Cardiac Conditions and Diseases

OT Dude Academy’s Free NBCOT® Exam Prep Course Cardiology Cardiac Conditions and Diseases
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1 Cardiac Tamponade
2 Valvular Heart Disease
3 Aortic Aneurysm
4 Arrhythmias
5 Heart Failure
6 Heart Defects
7 Heart Block

Cardiac Tamponade

A cardiac emergency is characterized by an abnormal increase in fluid accumulation in the pericardial sac which raises intracardiac pressures impedes normal cardiac filling and reduces cardiac output.1  Mimics cardiac arrest. The main causes include percutaneous cardiac interventions, malignancies, infection, inflammatory causes, and mechanical complications of MI and aortic dissection. Standard treatment is pericardiocentesis under local anesthesia.2 

Valvular Heart Disease

A condition in which any of the heart’s valves (mitral, tricuspid, aortic, pulmonary) are damaged or diseased. The valves become “leaky” and do not close completely, causing regurgitation and insufficient blood pumping through the heart. Another type of condition is stenosis of the heart valves. Causes include rheumatic disease, endocarditis, congenital malformations, heart failure, atherosclerosis, aortic aneurysm, hypertension, MI, autoimmune disease, Marfan syndrome, or environmental exposures. Symptoms include dyspnea, angina, fatigue, dizziness, fever, rapid weight gain, and irregular heartbeat. Surgery involve valve replacement may be recommended depending on severity.3 

Aortic Aneurysm

A life-threatening condition characterized by a bulge in the aorta that can dissect (blood leaks between the layers of the artery wall) or rupture. Types include thoracic aortic aneurysm, abdominal aortic aneurysm (AAA), or other types.4 5  The likelihood that an aneurysm will rupture depends on size, expansion rate, continued smoking, and persistent hypertension. Risk factors include hypertension, hyperlipidemia, and atherosclerosis. May present with abdominal pain or be complicated by thrombosis and embolization. Management includes the reduction of risk factors, medications such as beta-blockers, observation, endovascular stenting, and surgical repair.6  Patients with a current thoracic aortic aneurysm or dissection or a previous repair are advised to make lifestyle changes including avoiding strenuous lifting, pushing, or straining that would involve a Valsalva maneuver.7 

Arrhythmias

A variation from the normal heart rate and/or rhythm caused by irregular electrical impulses that control the heart. The two categories of mechanisms are (1) enhanced or abnormal impulse formation and (2) conduction disturbance.8  Arrhythmias can be fast (tachycardia with a resting heart rate greater than 100 beats per minute) or slow (bradycardia with a resting heart rate less than 60 beats per minute). Types of tachycardia include atrial fibrillation, atrial flutter, supraventricular tachycardia, Wolff-Parkinson-White syndrome, ventricular tachycardia, ventricular fibrillation, long QT syndrome. Types of bradycardia include sick sinus syndrome and conduction block. A premature heartbeat feels like a skipped heartbeat (but is actually an extra beat). Symptoms of arrhythmia include: fluttering in the chest, a racing heartbeat, a slow heartbeat, chest pain, and shortness of breath. Multiple conditions and behaviors can cause or increase the risk of arrhythmias. Arrhythmias may be complicated by stroke and heart failure. Treatment includes vagal maneuvers (holding the breath and straining), medications, cardioversion, catheter ablation, implantable devices, or surgery.9  Some patients with arrhythmias are advised not to drive10 11  or participate in vigorous competitive sports.12  There is a strong association between obesity and atrial fibrillation.13 

Heart Failure

Also known as congestive heart failure (CHF) – is the failure of the heart muscle to pump blood, resulting in fluid back-up that can build in the lungs and cause shortness of breath. Heart failure can be acute or chronic. Types include left-sided failure (fluid back up in the lungs), right-sided failure (fluid back up into the abdomen and lower extremities), systolic heart failure (a pumping problem), and heart failure with preserved ejection fraction (left ventricle can’t relax or fill fully). Risk factors include CAD, MI, heart valve disease, hypertension, arrhythmia, congenital heart disease, diabetes, alcohol use, sleep apnea, smoking, obesity, and viruses14  (including COVID-19).15  Signs and symptoms include shortness of breath, fatigue and weakness, edema, arrhythmias, decreased exercise tolerance, a persistent cough or wheezing with productive mucus, abdominal swelling, rapid weight gain, nausea, lack of appetite, difficulty concentrating, and angina. Exercise training in patients with stable mild to moderate CHF can increase their exercise capacity, reduce dyspnea, and fatigue.16  Patients with CHF have reported feeling restricted in their daily lives including social activities and relationships.17  “In stable CHF patients with systolic dysfunction, supine position is associated with a worsening of oxygenation.”18  Consider elevating the head of the bed or a seated position instead of a supine position after therapy.

Heart Defects

  • Patent ductus arteriosus is a congenital condition in which the ductus arteriosus fails to close. If untreated, the condition can result in congestive heart failure.
  • Patent foramen ovale is one type of atrial septal defect (ASD), due to a failure of the hole in the interatrial septum to close at birth. As much as 20 – 25 percent of the general population may have a patent foramen ovale, most have the benign, asymptomatic version but in extreme cases, a surgical repair is required to close the opening permanently.
  • Tetralogy of Fallot is a congenital condition that may also occur from exposure to unknown environmental factors; it occurs when there is an opening in the interventricular septum caused by blockage of the pulmonary trunk, normally at the pulmonary semilunar valve. This allows blood that is relatively low in oxygen from the right ventricle to flow into the left ventricle and mix with the blood that is relatively high in oxygen.
    • Symptoms include a distinct heart murmur, low blood oxygen percent saturation, dyspnea, polycythemia, clubbing of the fingers and toes, and in children, difficulty in feeding or failure to grow and develop.
    • It is the most common cause of cyanosis following birth. Other heart defects may also accompany this condition, which is typically confirmed by echocardiography imaging.
  • In the case of severe septal defects, including both tetralogy of fallot and patent foramen ovale, failure of the heart to develop properly can lead to a condition commonly known as a blue baby Regardless of normal skin pigmentation, individuals with this condition have an insufficient supply of oxygenated blood, which leads to cyanosis, especially when active.19 

    Heart Block

    An interruption in the normal conduction pathway. Heart blocks are generally named after the part of the conduction system that is causing the problem. For example, bundle branch blocks occur within either the left or right atrioventricular bundle branches.

    AV blocks are often described by degrees. A first-degree or partial block indicates a delay in conduction between the SA and AV nodes. A second-degree or incomplete block occurs when some impulses from the SA node reach the AV node and continue, while others do not. In the third-degree or complete block, there is no correlation between atrial activity and ventricular activity. This means that none of the impulses generated by the SA node get transmitted to the rest of the heart and the AV node must take over as the primary pacemaker, initiating contractions at 40–60 beats per minute, which is adequate to maintain consciousness.

    In order to speed up the heart rate and restore full sinus rhythm, a cardiologist can implant an artificial pacemaker, which delivers electrical impulses to the heart muscle to ensure that the heart continues to contract and pump blood effectively. These artificial pacemakers are programmable by the cardiologists and can either provide stimulation temporarily upon demand or on a continuous basis. Some devices also contain built-in defibrillators.20 

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  2. Imazio, M., & De Ferrari, G. M. (2021). Cardiac tamponade: an educational review. European heart journal. Acute cardiovascular care, 10(1), 102-109.[↩]
  3. Otto CM, Bonow RO. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014.[↩]
  4. Norman PE, Curci JA. Understanding the effects of tobacco smoke on the pathogenesis of aortic aneurysm. Arterioscler Thromb Vasc Biol. 2013;33(7):1473–7.[↩]
  5. Creager MA, Loscalzo J. Diseases of the aorta. In: Fauci AS, Longo DL, Kasper D, Braunwald E, Jameson JL, Loscalzo J, Hauser SL, eds. Harrison’s Principles of Internal Medicine. 17th ed. Columbus, OH: McGraw-Hill; 2008:1563–7.[↩]
  6. Aggarwal, S., Qamar, A., Sharma, V., & Sharma, A. (2011). Abdominal aortic aneurysm: A comprehensive review. Experimental & Clinical Cardiology, 16(1), 11.[↩]
  7. L.F. Hiratzka, G.L. Bakris, J.A. Beckman, R.N. Bersin, V.F. Carr, D.E. Casey Jr., et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease J Am Coll Cardiol, 55 (2010), pp. e27-e129[↩]
  8. Antzelevitch, C., & Burashnikov, A. (2011). Overview of basic mechanisms of cardiac arrhythmia. Cardiac electrophysiology clinics, 3(1), 23-45.[↩]
  9. Mayo Clinic. (n.d.). Heart arrhythmia. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/[↩]
  10. Banning, A. S., & Ng, G. A. (2013). Driving and arrhythmia: a review of scientific basis for international guidelines. European heart journal, 34(3), 236-244.[↩]
  11. Strickberger, S. A., Cantillon, C. O., & Friedman, P. L. (1991). When should patients with lethal ventricular arrhythmia resume driving? An analysis of state regulations and physician practices.[↩]
  12. Lampert, R. (2012). Evaluation and management of arrhythmia in the athletic patient. Progress in cardiovascular diseases, 54(5), 423-431.[↩]
  13. Nishimura, M., & Hsu, J. C. (2021). Dietary Considerations for the Prevention and Treatment of Arrhythmia. In Prevention and Treatment of Cardiovascular Disease (pp. 265-271). Humana, Cham.[↩]
  14. Mayo Clinic. (n.d.). Heart Failure. Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes[↩]
  15. Rey, J. R., Caro‐Codón, J., Rosillo, S. O., Iniesta, Á. M., Castrejón‐Castrejón, S., Marco‐Clement, I., … & Buño, A. (2020). Heart failure in COVID‐19 patients: prevalence, incidence and prognostic implications. European journal of heart failure, 22(12), 2205-2215.[↩]
  16. Coats AJS, Adamopoulos S, Radaelli A, et al. Controlled trial of physical training in chronic heart failure: exercise performance, hemodynamics, ventilation and autonomic function. Circulation 1992;85:2119–31.[↩]
  17. Thornhill, K., Lyons, A. C., Nouwen, A., & Lip, G. Y. H. (2008). Experiences of living with congestive heart failure: a qualitative study. British journal of health psychology, 13(1), 155-175.[↩]
  18. Vitacca, M., Scalvini, S., Volterrani, M., Paneroni, M., Giordano, A., & Ambrosino, N. (2016). Physiological and symptom effects of changing posture from sitting to supine, and vice versa, in stable chronic heart failure. Acta cardiologica, 71(5), 543-548.[↩]
  19. Betts, J.G., Young, K.A., Wise, J.A., Johson, E., Poe, B., Kruse, D. H., Korol, O., Johnson, J.E., Womble, M. & DeSaix, P. (2013). Anatomy and Physiology. OpenStax. http://cnx.org/content/col11496/latest/[↩]
  20. Betts, J.G., Young, K.A., Wise, J.A., Johson, E., Poe, B., Kruse, D. H., Korol, O., Johnson, J.E., Womble, M. & DeSaix,
    P. (2013). Anatomy and Physiology. OpenStax. http://cnx.org/content/col11496/latest/[↩]
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