CORONARY OCLUSSION.

CORONARY OCLUSSION.

Coronary oclussion generally occurs within the heart vessels that give rise to a myocardial infarct due to a thrombus causing obstruction of the flow of blood; it may or may not be associated with atherosclerosis.

Phagocytic cells may bring about an oclussion, HOW? If an area is deprived with blood, the fibres of the muscles undergoes necrosis and there is an intrusion of phagocytic cells, with time fibroblasts and blood vessels grow from the surrounding tissue into the area, necrotic tissue is absorbed and collagen fibres laid down, after several weeks scar tissue will replace destroyed muscle fibre, fibroblast and blood vessels will have disappeared.

A fibrous scar is formed if the affected area is small, if the scar is extensive tissue becomes thin and which may stretch into a saccular aneurysm or a diffuse bulge. In aneurysm build up of calcium and formation of a thrombus may show.

Where lot of tissue is lost there is ineffective pumping machinery by the heart. The extend of heart failure greatly depends on the severity of damage to the muscles, in many instances shock leads to patient kicking the bucket and if survives will never be able to live a normal life.

Mild necrosis is controlled with introduction of oxygen, diuretics and digitalis to enable the victim almost live a near normal life.

SYMPTOMS OF CORONARY OCLUSSION.

  

• Chest pain and discomfort that lasts longer than that of angina effort.

• Pale.

• Sweating.

• Vomiting.

• Low and rapid pulse pressure.

• Leucocytosis.

• Slight increase in temperature.

• Shortness of breath.

OTHER COMPLICATIONS ASSOCIATED WITH CORONARY OCLUSSION.

Disorders of rhythm- this is due to differences in electrical potential between necrotic myocardium and healthy myocardium. This potential difference brings about ventricular fibrillation and consequent cardiac arrest.

Rhythmic disorders occurs even where there is very small infarcts, patients suffering from myocardial infarcts are nursed in a cardiac monitor for detection of rhythmic disorders that is treated with ventilation and defibrillation.

Emboli – it is a thrombus that is life threatening that may rise from endocardial thrombosis or from deep vein or arterial thrombosis.

A thrombus may be found in the systemic circulation or in pulmonary circulation.

Thrombosis occurs due to the following reasons ; hypotension, shock and from a slow clotting mechanism, lack of clotting factors, hemiplegia is cerebral emboli causing mental problems.

If emboli forms at the peripheral it blocks abdominal aorta or iliac vessels leading to gangrene

TREATMENT OF CORONARY OCLUSSION.

• Anticoagulants to dissolve a thrombus.

• Provide oxygen and rest.

• Morphine.

• Treat arrhythmia and hypotension.

• Surgical procedures to open blocked arteries may be performed.

ANGINA PECTORIS.

ANGINA PECTORIS.

Angina pectoris is a heart complication that is characterized by sudden retrosternal pain where an increased demand for blood is directed to the heart. Pectoris angina occurs commonly due to lack of adequate blood in heart. Lack of blood supply may be contributed by factors such as presence of atheromatous in the heart vessels causing obstruction of blood due to clogged arteries, diseases such as ischemia, coronary occlusion, coronary heart disease, anemia, arterial embolism and which are complications of the heart.

HOW ANGINA PECTORIS CAUSES PAIN.

It is obvious that chemical changes occur when muscles are in action of contraction and waste products removed by an adequate circulatory system. If these wastes were to remain in the tissues as a result of inadequate blood supply to push them away they would cause pain.

In angina effort, myocardium blood is enough at rest but inadequate on effort, when the patient does strenuous work he is hit by pain of varying intensity that starts behind the sternum that could be felt up to the neck, spread to the jaw and to one or both hands. Angina effort pain does not last for long but so frightening that the patient feels death is looming.

Changes in emotion may trigger an angina attack where adrenaline is established to fight or fright resulting into an increased heart beat hence craves for oxygen by cardiac cells.

SYMPTOMS OF ANGINA PECTORIS.

• Chest discomfort.

• Chest pain is the core symptom of pectoris angina.

• Tightness and difficulties in breathing.

• Fatigue.

• Palpitations.

TREATMENT OF ANGINA PECTORIS.

There is no straight line as curing of angina pectoris is concerned but treatment of angina pectoris is aimed at relieving and slowing down the progression as coronary artery disease is usually present.

• Factors that predispose individuals to angina pectoris must be avoided, that includes; hypertension, thyrotoxicosis, smoking and anemia, maintain ideal body mass.

• Patients with this condition should try as much as possible to be calm and avoid hurry, worry and tension. And those are the simplest ways of avoiding angina of the pectoris.

• Vasodilators are best taken to relieve an attack of pectoris angina.

• Glycergl trinitrate ought to be taken prior to activity so to provoke an attack of pain in the chest.

• Apart from other effects of alcohol it is known to be a good vasodilator and is good for the heart especially when taken at night.

• Propranolol will reduce levels of scrum cholesterol associated with heart bubbling and complication of the heart.

• Clofibrate is an effective drug for pectoris angina.

• Phenobarbitone is a siutable drug to reduce fear and anxiety.

• In some cases surgery is essential to improve blood supply by removing clogged matter in the blood vessels.

TRICUSPID VALVE DISEASE.

TRICUSPID VALVE DISEASE.

Tricuspid valve is responsible for the control of blood entering and leaving the heart. Blood passes through the right aorta via tricuspid valve and into the right ventricle then the blood is pumped out through the pulmonary artery and into the lungs for circulation and oxygenation.

CAUSES OF TRICUSPID VALVE DISEASE.

• Hardening and thinning of the valve known as stenosis that may be due to atherosclerosis, narrows the valves with outcome being inadequate blood supply.

• Improper closing of the tricuspid valve. Valve that does not close properly results into blood leaking in the auricle.

• Pulmonary hypertension.

• Rheumatic endocarditis.

• Mitral valve.

• Aortic valve.

SYMPTOMS OF TRICUSPID VALVE DISEASE.

Tricuspid symptoms are often overshadowed by symptoms of other valvular disease.

• Dyspnoea and, or orthopnoea if the disease is associated with mitral stenosis.

• Irregular heart beats.

• Discomfort especially in the chest.

• Fatigue.

• Anxiety.

• Insomnia.

TREATMENT OF TRICUSPID VALVE DISEASE.

For tricuspid stenosis surgical procedure is necessary. It is important to treat incompetence by dealing directly with the cause.

VALVULAR HEART DISEASE.

VALVULAR HEART DISEASE.

It has become one of the most common heart disease affecting millions of people world wide.

The heart is a connection of valves; the valves are continuous with the endocardium which lines the chambers of the heart. The mitral valve and the tricuspid valve lie in the artrioventricular fibrous ring, they shut when the pressure in the ventricles is rising so that the blood does not regurgitate into the atrium, pulmonary valve, the right ventricle and the pulmonary artery, and the aortic valve between the left ventricle and the aorta remains shut until the ventricular pressures exceed the pressures in the arterial side of the valve.

TYPES OF VALVULAR HEART DISEASE.

Pulmonary stenosis –It is a congenital deformity that could be an isolated lesion but more commonly found in association with ventricular septal defect.

Pulmonary incompetence – In this condition the blood tends to leak due to fault valve that does not tightly close. The disease is associated with pulmonary hypertension in which the pulmonary artery dilates dilation of the right ventricle leads to an enlarged orifice from the right ventricle to the pulmonary artery.

CAUSES OF VALVULAR DISEASE.

• Congenital lesions may affect pulmonary valve, aortic and tricuspid valve.

• Syphilis affects the aortic valve.

• Rheumatic endocarditis.

• Subacute bacterial endocarditis.

• Trauma may rupture valves.

• Stenosis.

• Cholesterol.

SYMPTOMS OF VALVULAR DISEASE.

• Stenosis – this is thinning and hardening of valve’s cusp leading to overall reduction in the cross sectional area of its open orifice.

• Pulmonary incompetence.

• Subacute bacterial endocarditis.

• Rheumatic endocarditis.

• Heart failure cardiac arrest.

• Aortic dissection.

TREATMENT OF VALVULAR HEART DISEASE.

There are many defects that are associated with the heart valves and the presence of one or more defects brings about stress and strain on the heart which must work too hard to maintain a steady supply of the blood.

• Valves are repaired by special procedures.

• Adhered cusps and fibrosed valve rings can be dealt with by valvotomy.

• Prosthesis involves complete replacement of valves.

• Cardiac arrythmia and palpitations are treated with suitable drugs.

• Heart failure is treated with drugs, diet, enough rest and supply of oygen to relieve the work load of the heart. After recovery the patient should accept to live within the limits imposed by the condition to avoid becoming a chronic cardiac invalid.

• Anticoagulants – This are drugs used in treating valvular disease complications more so artery emboli.

• Infections of the lungs must be avoided and treated as soon as it appears.

• Abortion to terminate pregnancy may be carried out or pregnancy dealt with a lot of care and caution.

• Conservative treatment where surgery is not suitable due to age factor and as the state of the patient.

• Valvular lesion patients are advised not to engage in heavy manual work.