnected in the proper positions.)*

left ventricular assist device (LVAD)

A device that assist the heart's pumping. LVAD is a booster pump implanted in the abdomen, with a cannula (tube) inserted into the left ventricle. It pumps blood out of the heart to all parts of the body.

bruit

Abnormal blowing or swishing sound heard during auscultation of an artery or organ.

arrhythmias

Abnormal heart rhythms (dysrhythmias). Arrhythmias are problems with the conduction or electrical system of the heart.

varicose veins

Abnormally swollen and twisted veins, usually occurring in the legs. This condition is caused by damaged valves that fail to prevent the backflow of blood. The blood then collects in the veins, which distend to many times their normal size

coronary artery bypass grafting (CABG)

An open heart operation performed by cardiac surgeons to treat CAD by replacing clogged vessels.

Saturated fats

Animal origin, such as milk, butter, and meats; increase cholesterol in the blood

Angiotensis-converting enzyme (ACE) inhibitors

Antihypertensive drug that blocks the conversion of aniotensin I to angiotensin II, causing blood vessels to dilate. It prevents heart attacks, CHF, stroke, and death. Simply reduces high blood pressure and the risk of future heart attack even if the patient is not hypertensive

Shift of the aorta to the right

Aorta overrides the interventricular septum. Oxygen-poor blood passes from the right ventricle to the aorta.

Defibrillation

Application of an electrical shock. Defibrillation stops electrical activity in the heart for a brief moment so that normal rhythm takes over.

peripheral arterial disease (PAD)

Blockage of arteries carrying blood to the legs, arms, kidneys and other organs. Any artery can be affected. A sign of PAD in the lower extremities is intermittent claudication.

deep vein thrombosis (DVT)

Blood clot (thrombus) forms in a large vein, usually in a lower limb. This condition may result in a pulmonary embolism (clot travels to the lung) if not treated. Anticoagulants such as heparin and warfarin are used to prevent DVTs and PEs

vegetations

Clumps of platelets, clotting proteins, microorganisms, and red blood cells on diseased heart valves. (resembles cauliflower)

cardiac tamponade

Compression of the heart caused by collection of fluid in the pericardial cavity

thallium 201 scan

Concentration of radioactive thallium is measured to give information about blood supply to the heart muscle. Thallium studies show the viability of heart muscle. Infarcted or scarred myocardium shows up as "cold spots"

tetralogy of Fallot

Congenital malformation involving four (tetra-) distinct heart defects. An infant with this condition is described as a "blue baby" because of the extreme degree of cyanosis present at birth. Surgery includes a patch closure of the ventricular septal defect and removing obstruction to the outflow at the pulmonary artery.

treatment for rheumatic heart disease

Consists of reduced activity, drugs to control arrhythmia, surgery to repair a damaged valve, and anticoagulant therapy to prevent emboli from forming. Artificial and porcine (pig) valve implants can replace deteriorated heart valves.

bacterial endocarditis

Damage to the heart valves from infection which produces lesions called vegetations (resembling cauliflower) that break off into the bloodstream as emboli(material that travels through the blood). The emboli can lodge in other vessels, leading to a stroke or petechiae. Antibiotics can cure bacterial endocarditis.

cardiac biomarkers

Damaged heart muscle releases chemicals into the bloodstream. These chemicals are measured in the blood as evidence of a heart attack. The substances tested for are tropoinin-I (cTnI) and troponin-T (cTnT). Troponin is heart muscle protein released into circulation after myocardial injury.

biventricular pacemaker

Device enabling ventricles to beat together (in synchrony) so that more blood is pumped out of the heart.

coronary artery disease (CAD)

Disease of the arteries surrounding the heart. The coronary arteries are a pair of blood vessels that arise from the aorta and supply oxygenated blood to the heart. CAD usually is the result of atherosclerosis.

Calcium Channel Blockers

Drug used to treat angina and hypertension. It dilates blood vessels by blocking the influx of calcium into muscle cells lining vessels; relax muscles in blood vessels

beta-blockers

Drug used to treat angina, HTN, and arrhythmias. It blocks the action of epinephrine (adrenaline) at receptor sites on cells, slowing the heartbeat and reducing the workload on the heart; reduces the force and speed of the heartbeat and lower blood pressure;

nitrates

Drugs used in the treatment of angina. They dilate blood vessels, increasing blood flow and oxygen to myocardial tissue.

echocardiography (ECHO)

Echoes generated by high-frequency sound waves produce images of the heart. ECHOs show the structure and movement of the heart.

electron beam computed tomography (EBCT or EBT)

Electron beams and CT identify calcium deposits in and around coronary arteries to diagnose early CAD. A coronary artery calcium score is derived to indicate future risk of heart attack and stroke.

stress test

Exercise tolerance test (ETT) determines the heart's response to physical exertion (stress). A common protocol uses 3-minute stages at set speeds and elevations of a treadmill. Continual monitoring of vital signs and ECG rhythms is important in the diagnosis of CAD and left ventricular function.

murmur

Extra heart sound, heard between normal beats.

bradycardia and heart block *(atrioventricular block)*

Failure of proper conduction of impulses from the SA node through the AV node to the atrioventricular bundle (bundle of His). Damage to the SA node may cause its impulses to be too weak to activate the AV node and impulses fail to reach the ventricles. The heart beats slowly and bradycardia results.

rheumatic heart disease

Heart disease caused by rheumatic fever. Rheumatic fever is a childhood disease that follows a streptococcal infection. The heart valves can be damaged by inflammation and scarred with vegetations, so that they do not open and close normally.

congestive heart failure (CHF)

Heart is unable to pump its required amount of blood. Sx of CHF includes shortness of breath, exercise intolerance, and fluid retention. Pulmonary edema (fluid accumulation in the lungs) and swelling or edema in the legs, feet, and ankles are common.

hypertensive heart disease

High blood pressure affecting the heart resulting from narrowing of arterioles, which leads to increased pressure in arteries. The heart is affected because it pumps more vigorously to overcome the increased resistance in the arteries.

essential hypertension

High blood pressure with no identifiable cause. Treatment includes Diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers.

High-density lipoprotein (HDL)

High levels of HDL protect adults from atherosclerosis. Factors that increase HDL are estrogen, exercise, and alcohol in moderation.

Complete heart block

If no impulses reach the AV node from the SA node, the ventricles contract slower than the atria and are not coordinated. Right and left bundle branch block are common types of heart block. They involve delay or failure of impulses traveling through the right and left bundle branches to the ventricles.

cardiac MRI

Images of the heart produced using radiowave energy in a magnetic field. These images in multiple planes give information about left and right ventricular function, wall thickness, and fibrosis, aneurysms, cardiac output, and patency of peripheral and coronary arteries.

positron emission tomography (PET) scan

Images show blood flow and myocardial function following uptake of radioactive glucose. PET scanning can detect CAD, myocardial function, and differences between ischemic heart disease and cardiomyopathy.

mitral valve prolapse (MVP)

Improper closure of the mitral valve due to the enlargement of the mitral valve and prolapses into the left atrium during systole. Prolapsed valves infection are rare.

Treatment for PDA

Indomethacin drug to promote closure; surgery via catheterization (with coil embolization to "plug" the ductus); and ligation (tying off) via a small incision between the ribs.

endocarditis

Inflammation of the inner lining of the heart

pericarditis

Inflammation of the membrane (pericardium) surrounding the heart. In most cases pericarditis results from pulmonary infection. Bacteria and viruses causes the condition and malaise, fever, chest pain, and auscultation with stethoscope often reveal a pericardial friction rub

Low-density lipoprotein (LDL)

LDL is less than 130 mg/dL in normal persons and less than 70 mg/dL in patients with CAD, PAD, and Diabetes mellitus.

Ventricular septal defect.

Large hole between two ventricles lets venous blood pass from the right to the left ventricle and out to the aorta without oxygenation.

lipoprotein electrophoresis

Lipoproteins (combinations of fat and protein) are physically separated and measured in a blood sample. Examples of lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL)

statins

Lower cholesterol levels by reducing its production in the liver; Also reduces the risk of heart attack, stroke, and cardiovascular death. Examples are simvastatin, atorvastatin (Lipitor), and pravastatin.

BNP test

Measurement of BNP, brain natriuretic peptide, in blood. BNP is secreted when the heart becomes overloaded, and it acts as a diuretic to help heart function return to normal. BNP is elevated in patients with heart failure and diagnose CHFs.

lipid tests (lipid profile)

Measurement of cholesterol and triglycerides (fats) in a blood sample. High levels of lipids are associated with atherosclerosis. The general guideline for total cholesterol in the blood is less than 200 mg/dL. Treatment of hyperlipidemia includes proper diet (low-fat, high-fiber intake) and exercise. Niacin also helps reduce lipids. Drug therapy includes statins.

Treatment for fibrillation

Medications such as digoxin, beta-blockers, and calcium channel blockers convert fibrillation to normal sinus rhythm.

Hypertrophy of the right ventricle

Myocardium works harder to pump blood through a narrowed pulmonary artery.

coarctation of the aorta (CoA)

Narrowing (coarctation) of the aorta. Surgical treatment consists of removal of the constricted region and end-to-end anastomosis of the aortic segments.

nitroglycerin

Nitrate drug used for acute attacks of angina; given sublingually under the tongue.

patent ductus arteriosus (PDA)

Passageway between the aorta and the pulmonary artery remains open after birth. The ductus arteriosus normally closes after birth, but in this congenital condition it remains open, resulting in the flow of oxygenated blood from the aorta into the pulmonary artery. PDA occurs in premature infants, causing cyanosis, fatigue, and rapid breathing.

Percutaneous coronary intervention (PCI)

Performed by interventional cardiologist in which catheterization with balloons and stents opens clogged coronary arteries.

Treatment for CAD and ACSs

Physicians advise patients to avoid risk factors such as smoking, obesity, and lack of exercise, and prescribe effective drugs including aspirin, beta-blockers, ACE inhibitors, calcium channel blockers, and statins.

aspirin

Prevents clumping of platelets

Pulmonary artery stenosis

Pulmonary artery is narrow or obstructed

flutter

Rapid but regular contractions, usually of the atria. Heart rhythm may reach up to 300 beats per minute. Atrial flutter is often symptomatic of heart disease and frequently requires treatment such as medication, electrical cardioversion, or cathether ablation.

electrocardiography (ECG)

Recording of electricity flowing through the heart. Sinus rhythm begins in the SA node, and the normal rate is between 60-100 beats/min.

Raynaud disease

Recurrent episodes of pallor and cyanosis primarily in fingers and toes. The disorder is marked often on young healthy women. Episodes can be triggered by cold temperatures, emotional stress, or cigarette smoking. Protecting the body from cold and use of vasodilators are effective treatments.

Treatment for varicose veins

Sclerotherapy (injections with sclerosing solution) or laser and pulsed-light treatments to seal off veins.

Raynaud phenomenon

Similar condition to arterial insufficiency but is secondary to arterial narrowing from other conditions such as atherosclerosis, systemic lupus erythematosus, or scleroderma.

septal defects

Small holes in the wall between the atria (atrial septal defects) or the ventricles (ventricular septal defects). Although many septal defects close spontaneously, others require open heart surgery to close the hole between heart chambers. Alternatively, septal defects may be repaired with a less invasive catheter technique using a device (Amplatzer device) in the defect to close it.

technetium Tc 99m sestamibi scan

Technetium Tc 99m sestamibi injected intravenously is taken up in cardiac tissue, where it is detected by scanning. This scan assess the amount of damaged heart muscle after an a person who had an MI. It is also used with an exercise tolerance test. SEstamibi is a radioactive tracer compound used to define areas of poor blood flow in heart muscle.

Thrombotic occlusion

The blocking of the coronary artery by a clot from the roughened lining of the artery.

atherosclerosis

The deposition of fatty compounds on the inner lining of the coronary arteries. The ordinarily smooth lining of the artery becomes roughened as the atherosclerotic plaque collects in the artery. The plaque is the first that causes plugging of the coronary artery.

secondary hypertension

The increase in pressure is caused by another associated lesion, such as glomerulonephritis, pyelonephritis, or disease of the adrenal glands.

Atrial fibrillation (AF)

The most common type of cardiac arrhythmia affecting 15% of individuals in their 80s. Electrical impulses move randomly throughtout the atria, causing the atria to quiver instead of contracting in a coordinated rhythm. Common symptoms are palpitations (uncomfortable sensations in the chest from missed heartbeats), fatigue, and shortness of breath; AF can make the heart beat very fast for long periods of time, leading to the weakening of the heart muscles.

cardiac catheterization

Thin, flexible tube is guided into the heart via a vein or an artery. This procedure detects pressures and patterns of blood flow in the heart. Contrast may be injected and x-ray images taken of the heart and blood vessels. This procedure may be used in diagnosis and treatment of heart conditions.

heart-lung machine

This machine connects the patient's circulatory system, relieves the heart and lungs of pumping and oxygenation functions during heart surgery.

Computed tomography angiography (CTA)

Three-dimensional x-ray images of the heart and coronary arteries using computed tomography. This newer technique takes hundreds of images of the heart per second. Cross-sectional images are assembled by computer into a three-dimensional picture.

Acute coronary syndromes (ACSs)

Unstable angina and myocardial infarction (heart attack), which are consequences of plaque rupture in coronary arteries.

fibrillation

Very rapid, random, inefficient, and irregular contractions of the heart (350 beats or more per minute)

digital subtraction angiography (DSA)

Video equipment and a computer produce x-ray images of blood vessels.

Arteriography

X-ray imaging of arteries after injection of contrast via a catheter into the aorta or an artery.

angiography

X-ray imaging of blood vessels after injection of contrast material

Catheter ablation

a minimally invasive treatment to treat cardiac arrhythmias. *The technique, using radiofrequency energy delivered from the tip of a catheter inserted through a blood vessel and into the heart, destroys tissue that causes arrhythmias*. Supraventricular tachycardia (SVT), atrial flutter, atrial fibrillation, and ventricular tachycardia (VT) may be treated with ablation when clinically indicated. This procedure may provide a permanent cure in many clinical situations.

Implantable cardioverter-defibrillator (ICD)

a small electrical device that is implanted inside the chest (near the collarbone) to sense arrhythmias and terminate them with an electric shock. Candidates for ICDs are people who are at high risk for having ventricular tachycardia, ventricular fibrillation, and cardiac arrest.

transesophageal echocardiography (TEE)

a transducer placed in the esophagus provides ultrasound and Doppler information. This technique detects cardiac masses, prosthetic valve function, aneurysms, and pericardial fluid.

Magnetic resonance angiography (MRA)

a type of MRI that gives highly detailed images of blood vessels. Physicians use MRA to view arteries and blockage inside arteries.

thrill

a vibration felt on palpation over an area of turmoil in blood flow (as a blocked artery)

congenital heart disease

abnormalities in the heart at birth

claudication

absence of pain or discomfort in a leg at rest, but pain, tension, and weakness after walking has begun.

Holter monitoring

an ECG device is worn during a 24 hour period to detect cardiac arrhythmias. Rhythm changes correlated with symptoms are recorded in a diary.

Ventricular fibrillation (VF)

electrical impulses move randomly throughout the ventricles. The life-threatening situation may result in sudden cardiac death or cardiac arrest (sudden stoppage of heart movement) unless help is provided immediately. If treatment is immediate, VF can be interrupted with defibrillation.

Treatment for PAD

exercise, avoidance of nicotine, and control of risk factors such as hypertension, hyperlipidemia, and diabetes. Surgical treatment includes endarterectomy and bypass grafting.

pericardial friction rub

heard as a scraping or grating noise heard on auscultation of the heart; suggestive of pericarditis.

myocardial infarction

heart attack; When blood flow is decreased (ischemia) or stopped entirely, leading to death (necrosis) of a part of the myocardium. The area of dead myocardial tissue is known as an infarct. The infarcted area is eventually replaced by scar tissue.

hypertension (HTN)

high blood pressure. In adults, a blood pressure of 140/90 mm Hg or greater is considered high. Losing weight, limiting sodium intake, stopping smoking, and reducing fat in the diet also can reduce blood pressure.

cardiac pacemaker

implantation of an artificial that overcomes arrhythmias and keeps the heart beating at the proper rate. The pace maker power source is a generator that contains a computer and lithium battery. It is implanted under the skin just below the collarbone, with leads (wires) to both chambers, usually on the right side of the heart.

Systolic CHF

left ventricular dysfunction results in a low ejection fraction ( the amount of blood that leaves the left ventricle). Less blood is pumped from the heart.

auscultation

listening for sounds in blood vessels or other body structures, typically using a stethoscope

aneurysm

local widening (dilation) of an arterial wall usually caused by atherosclerosis, hypertension or congenital weakness in the vessel wall; commonly occur in the aorta, but may occur in peripheral vessels as well. Rupture and hemorrhage of an aneurysm is critically dangerous.

Treatment for Congestive Heart Failure (CHF)

lowering dietary intake of sodium and the use of diuretics to promote fluid loss. Angiotensin-converting enzyme (ACE) inhibitors (type 1), beta-blockers, spironolactone (increases excretion of water and sodium by the kidney), and digoxin are also used. If drug and lifestyle changes fail to control CHF, heart transplantation may be the only treatment option.

Automatic external defibrillators (AEDs)

may be found in workplaces, airports, and other public places and are used in an emergency situation to reverse ventricular fibrillation.

Embolic protection devices

parachute-like filters used to capture embolic debris during stenting.

Petechiae

small vessels of the skin, where multiple pinpoint hemorrhages are seen (like flea bites)

Diastolic CHF

the heart can contract normally but is "stiff" or less compliant when relaxed or filling with blood. Fluid backs up in the lungs and other parts of the body. The most common cause of diastolic CHF is hypertension.

Hemorrhoids

varicose veins near the anus

Polyunsaturated fats

vegetable origin, such as corn and sunflower oil; decreases blood cholesterol.