Heart failure
o Right sided neck vein distention, ascites,
o Left sided dyspnea, orthopnea, nocturnal
paroxysmal dyspnea
Murmurs
o Systolic aortic stenosis, pulmonic stenosis,
mitral and tricuspid regurgitation
o Diastolic aortic regurg, pulmonic regurg, mitral
and tricuspid stenosis
Arrhythmias
o Example: Ventricular arrhythmia
o Ventricular tap vs supraventricular tap in ECG
unless theres no bundle branch block you look
at QRS. QRS in supraventricular is narrow,
ventricular wide QRS
Conduction disturbance
o AV blocks
Pericardial effusion or tamponade
Diagnosis: SIGNS AND SYMPTOMS
Essential is positive imaging for characteristic cardiac
masses and biopsy of that masses
Have to open up the patient
MYXOMA
CLINICAL PRESENTATION
DIAGNOSIS
RHABDOMYOMAS
Common findings on cardiac valves or the adjacent
endothelium at post-mortem
Most common in infants and children (75% < 1 y/o)
Seldom result in clinical manifestations
Most common in ventricles s/sx due to mechanical
obstruction mimic valvular stenosis, CHF, restrictive or Growth may cause mechanical interference with valve
hypertrophic cardiomyopathy, & pericardial constriction function -> regurg problems
CARDIAC LIPOMAS
Generally small tumors
nd
2 most common benign tumor Most often intra-myocardial in location
Usually incidental post mortem findings May cause atrioventricular (AV) conduction disturbances
and sudden death due to predilection for region of AV node
Usually solitary; grow as large as 15 cm -- AV blocks
Clinical: SARCOMA
FIBROMAS 3. Fibrosarcoma
4. Osteosarcoma
nd
2 most common in pediatric age group
Dont let anyone look down on you because you are
At presentation, often spread extensively for surgical a) Chest pain aggravated by coughing, inspiration or
excision recumbency
Commonly involve RA & pericardium right-sided failure, b) Pericardial friction rub on auscultation
pericardial disease, vena cava obstruction
c) Characteristic ECG changes
May occur in left side mistaken for myxoma
3. Cardiac tamponade
TREATMENT AND PROGNOSIS
a) Increased JVP
Occurrence of distant metastases Look for the pulse, palpate it, if nawala
in neck vein engorgement
Poor prognosis
c) To confirm: Echo evidence of RA and RV collapse
CARDIAC METASTASIS (metastatic to the heart)
CARDIOVASCULAR MANIFESTATIONS OF SYSTEMIC DISEASES
Malignant melanoma highest predilection for cardiac 1. Increased incidence of CAD most common cause of death
metastasis (50-65%) can go to heart and cause problems, in adults with DM
kala niyo ganun ganun lang yung melanoma.
o CAD is the most common cause of death in adult
Most common from breast (if female) and lung CA (if male) DM patients
o Equivalent ang survival rate with DM patient vs
Almost always occur in the setting of widespread primary patient with MI
disease
Two types of vascular disease
May be the initial presentation of tumor elsewhere
a) Macrovascular
Reach the heart via bloodstream, lymphatics or direct
invasion Atherosclerosis &
arteriosclerosis - CAD
Usually present as small, firm nodules in the pericardium (
most common kasi) Cerebral circulation TIA,
stroke
LOCATION
>50% of DM have CAD; >50%
of DM ending up with stroke
Pericardium most common
Lower limb circulation
Pericardial tamponade claudication, ulceration,
gangrene
Myocardium
b) Microvascular
Rarely, endocardium and cardiac valves
Retinopathy (number 1 cause
CLINICAL PRESENTATION of blindness) , nephropathy
(number 1 cause of dialysis),
neuropathy, small artery
Depends on location and size of tumor occlusions of the heart
Signs & symptoms occur only in 10%; non-specific MI more frequent but also tend to be larger in
size and more likely to result in complications
Usually occurs in the setting of recognized neoplasm such as heart failure, shock, and death
(stage 4 carcinomas)
Complete autonomic denervation HR no longer Low systolic pressure and cardiac output
responsive to physiologic stimuli
Narrow pulse pressure
All DM patients should receive statin therapy
unless contraindicated Generalized edema due to:
All receive anti thrombotic unless contraindicated Reduced serum oncotic pressure
Best drug for DM patients: ACEI or ARB Effects of starvation on the heart:
May occur in the presence of adequate intake of calories and Presence of thiamine deficiency
Decreased blood thiamine concentration
protein if polished rice is used
Decreased ESR
Deficiency common among alcoholics
Dont forget there is such a thing as thiamine deficiency or
Improvement after adequate thiamine therapy
beriberi heart disease.
The major cause of the high-output state is vasomotor
This is common in alcoholic patients
depression leading to reduced systemic vascular resistance, the
Probably those who are nagaavoid ng four legged animals. precise mechanism of which is not understood.
May ituturo ako sa inyo, you know, best food for patients The cardiac examination reveals a wide pulse pressure,
with increased cholesterol, you should avoid 4 legged tachycardia,a third heart sound, and, frequently, an apical
animals. Baka, baboy, lahat ng 4 legged animals, mataas ang systolic murmur.
cholesterol. Sarap sarap ng baboy ano? Advise them to eat The electrocardiogram (ECG) may reveal decreased voltage, a
2 legged animals. Pag 2 legged animals, kita mo, mababa prolonged QT interval, and T-wave abnormalities. The chest x-
ray generally reveals cardiomegaly and signs of congestive heart
ang cholesterol mo. Turkey, chicken
failure (CHF).
Clinical:
The response to thiamine is often dramatic, with an increase in
Generalized malnutrition systemic vascular resistance, a decrease in cardiac output,
Peripheral neuropathy clearing of pulmonary congestion, and a reduction in heart size
Glossitis often occurring in 1248 h
Anemia
OBESITY
Dont forget in Beriberi heart disease there is generalized
malnutrition, peripheral neuropathy, glossitis, anemia. Increased CV mortality and morbidity
What is glossitis? Tama din yung mga Chinese, tinitingnan Increased prevalence of
yung dila, may sakit ka, di ba? Tapos pulang pula. So that is
Hypertension
your P.E.
Glucose intolerance
When thiamine stores are measured using the thiamine-
pyrophosphate effect (TPPE), thiamine deficiency has been Atherosclerotic coronary artery disease
found in 2090% of patients with chronic heartfailure. Obesity can have problems, alam niyo naman yun pag
This deficiency appears to result from both reduced dietary obese, increased cardiovascular mortality and
intake and a diuretic-induced increase in the urinary morbidity because they have more likely to have
excretion of thiamine. hypertension, more likely to have diabetes,
atherosclerosis.
Dont let anyone look down on you because you are
o Heart failure (+) crackles, inc. JVP, S3, S4 SIGNS AND SYMPTOMS
o Edema
o Exercise intolerance
TREATMENT
Systemic s/sx
Weight loss
Weight reduction most effective Increased appetite
Resting tremors of the hand
The most important effective way of preventing Nervousness, anxiety, insomnia, mood swings,
complications in obesity is lifestyle modification irritability
Heat intolerance & sweaty skin
Digitalis
Proximal muscle weakness & wasting
Sodium restriction Increased bowel movement or diarrhea
Diplopia
Diuretics Periodic paralysis
And when you say periodic paralysis, bigla
So how do you prefer to treat a patient with hypertensive nanghihina ang extremities mo. Kaya kailangan
obesity? so what will be your drug of choice probably? kumain kayo ng saging. Sa mga low
You have to give diuretic therapy. Sisikat ka pa. Bakit socioeconomic status, ang ulam ngayon, high
kamo? Aba, kapag umihi ang pasyente mo, bagsak ang carbo and high sodium intake. Pag nag high
timbang niya. Bumaba na yung blood pressure mo, carbo ka, bakit di bumababa potassium mo?
bumaba pa timbang mo. Because of insulin secretion. Kung alam mo
yung pinapakain mo sa pasyente mo.
THYROID DISEASE
Cardiovascular s/sx
Physiologic effects of thyroid hormone: Palpitations
Increased total body metabolism and oxygen consumption Dyspnea with or without LV failure
Increase workload on the heart Atypical chest pain
Direct inotropic, chronotropic, and dromotropic effects Cardiac arrhythmias AF, PACs
Tachycardia, increased cardiac output
Dont let anyone look down on you because you are
CLINICAL FINDINGS
ECG sinus tachycardia, AF
Echocardiography hypercontractility, increased
LV mass & hypertrophy Systemic signs and symptoms
Dont let anyone look down on you because you are
ACROMEGALY
Thrombotic Disease
Deep venous thrombosis
Pulmonary, peripheral or cerebral thrombosis
Associated with anti-phospholipid antibodies
produce endothelial dysfunction
TREATMENT
Treat underlying RA
Glucocorticoids
Pericardiectomy
Pericarditis
2/3 of patients
Benign course
Rarely tamponade or constriction
Myocarditis
Seen in autopsy in up to 80%
Only 20% clinically detected
Parallels the activity of the disease
Seldom results to clinical heart failure, unless
associated with hypertension