19. – HEART

19. – HEART

The heart is a myogenic muscular organ found in all animals with a circulatory system (including all vertebrates), which pumps blood throughout the blood vessels by repeated, rhythmic contractions. The term cardiac (as in cardiology) means "related to the heart" and comes from the Greek καρδιά, kardia, for "heart".
The vertebrate heart is principally composed of cardiac muscle and connective tissue. Cardiac muscle is an involuntary striated muscle tissue found only in this organ and responsible for the ability of the heart to pump blood. The average human heart, beating at 72 beats per minute, will beat approximately 2.5 billion times during an average 66 year lifespan. It weighs approximately 250 to 300 grams (9 to 11 oz) in females and 300 to 350 grams (11 to 12 oz) in males.^[1]
In invertebrates that possess a circulatory system, the heart is typically a tube or small sac and pumps fluid that contains water and nutrients such as proteins, fats, and sugars. In insects, the "heart" is often called the dorsal tube and insect "blood" is almost always not oxygenated since they usually respirate (breathe) directly from their body surfaces (internal and external) to air. However, the hearts of some other arthropods (including spiders and crustaceans such as crabs and shrimp) and some other animals pump hemolymph, which contains the copper-based protein hemocyanin as an oxygen transporter similar to the iron-based hemoglobin in red blood cells found in vertebrates.

CARDIOVASCULAR DISEASE

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries and veins). Cardiovascular disease refers to any disease that affects the cardiovascular system, principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of cardiovascular disease are diverse but atherosclerosis and/or hypertension are the most common.
Cardiovascular diseases remain the biggest cause of deaths worldwide, though over the last two decades, cardiovascular mortality rates have declined in many high-income countries. At the same time cardiovascular deaths and disease have increased at an astonishingly fast rate in low- and middle-income countries. Although cardiovascular disease usually affects older adults, the antecedants of cardiovascular disease, notably atherosclerosis begin in early life, making primary prevention efforts necessary from childhood.^[4] There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise, and avoidance of smoking.

NONINVASIVE TEST

A noninvasive test is a procedure that does not involve tools that break the skin or physically enter the body.

Echocardiography

The Echocardiogram is currently the procedure noninvasive more used for the diagnosis, treatment and follow-up of heart, valvular disease, pericardial and myocardial and great vessels, due to your safety, ease of preparation and large amount of information provided. It is useful in the evaluation of the heart murmurs, heart function and ischemic heart disease (angina pectoris).Echocardiography has several modes:

· Ecocardiografía adult and paediatric Doppler.

· Echocardiography of stress with pharmacological testing (dobutamine, dipyridamole, ergonovine).

· Echocardiography of stress with exercise.

· Echocardiography trasesofagica.

· Three-dimensional echocardiography.

· Transthoracic echocardiography.

· Strain, strain rate, speckel tracking echocardiography.

Through the images obtained in each of the above tests is evaluated also the hemodynamic impact of cardiac valvular disease and aortic systolic and diastolic left ventricular function and the degree of pulmonary arterial hypertension of the patient, also detected the presence of blood clots in the heart cavities and rule out the presence of an infection of the heart valves to the patients with coronary heart disease.


Dynamic electrocardiogram (Holter 24 hours)

Monitoring Holter is a test that involves the continuous reading of the frequency and rhythm heart (electrocardiogram) during a period of 24 hours. It is useful for the evaluation and diagnosis of arrhythmias and cardiac conduction disorders. It is indicated for patients with palpitations, tachycardia (rapid pulse), bradycardias (slow pulse), arrhythmia, dizziness, syncope (sudden loss of consciousness), silent ischemia and in the follow-up of patients with pacemaker.

 

Table tilting (Tilt Test) test

The Tilt Test or tilt table test is a diagnostic method for patients who consulted by transient loss of consciousness or symptoms of Dysautonomia.

Exercise (stress test) test

It consists of evaluating cardiovascular patients during exercise in a "band without end" or Walker. Determines the physical state or functional class of patients, behavior of arterial pressure and heart rate during the exercise. It is very useful for the diagnosis and follow-up of patients with coronary artery disease.

Ambulatory monitoring of blood pressure – map

This test is performed on an outpatient basis over a period of 24 hours, during which the patient perform daily activities, while the team of monitoring takes blood pressure every 20 minutes during the day and every hour during the night. The diagnosis obtained after the automatic registration allows you to identify if the blood pressure is normal or altered, to determine the presence of diseases such as hypertension and arterial hypotension, in addition to assessing the pressure response to drug treatments.This test is very useful to detect the "white coat" hypertension (patients which are increased blood pressure figures when they consult your doctor).

 

INVASIVE TESTING

Invasive Tests involve inserting catheters into the blood vessels of the heart in order to get a closer look at the coronary arteries or to stimulate and test the electrical system of the heart.

 

 

BLOOD TEST

A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick. Blood tests are used to determine physiological and biochemical states, such as disease, mineral content, drug effectiveness, and organ function. They are also used in drug tests.

CARDIAC ARRHYTHMIA

An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that is too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that is too slow is called bradycardia (bray-de-KAR-de-ah).

Most arrhythmias are harmless, but some can be serious or even life threatening. During an arrhythmia, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.

The clinical manifestations depend on the type of arrhythmia and for each arrhythmia can be likewise variable, and may range from no symptoms to have a very significant impact. The main symptoms are:

·         Palpitations: under normal conditions to the heartbeat is not received. The perception that the heart beats, is known under the name of palpitations. Palpitations does not always indicate a pathological situation nor mean that tachycardia have.

·         Syncope: known by the name of syncope to a relatively sudden unconsciousness, which is spontaneously recovered in a short period of time. The causes of syncope can be manifold. Some fainting may be due to arrhythmias, both tachycardias and bradycardias.

·         Heart failure: is known by this name to a situation of loss of consciousness, serious, which does not recover spontaneously. Does not recover what difference this box syncope is that in this situation it must be conducted maneuvers of cardiac resuscitation or otherwise the patient causing death in a few minutes. This situation may be due to various causes that are not always heart, but serious arrhythmias are often the cause more frequent

PERICARDITIS

Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart). A characteristic chest pain is often present.

The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the pericardium (e.g., Mycobacterium tuberculosis), post-infarct pericarditis (pericarditis due to heart attack), or Dressler's pericarditis.

The cause of pericarditis is often unknown or unproven, but is often the result of an infection such as:

• Viral infections that cause a chest cold or pneumonia, such as the echovirus or coxsackie virus (which are common in children), as well as influenza
• Infections with bacteria (much less common)
• Some fungal infections (even more rare)

Chest pain is almost always present. The pain:

• May be felt in the neck, shoulder, back, or abdomen
• Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
• Can be a sharp, stabbing pain
• Is often relieved by sitting up and leaning or bending forward

You may have fever, chills, or sweating if the condition is caused by an infection.

Other symptoms include:

• Ankle, feet, and leg swelling (occasionally)
• Anxiety
• Breathing difficulty when lying down
• Dry cough
• Fatigue

Exams and Tests

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

• Crackles in the lungs
• Decreased breath sounds
• Other signs of fluid in the space around the lungs (pleural effusion)

The following imaging tests may be done to check the heart and the tissue layer around it (pericardium):

• Chest MRI scan
• Chest x-ray
• Echocardiogram
• Electrocardiogram
• Heart MRI or heart CT scan
• Radionuclide scanning

 

 

 

ENDOCARDITIS

 

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices. Endocarditis is characterized by a prototypic lesion, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells.^[1] In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.
There are multiple ways to classify endocarditis. The simplest classification is based on etiology: either infective or non-infective, depending on whether a microorganism is the source of the inflammation or not. Regardless, the diagnosis of endocarditis is based on clinical features, investigations such as an echocardiogram, and blood cultures demonstrating the presence of endocarditis-causing microorganisms.

The signs and symptoms of IE can vary from person to person. They also can vary over time in the same person. Symptoms you might notice include fever, shortness of breath, fluid buildup in your arms or legs, tiny red spots on your skin, and weight loss. Your doctor will diagnose IE based on your risk factors, medical history, signs and symptoms, and lab and heart tests.

Early treatment can help you avoid complications. Treatment usually involves high-dose antibiotics. If your heart valve is damaged, you may need surgery.

 

 

RHEUMATIC HEART DISEASE

Rheumatic heart disease is the most serious complication of rheumatic fever. Acute rheumatic fever follows 0.3% of cases of group A beta-hemolytic streptococcal pharyngitis in

children. We have information articles and valuable links to other resources.

The effects of rheumatic fever:

·         Rheumatic fever, an inflammatory disease, can affect many connective tissues, especially to the heart, joints, skin and brain.

·         Rheumatic fever can appear at any age, but usually occurs in children from five to 15 years of age.

·         Rheumatic fever causes damage to the heart - especially retractions of heart valves - forcing the heart to work harder to pump blood, and can ultimately cause congestive heart failure.

The following are the most common symptoms of rheumatic fever. However, each individual may experience symptoms differently. Symptoms, which vary greatly, starting typically from one to six weeks after an infection of the throat streptococcal, although sometimes the infection may have passed unnoticed by mild. Symptoms may include:

·         Fever.

·         Joints swollen, red, sensitive and extremely painful, especially in the knees, ankles, elbows or wrists.

·         Nodules on the swollen joints.

·         Red rash, with flanges and reticular form that usually appear on the chest, back and abdomen.

CARDIOMYOPATHY

Cardiomyopathy (literally "heart muscle disease") is the measurable deterioration of the function of the myocardium (the heart muscle) for any reason, usually leading to heart failure; common symptoms are dyspnea (breathlessness) and peripheral edema (swelling of the legs). People with cardiomyopathy are often at risk of dangerous forms of irregular heart beat and sudden cardiac death. The most common form of cardiomyopathy is dilated cardiomyopathy.

Cardiomyopathy is the name for diseases of the heart muscle. These diseases enlarge your heart muscle or make it thicker and more rigid than normal. In rare cases, scar tissue replaces the muscle tissue.

Some people live long, healthy lives with cardiomyopathy. Some people don't even realize they have it. In others, however, it can make the heart less able to pump blood through the body. This can cause serious complications, including

• Heart failure
• Abnormal heart rhythms
• Heart valve problems
• Sudden cardiac arrest

Heart attacks, high blood pressure, infections, and other diseases can all cause cardiomyopathy. Some types of cardiomyopathy run in families. In many people, however, the cause is unknown. Treatment might involve medicines, surgery, other medical procedures, and lifestyle changes.

HEART ATTACK

A heart attack, also known as a heart attack, occurs when the blood which must move through an area of the heart is broken completely.

Unfortunately, heart attacks are the leading cause of death in Spain and in almost all developed countries, also we do not contribute to paralyze it, since continue hurting ourselves with tobacco, alcohol, stress

Currently, both men and women are almost at the same level when assessing who is more likely to suffer a heart attack.

Although men are still affected major, women, due to their new habits (tobacco, little sport, etc...) and after menopause, become the main ones affected, ending in a balance thus, one of every two women death by heart attack

Symptoms of a heart attack:

·         Pain in the chest behind the breastbone, which lasts approximately 20 minutes and that radiates both arms and shoulders; also to the neck, teeth or jaw, even to the abdomen or back. You can only feel in one of these places

·         Tightness in the chest

·         Difficulty in breathing, tiredness, fatigue

·         Lightheadedness, dizziness, paleness in the face

·         Fainting

·         Cough

·         Nausea or vomiting

·         Sweating

• Anxiety

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