Angiography and Notes

Angiography

Left Heart Failure and Right Heart Failure

Key point about:
1. Left Heart Failure

• Forward failure, that means have problem getting the blood out of heart. So EDV will increase, because you cannot get all the blood out.
• Pulmonary Edema - Ok, how does this happens? The pressure and volume build up in the left ventricle go back to left atrium, and then back to pulmonary vessels, which increases hydrostatic pressure and then results in pulmonary edema.
• There will be hemorrhage and the alveolar macrophages will phagocytose RBCs, leading to rusty colored sputum. 
• Main symptom in LHF is Dyspnea [trouble breathing because of fluid in lungs].
• Paroxysmal Nocturnal Dyspnea and Pillow Orthopnea.

2. Right Heart Failure 

• Backward failure, cannot get blood into heart [through pul vessels], so there is a build up of blood causes increases pressure --> leads to Neck vein distention, Hepatomegaly, Nutmeg liver [due to increased pressure in the vena cava ]. 
• Thus MCC of congested hepatomegaly is RHF. Pitting edema can also be seen as a sign.

Heart Murmers

These are the keep point that you should make out of murmers, well mainly high yeild. I got little lazy to type up the material so put up my notes, if you cannot read it clearly, let me know. I will type up the material in detail.

Complications of Hypertension

1.Hypertension is a major risk factor for Coronary Artery disease, which lead to Multiple Infarction [so tits the main common cause of death], this could result in stroke. 

2. Another risk factor is Aneurysm [Charcot Bouchard Aneurysms] - Blood located in globus pallidus and putamen [ this is the place where there is almost all of the hypertension bleeds which occur in brain]. This is because the lenticulostriate vessels[ which is a small vessels of the middle cerebral artery] and under increase pressure form aneuryms and then rupture. This is not an infarct - it is a hematoma - its a blood clot right there. So this is the 2nd main common cause of death in hypertension bleed.

3. Next main cause is due to hylaine arteriosclerosis - a small vessel disease which cause ischemia of the kidney, atrophy of the tubulesand destruction of glomeruli, thus there is shrinkage of kidney and leads to kidney failure. Thus cause death in HTN patients. 

Main cause overall abnormality in hypertension is Left Ventricular hyperplasia which can cause heart failure.

 Various organs and how its related.
1. Adrenal - Cushing's syndrome  [increase mineralocorticoids], Pheochromocytoma [increase catecholamines], Neuroblastoma [ catecholamines], 11-hydroxylase deficiency [increase 11-Deoxycortisol: mineralocorticoid]

2. Aorta - Post-ductal coarctation [Activation of RAA system in elderly]. Renal retention of sodium.

3. CNS - Intracranial hypertension [due to catecholamines and other various reasons]

4. Drugs - Oral contraceptive [Estrogen increase angiotensinogen synthesis]

5. Parathyroid - Primary hyperparathyroidism [Calcium effect on TPR arterioles]

6. Pregnancy - Preclampsia [increase angiotensin 2]

7. Renal - Renovascular disease [increase AT3 and aldosterone], Renal parenchymal disease [Sodium retention]

8. Thyroid - Grave's disease [Systolic hypertension: increase stroke volume], Hypothyroidism [Sodium retention].