Cardiology Dr Osama Mahmoud

Peripheral vascu.lilr ..·•disiE!i!J!i

(I) Peripheral arterial-disease:

TTT:Thrombolysis, embolectomy.

(c)Buerger's disease in heavy smokers ..

(d)Aortic aneurysms (see before).

(e)Takayasu's disease (see rheumatology).

(f)Rayanud's phenomenon or disease:

Raynaud's phenomenon consists of spasm of the digital arteries

•The duration of the attacks is variable but they may last for hours.

•Numbness, burning sensation and severe pain occur as the fingers warm up.

TTT:• Avoid cold - wearing gloves - stop smoking.

•Avoid BB - give Ca.Ch.B.

•Sympathectomy or prostacyc1ine infusion for severe cases.

(II)Peripheral venous disease:

(a)Varicose veins.

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Shock

(Acute ctrculatory-failuse)

This term is used to describe acute circulatory failure with inadequate tissue perfusion resulting in generalized cellular hypoxia.

~ Causes of shock:

·0 Hypovolemic shock:

A condition causing major reduction of the blood volume e.g. internal or external hemorrhage, severe bums & dehydration (e.g diabetic ketoacidosis)

8 Cardiogenic shock:

Any form of severe heart failure. e.g. extensive myocardial infarction & acute mitral regurgitation.

@) Obstructive shock:

Obstruction of the blood outflow. e.g. massive pulmonary embolism, cardiac tamponade & tension pneumothorax.

o Neurogenic shock:

It is caused by major brain or spinal injury, producing disruption of brain stem & neurogenic vasomotor control.

It may be associated with neurogenic pulmonary edema.

@) Anaphylactic shock:

Due to inappropriate vasodilatation triggered by an allergen e.g.: shellfish, drugs or bee sting.

<D Septic shock / SIRS:

(Systemic inflammatory response syndrome):

Infection or any other causes of a systemic inflammatory response that produce widespread endothelial damage with vasodilatation, arteriovenous shunting, microvascular occlusion & tissue edema, resulting in multi-organ failure.

~ Haemodynamic changes in shock:

¢ Hypovolemic shock:

aIncrease systemic vascular resistance.

¢Cardiogenic shock:

a Increase systemic vascular resistance.

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¢ Cardiac tamponade & pulmonary embotism .."

aLow systemic vascular resistance.

¢Septic shock:

General features of shock:

• Hypotension (systolic Bp < 100 mmHg).

•Tachycardia> 100/minute.

•Rapid shallow respiration.

•Drowsiness, confusion, irritability.

•Oligurea (urine output < 30 ml/hr).

•Elevated or reduced CVP (see before).

• Cold or warm extremities (see later).

•Multi-organ failure (see later).

~Manifestations of shock ."According o types"

o Hypovolemic shock:

.:. Inadequate tissue perfusion:

A.Skin is pale, cold, slow capillary refilling.

B.Kidneys -7 oligurea or anuria.

C.Brain -7 confusion & restlessness .

•:. Increased sympathetic tone

A.Tachycardia, low pulse volume.

B.Sweating .

•:. Metabolic acidosis.

8 Cardiogenic shock:

Signs of myocardial failure: e.g. congested neck veins, gallop rhythm, basal crepitations, pulmonary edema.

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Cardi~l"d

@) Obstructive shock:

A.Cardiac tamponade:

A. Pulsus paradoxus & distant heart sounds.

~ Monitoring of patients in shoe

1- Clinical indices of tissue perfusion:

a.Pale cold skin, delayed capillary refilling & absence of visible veins in the hands & feet indicate poor perfusion.

b.Urinary output is a sensitive indicator of renal perfusion & haemodynamic performance.

2- Blood pressure.

3- Central venous pressure (CVP).

4- Wedged pulmonary artery pressure, by Swan-Ganz

catheter. It is inserted centrally or through the femoral vein or the antecubital vein -7 major veins -7 right atrium -7 right ventricle -7 pulmonary artery & into the wedge position.

Complications of Swan-Ganz catheter:

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.~ Tr~atment of shock:

Delay in making the diagnosis and in initiation of treatment and inadequate resuscitation leads to the development of multiple organ failure (MOF).

(A)General measures:

•Patent airway.

•Oxygen therapy.

•Fluid therapy either:

Crystalloid solution e.g saline or colloidal solutions e.g. Dextrans and hydroxyethyl starch

(More increase in plasma volume)

The fluid therapy is given according to the need and according to (CVP, type of shock)

2. Septic shock:

• Treatment of infection by antibiotic (IV)

•Surgical drainage for any collections elsewhere.

3.Anaphylactic shock:

4. Massive pulmonary embolism:

5.Cardiac Tamponade:

•Pericardiocentesis.

6.Cardiogenic shock:

•Dopamine, Dobutamine.

(C)Treatment of complications:

e.g. renal failure, coagulopathy and ARDS.

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Rheumatic fever is a systemic disease mainly affects the heart.

Immune mediated cardiovascular diseases.

-Rheumatic fever.

-Cardiac involvement in SLE, Rh 0, Vasculitis (see rheumatology).

Cardiovascular emergencies

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