Chronic illness

Key problem areas experienced by patients with chronic illness

http://www.innerwisdom.com/chronic-illnesses-and-medical-problems.htm

PATHO

1. Coronary artery disease

2. Faulty heart valves / vulvar heart disease
3. Cardiomyopathy
4. Congestive heart failure

VALVULAR HEART DISEASES

1. Mitral valve stenosis – obstruction of mitral orifice (this disorder causes overwork for the left
atrium)

Etiology – RHF,

As valves becomes calcified and immobile. Valvular orifice narrows -> preventing normal
passage of blood from the left atrium to the left ventricle -> blood flow from the left atrium to
the left ventricle is still allowed but pressure is still generated -> as the mitral valve progressively
narrows, pressure in the left atrium, pulmonary veins and pulmonary capillaries increases ->
pressure is still elevated that causes the left atrium to dilate, pulmonary artery pressure to
increase and pulmonary fluid to transudate in perivascular and perialveolar areas, making the
lungs stiff -> fluid gradually accumulate in the alveoli causing pulmonary edema -> right ventricle
hypertrophies as pulmonary vascular resistance increase -> right ventricle fails, followed by right
atrial hypertension and systemic congestion -> inadequate filling of the left ventricle results in
reduced cardiac output.
PATHOPHY

CONGESTIVE HEART FAILURE – state which abnormal circulatory congestion exists as a result of heart
failure

 MAINTAINING NORMAL CARDIAC OUTPUT

1. Compensatory mechanisms
A. Enlargements
a. Hypertrophy, cardiac dilatation or both.
B. Tachycardia
a. Norepinephrine
b. Renin-angiotensin aldosterone mechanism.
C. Myocardial contractility – (maintain stroke volume)
D. Stretching
a. Cardiac dilatation – (occurs when the left ventricle fails to eject normal end diastolic
volume)

I. Sympathetic nervous system stimulation

II. Renin-angiotensin system activation
III. Altered cardiac rhythm

i. LEFT VENTRICULAR FAILURE and RIGHT VENTRICULAR FAILURE

Ischemic heart disease – atherosclerosis and endothelial dysfunction -> fixed vessels narrowing and
abnormal vascular tone -> reduced blood flow in coronary arteries -> imbalanced myocardial oxygen
supply and demand. (mi) (left vent dilatation)

Myocarditis – entry of species (bacteria, virus, fungi, etc) -> acute inflammatory reaction with
polymorphonuclear leukocytes 1st day of infection -> mononuclear leukocytes infiltrate by the end ->
changes in fibrosis and loss of myofibers -> necrosis of myofibers either patchy or diffuse.

Valvular heart disease – incomplete closure of valve -> backflow of blood to the chambers -> decrease
volume of blood ejected -> increase atrial pressure -> atrial hypertrophy -> increase pulmonary pressure
-> increase ventricular pressure – right or left sided heart failure.

Pulmonary hypertension – pulmonary arteries become clogged and narrowed -> pulmonary
hypertension -> right heart ventricle overworked -> enlargement and weakening of the organ or death.

Cor pulmonale – abnormal enlargement of the right side of the heart -> disease of the lungs or the
pulmonary blood vessels
 ii. COMPENSATORY MECHANISMS
A. Sympathetic nervous system stimulation -> tachycardia -> further stress on myocardium
B. Activation of norepinephrine atrial natriuretic peptide -> tachycardia -> further stress on
myocardium
C. Activation of renin-angiotensin-aldosterone mechanism -> Na and water retention -> further
stress on myocardium

CONGESTIVE HEART FAILURE – doesn’t pump blood well

D. Increase myocardial contractility -> increase cardiac workload -> cell stretching

COMPENSATORY HYPERTROPHY AND DILATATION

CHRONIC ILLNESS

Disease that is persistent or long-lasting

Generally, cannot be prevented by vaccines or cured by medication

Do not just disappear