SCHOOL: INFOCOMS. DEPARTMENT: INFORMATION SCIENCE AND INFORMATICS. NAMES: REGISTRATION NUMBERS: 1. DANIEL KIRUI KWEMOI. HRI/054/2020 2. CEPHAS OMONDI. HRI/005/2020 COURSE TITTLE: HUMAN PATHOLOGY. COURSE CODE: HRI 123. TASK: ASSIGNMENT. LECTURER : DR. ODERO SIBUOR. 1. CORONARY ARTERY DISEASES It is the build-up of plaque in the arteries that supply oxygen rich blood to your heart. Plaque causes narrowing or blockage that could result in a heart attack. Categories of arteries a. b. c. d. The right coronary artery The left coronary artery The left anterior descending artery The left circumflex artery Coronary artery disease is caused by atherosclerosis. Atherosclerosis is the build-up of plaque inside your arteries. Plaque consist of cholesterol, fatty substances, waste products, calcium and the clot-making substances fibrin. As plaque continues to collect on your artery wall, your arteries narrow and stiffen. Plaque clog or damage your arteries, which limits or stop blood flow to your heart muscle. If your heart does not get enough blood, it can’t get the oxygen and nutrients it needs to work properly. This condition is called ischemia. Not getting enough blood supply to your heart muscle can lead to chest discomfort or chest pain (called angina) it also puts you at risk of heart attack. Process of plaque build-up in the arteries. Coronary heart disease happens in everyone. The speed at which it develops differs from person to person. The process usually start when you are very young. Before your teen years, the blood vessel walls start to show striates of fat. As plaque deposits in your artery’s inner walls, your body fights back against this ongoing process by sending white blood cells to attack the cholesterol, but the attack causes more inflammation. This triggers yet other cells in the artery wall to form soft cap over the plaque. This thin cap over the plaque can break open (due to blood pressure and other causes). Blood cell fragments called platelets stick to the site of ”the injury” causing a clot to form. The clot further narrows arteries. Sometimes a blood clot breaks a part on its own. Other times the clot block blood flow through the artery, depriving the heart of oxygen and causing a heart attack. The following are at risk of getting coronary artery disease ;a. b. c. d. e. f. g. h. Have high cholesterol level. Have high blood pressure. Family history of heart disease. Have diabetes. Are a smoker. Are a man over 45 year of age or a postmenopausal woman. Are over weight. Are physically inactive. Symptoms. You may not know you have coronary artery disease since you may not have symptoms at first. The build-up of plaque in your arteries takes years to decades. The common symptoms include;a. Chest pain or shortness of breath especially after light physical activity like walking up stairs, but even at rest Sometimes you wont know you have coronary artery disease until you have a heart attack. Symptoms of heart attack include;a. b. c. d. e. Chest discomfort (angina) Feeling tired Dizziness, light headedness Nausea Weakness Symptoms of heart attack in women can be slightly different, they include;a. b. c. d. Discomfort or pain in the shoulders, neck, abdomen (belly) or back. Felling of indigestion or heartburn. Unexplained anxiety. Cold sweat. N\B: if a blood clot in coronary artery has broken loose and moved into your brain, it can cause stroke, although this is rare. Symptoms of stroke. a. Dropping of one side of your face. b. Arm weakness or numbness. c. Difficulty speaking/slurred speech. Diagnosis of coronary artery disease. a. Electrocardiogram test (EKG);- this test records the electrical activity of the heart. Can detect heart attack, ischaemia and heart rhythm issue. b. Exercise stress test ;- this is a treadmill test to determine how well your heart functions when its working the hardest. can detect angina and coronary blockages. c. Pharmacologic stress test ;- medication is given to increase your heart rate and mimic exercise. This test can detect angina and coronary blockages. d. Coronary calcium scan ;- this test measures the amount of calcium in the walls of your coronary arteries, which can be a sign of atherosclerosis. e. Echocardiogram ;- this test uses sound wave to see how will structures of your heart are working and overall function of your heart. f. Blood test ;- many blood test are ordered for factors that affect arteries such as triglycerides, cholesterol, lipoprotein, c-reactive protein, glucose, HbA1c (a measure of diabetic control and other tests. g. Cardiac catheterization ;- this test involves inserting small tubes into the blood vessels of the heart to evaluate heart function including the presence of coronary heart disease. Other diagnostic imaging test. a. Nuclear imaging;- produces images of the heart after administrating a radioactive tracer. b. Computed tomography angiogram ;- uses CT and contrast dye to view 3D pictures of the moving heart and detect blockages in the coronary arteries. Management and treatment of coronary artery disease. Life lifestyle changes ;- The first step in treating coronary artery disease is to reduce risk factors. This involves moving changes in your lifestyle. Don’t smoke ;- If you smoke or use tobacco products. Manage health problems like high cholesterol, high blood pressure and diabetes. Eat a heart-healthy diet ;- change in diet reduces risk of heart disease. Limit alcohol use ;- limit daily drinks to more than one drink per day for women two drinks per day for men. Increase your activity level ;- exercise help you to loose weight, improve your physical condition and relieve stress. Medications. Medication to lower your cholesterol level; such as stostins, bile acid sequestrants’, niacin and fibrates. Medications to lower blood pressure, such as beta blockers, calcium channel blockers angiotensin converting enzyme (ACE) inhibitors or angiotensin ii receptor blockers. Medication to stop angina, such as nitrates/ nitroglycerin or ranolazine. Medications to reduce the risk of blood clots such as anticoagulation (including aspirin) and antiplatelets. Procedures and surgery. I. II. Interventional procedures;- are non-surgical treatments to get rid of plaque build-up in the arteries and prevents blockers. Common procedures are balloon angioplasty and stenting. Coronary artery bypass graft (CABIS) surgery – involves creating a new path for blood to flow when there is a blockage in the coronary artery. Surgeons remove blood vessels from your chest, arm or leg and creates a new pathway to deliver Oxygen rich in blood to the heart. Enhanced external counter pulsation (EECP). In this procedure, inflatable cuffs (like blood pressure cuffs) are used to squeeze the blood vessel in your lower body. This helps improved blood flow to the heart and helps course natural bypass (cell areal circulation) around blocked coronary arteries. Enhanced external counter pulsation is a possible treatment for these with chronic stable angina who can’t have an invasive procedure or bypass surgery and do not get relief from medication. Complications of coronary artery disease. Angina Heart attack Heart rhythm problems Heart failure Cardiogenic shock Sudden cardiac arrest Prevention. Coronary heart disease can’t be cured but only can be prevented from getting worse. If your coronary artery disease has led to a heart attack, your health care provider can recommend a cardiac rehabilitation program to reduce your risk of future heart problems, regain strength and improve the quality of your life. Acute coronary syndrome is the name given to types of coronary disease that are associated with a sudden blockage in the blood supply to your heart. Types of heart attack. Non- ST segment elevation myocardial infarction (NSTEMI). This is a type of heart attack (MI) that does not cause major changes on an ECG. But a blood test will show that there is damage to your heart muscle. ST segment elevation myocardial infarction (STEMI). This type of heart attack (MI) is caused by a sudden blockage of blood supply to the heart. Difference between angina and heart attack. Angina is caused by a drop of blood supply to the heart due to the gradual build-up of blockage in the arteries. While heart attack is caused by a sudden lack of blood supply to the heart muscles. The blockage is often due to clot in coronary artery. Angina does not cause permanent damage to the heart while heart attack can cause permanent damage to the heart muscle. Angina symptoms last for a few minutes and usually stop if you rest or take medication (triggered by strenuous activity stress, eating or being in the cold) while heart attack symptoms usually last more than a few minutes and do not complete go away after taking nitroglycerin. Angina does not need emergency medical attention while heart attack needs emergency medical attention if symptoms last longer than 5 minutes. 2. PULMONARY STENOSIS. Pulmonary stenosis is a congenial (present at birth) defect that occurs due to abnormal development of the fetal heart during the first eight weeks of pregnancy. The pulmonary valve is found between the right ventricle and the pulmonary artery .it has 3 leaflets that function like one-way door, allowing blood to flow forward into the pulmonary artery but not backwards into the right ventricle. With pulmonary stenosis, problems with the pulmonary valve make it harder for the leaflets to open and permit blood to flow forward from the right ventricle to the lungs in a normal fashion. In children this problem can include: a) A valve that has thick leaflets that do not open all the way. b) A valve that has leaflets that are partially fused together. c) The area above or below the pulmonary valve is narrowed. Types of pulmonary stenosis. I) valvular stenosis; - the valve leaflets are thickened or narrowed. ii)Supravalvar stenosis; - the pulmonary artery just above the pulmonary valve is narrowed. III) Subvalvar (infundibular) pulmonary stenosis; - The muscle under the valve area is thickened, narrowing the outflow tract from the right ventricle. iv) Branch peripheral pulmonic stenosis; - the left or right pulmonary artery is narrowed, or both may be narrowed. Causes of pulmonary stenosis Occurs due to improper development of pulmonary valve in the first eight weeks of fetal growth, has no clear reason evident for its development. Some congenital defects may have a genetic link, either occurring due to a defect in gene , a chromosome abnormality or environmental exposure causing heart problems to occur more often in certain families. Symptoms of pulmonary stenosis Heavy or rapid breathing. Shortness of breath. Fatigue. Rapid heart rate. Swelling in the feet, ankles, face, eyelids and abdomen. Diagnosis Tests a) Chest x-Ray; - A diagnostic test that uses x-Ray beams to produce images of internal tissues, bones and organs onto film. b) Electrocardiogram (ECG or EGK); - A test that records the electrical activity of the heart, shows abnormal rhythms (arrythmias) and detects heart muscle stress. d) Echocardiogram (echo); - A procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves. Treatment Specific treatment for pulmonary stenosis will be determined by your child's doctor based on: The child's age, overall health and medical history. Extent of the condition. The child's tolerance for specific medications, procedures or therapies. Expectations for the cause of the condition. The family's opinion or preference. Repair options include (for the very sick): I) Balloon dilation /valvuloplasty; - A small, flexible tube (catheter) is inserted into a blood vessel in the groin and guide to the inside of the heart. The tube has a deflated balloon in the tip. When the tube is placed in the narrowed valve, the balloon is inflated to stretch to the area open. ii) Valvotomy; - Is the surgical release of the scur tissue within the aortic valve leaflets that are preventing the valve leaflets from opening properly. III)vulvectomy; - Is the surgical removal of the valve and is frequently a accompanied by the replacement of an outflow patch to improve blood flow from the right ventricle into the pulmonary artery. Once the individual reaches adulthood, the pulmonary artery needs to be replaced. iv)Patch enlargement; - Patches are used to enlarge the narrowed areas. In Subvalvar pulmonary stenosis, an incision is made into the right ventricles to enlarge the area Below the pulmonary valve where the narrowing used to be. In Supravalvar pulmonary stenosis, the narrowing is in the artery just below the pulmonary valve. partches are sewn into the artery to enlarge its diameter and relieve the narrowing. v) pulmonary valve replacement; - Is a surgical procedure that is often recommended in adulthood in the case of leaky pulmonary valve. A tissue valve (pig or human) may be used. Children who have undergone a valve replacement will need to follow antibiotic prophylaxis throughout their life. Special equipment’s used in CVICU to help a child recover from surgery a) Ventilator; - a machine that helps your child breath while he/ she is under anesthesia during operation. A small, plastic tube is guided into the windpipe and attached to the Ventilator, which breaths for your child while he/she is too sleepy to breathe effectively on his or her own. b) Intravenous (IV) catheters; - Small, plastic tubes inserted through the skin into the blood vessels to provide (iv) fluids and important medicines that help your child recover from the operation. c)Arterial line; - A specialized (iv) placed in the wrist or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery or while your child is in the CVICU. d) Nasogastric (NG) tube; - A small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery. e) Urinary catheter; - A small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. F) Chest tube; - A drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours or even a few days after surgery. g) Heart monitor; - a machine that constantly displays the picture of your child's heart rhythm and monitors heart rate, arterial blood pressure and values. 3. VALVULAR HEART DISEASE Valvular heart disease is when any valve in the heart has damage or is diseased. There are several causes of valve disease. The normal heart has four chambers (right and left atria, and right and left ventricles) and four valves. The mitral valve, also called the bicuspid valve, allows blood to flow from the left atrium to the left ventricle. The tricuspid valve allows blood to flow from the right atrium to the right ventricle. The aortic valve allows blood to flow from the left ventricle to the aorta. The pulmonary valve allows blood to flow from the right ventricle to the pulmonary artery. The valves open and close to control or regulate the blood flowing into the heart and then away from the heart. Three of the heart valves are composed of three leaflets or flaps that work together to open and close to allow blood to flow across the opening. The mitral valve only has two leaflets. Healthy heart valve leaflets are able to fully open and close the valve during the heartbeat, but diseased valves might not fully open and close. Any valve in the heart can become diseased, but the aortic valve is most commonly affected. Diseased valves can become “leaky” where they don’t completely close; this is called regurgitation. If this happens, blood leaks back into the chamber that it came from and not enough blood can be pushed forward through the heart. The other common type of heart valve condition happens when the opening of the valve is narrowed and stiff and the valve is not able to open fully when blood is trying to pass through; this is called stenosis. Sometimes the valve may be missing a leaflet—this more commonly involves the aortic valve. If the heart valves are diseased, the heart can’t effectively pump blood throughout the body and has to work harder to pump, either while the blood is leaking back into the chamber or against a narrowed opening. This can lead to heart failure, sudden cardiac arrest (when the heart stops beating), and death. Facts About Valvular Heart Disease; About 2.5% of the U.S. population has valvular heart disease, but it is more common in older adults. About 13% of people born before 1943 have valvular heart disease.1 Rheumatic heart disease most commonly affects the mitral valve (which has only two leaflets) or the aortic valve, but any valve can be affected, and more than one can be involved. Bicuspid aortic valve (having only two leaflets rather than the normal three) happens in about 1% to 2% of the population and is more common among men. In 2017, there were 3,046 deaths due to rheumatic valvular heart disease and 24,811 deaths due to non-rheumatic valvular heart disease in the United States.2 Nearly 25,000 deaths in the U.S. each year are due to heart valve disease from causes other than rheumatic disease.2 Valvular heart disease deaths are more commonly due to aortic valve disease. What causes valvular heart disease? There are several causes of valvular heart disease, including congenital conditions (being born with it), infections, degenerative conditions (wearing out with age), and conditions linked to other types of heart disease. Rheumatic disease can happen after an infection from the bacteria that causes strep throat is not treated with antibiotics. The infection can cause scarring of the heart valve. This is the most common cause of valve disease worldwide, but it is much less common in the United States, where most strep infections are treated early with antibiotics. It is, however, more common in the United States among people born before 1943. Endocarditis is an infection of the inner lining of the heart caused by a severe infection in the blood. The infection can settle on the heart valves and damage the leaflets. Intravenous drug use can also lead to endocarditis and cause heart valve disease. Congenital heart valve disease is malformations of the heart valves, such as missing one of its leaflets. The most commonly affected valve with a congenital defect is a bicuspid aortic valve, which has only two leaflets rather than three. Other types of heart disease: Heart failure. Heart failure happens when the heart cannot pump enough blood and oxygen to support other organs in your body. Atherosclerosis of the aorta where it attaches to the heart. Atherosclerosis refers to a buildup of plaque on the inside of the blood vessel. Plaque is made up of fat, calcium, and cholesterol. Thoracic aortic aneurysm, a bulge or ballooning where the aorta attaches to the heart. High blood pressure. A heart attack (also known as myocardial infarction or MI), which can damage the muscles that control the opening and closing of the valve. Other: Autoimmune disease, such as lupus. Marfan syndrome, a disease of connective tissue that can affect heart valves. Exposure to high-dose radiation, which may lead to calcium deposits on the valve. The aging process, which can cause calcium deposits to develop on the heart valves, making them stiff or thickened and less efficient with age. What are the symptoms of valvular heart disease? Heart valve disease can develop quickly or over a long period. When valve disease develops more slowly, there may be no symptoms until the condition is quite advanced. When it develops more suddenly, people may experience the following symptoms: Shortness of breath Chest pain Fatigue Dizziness or fainting Fever Rapid weight gain Irregular heartbeat How is valvular heart disease diagnosed? The doctor may hear a heart murmur (an unusual sound) when listening to your heartbeat. Depending on the location of the murmur, how it sounds, and its rhythm, the doctor may be able to determine which valve is affected and what type of problem it is (regurgitation or stenosis). A doctor may also use an echocardiography, a test that uses sound waves to create a movie of the valves to see if they are working correctly. How is valvular heart disease treated? If the condition isn’t too severe, it might be managed with medicines to treat the symptoms. If the valve is more seriously diseased and causing more severe symptoms, surgery may be recommended. The type of surgery will depend on the valve involved and the cause of the disease. For some conditions, the valve will need to be replaced by either opening the heart during surgery or replacing the valve without having to open the heart during surgery. References;1. Otto CM, Bonow RO. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014. 2. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Oct 24, 2019.
