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INTRO TO CARDIOVASCULAR DISORDERS (Approach to the Patient with Possible…
INTRO TO CARDIOVASCULAR DISORDERS
Approach to the Patient with Possible Cardiovascular Disease
ASSESSMENT OF THE PATIENT WITH A HEART MURMUR (FIgURE 264-1 Approach to the evaluation of a heart murmur.)
echo generally not required
midsystolic and soft (grades I–II/VI) (majority of heart murmurs) occuring in an asymptomatic child or young adult w/o other evidence of heart disease on clinical examination
echo indicated
loud systolic murmurs (grades ≥III/VI), esp those holosystolic or late systolic
most patients w/ diastolic or continuous murmurs
PITFALLS IN CARDIOVASCULAR MEDICINE
ELECTROCARDIOGRAM: generally does not establish a specific diagnosis, should be interpreted in context of other abnormal CV findings
DISEASE PREVENTION AND MANAGEMENT
ASSESSMENT OF FUNCTIONAL IMPAIRMENT
degree of customary physical activity at work + recreation ex: development of two-flight dyspnea in a well-conditioned marathon runner
detailed consideration of therapeutic regimen. ex: persistence or development of edema.. in a patient who is receiving optimal doses of diuretics and other therapies for heart failure
ascertain level of activity + rate performed before symptoms develop. ex: breathlessness that occurs after running up two long flights of stairs better than after taking a few steps on level ground
determine severity of underlying illness: ascertain what, if any, specific tasks patient could have carried out 6 mths or 1 yr earlier that cannot carry out at present.
FAMILY HISTORY
single gene defects: hypertrophic cardiomyopathy, Marfan’s syndrome, and sudden death associated with a prolonged QT syndrome
polygenic: Premature coronary disease and essential hypertension, DMII, and hyperlipidemia (the most important risk factors for CAD)
DIAGNOSIS
systematic consideration of
anatomic abnormalities
physiologic disturbances
underlying etiology
Functional disability
Class II
Class III
Class IV
Class I
lab tests
blood tests to assess risk or cardiac function
pecialized invasive examinations
noninvasive imaging examinations
genetic tests to identify monogenic cardiac diseases
ECG
CARDIAC SYMPTOMS
result most commonly from
disturbance of contraction and/or relaxation of myocardium--> fatigue + :arrow_up: intravascular P upstream of failing ventricle (latter-->abnormal fluid accumulation w/ peripheral edema or pulmonary congestion and dyspnea
Obstruction to blood flow--> symptoms resembling those of myocardial failure
Cardiac arrhythmias often develop suddenly--> dyspnea, hypotension, and syncope —generally occur abruptly and may disappear as rapidly as they develop
Ischemia--> manifests most frequently as chest discomfort
NATURAL HISTORY: often present acutely
THE MAGNITUDE OF THE PROBLEM
Epidemiology of Cardiovascular Disease
Basic Biology of the Cardiovascular System
CELLULAR BASIS OF CARDIAC CONTRACTIO
CARDIAC ULTRASTRUCTURE
CARDIAC ACTIVATION
THE CONTRACTILE PROCESS
CONTROL OF CARDIAC PERFORMANCE AND OUTPUT
THE ROLE OF MUSCLE LENGTH (PRELOAD)
CARDIAC PERFORMANCE
VENTRICULAR AFTERLOAD
EXERCISE
THE BLOOD VESSEL
VASCULAR CELL BIOLOGY
VASCULAR REGENERATION
ORIGIN OF VASCULAR CELLS
VASCULAR PHARMACOGENOMICS
VASCULAR ULTRASTRUCTURE
ASSESSMENT OF CARDIAC FUNCTION
CARDIAC METABOLISM
REGENERATING CARDIAC TISSUE
DIASTOLIC FUNCTION