Pathophysiology of Cardiovascular disorders

Tetralogy of fallot is a type of cardiovascular disorder classified as one of the most common congenital heart diseases which mean that it may be present at birth. Tetralogy of fallot consists of a combination of four different heart defects namely ventricular septal defect or VSD, right ventricular hypertrophy or RVH, overriding of the aorta or OA and pulmonary stenosis or PS. In VSD, there is an opening in the ventricular wall that separates the left and the right side of the heart that causes the mixing of oxygenated and non-oxygenated blood.

RVH signifies the increase in the muscle mass of the right ventricle due to the increase in the volume of blood that it needs to pump out into the circulation. In OA, the location of the aorta may be in between the right and left ventricles. PS limits the blood that can pass through the lungs. Symptoms: Hematologic system • Decreased oxygen saturation rate • Polycythemia or erythrocytosis • Elevated Erythrocyte sedimentation rate or ESR Both PS and VSD cause an increase in the amount of non-oxygenated blood present in the system as evidenced by a decrease in the oxygen saturation present in the arterial blood gas.

As deoxygenated blood is pumped out of the heart and into other organs, the body produces an increased amount of red blood cells or erythrocytosis in order to compensate for the lack of oxygen. The increase in the amount of erythrocytes as a result of the tetralogy cause the blood flow to decrease. This decrease in the blood flow predisposes the patient to infections which can cause the elevated erythrocyte sedimentation rate. Respiratory system • Dyspnea

The decrease in the amount of oxygen in the blood causes dyspnea or difficulty of breathing, and a bluish discoloration or cyanosis of the skin and the mucus membranes such as the lips and the buccal mucosa. During tet spells, worsening of the dyspnea as well as an increase in the amount of cyanosis causing a deepening of the blue discoloration is seen. Renal system • Oliguria or Polyuria The Tetralogy of Fallot can coexist with other organ malformations that can cause either oliguria or polyuria. Decreased urine can also be found after infection has set in following the surgical treatment of this disorder.

Disorder 2: Peripheral Arterial Disease Peripheral arterial disease is the most common cause of peripheral vascular disorders. It is caused by the build-up of plaque that is composed of fat and cholesterol deposits within the walls of the blood vessels. This condition is caused by smoking, high blood pressure and diabetes. A decreased blood flow to the legs can cause pain and numbness especially after exercise known as intermittent claudication. The decreased volume of blood flow to the legs can predispose the patient for infections that can result to leg amputation if left untreated. Symptoms: Hematologic system

• Hypercholesterolemia • Decreased blood flow • High blood pressure Decreased blood flow to the organs is due to the presence of the occlusion in the blood vessels. An elevated amount of cholesterol can predispose the patient to develop more plaques that can be located in any organ of the body. High blood pressure can cause turbulence in the blood flow predisposing a patient to develop plaques in the blood vessels. Respiratory system • Dyspnea Peripheral arterial hypertension or vascular compression of the left main stem bronchus can cause dypnea among patients with peripheral arterial disease.

Renal system • Oliguria Plaques in the renal arteries can cause a decrease in the blood flow to the kidneys causing renal failure initially manifested as oliguria or decreased amount of urine. Disorder 3: Congestive Heart Failure Congestive heart failure occurs when the heart fails to adequately pump blood out in order to reach the other organs. Right-sided heart failure occurs when the blood from the right ventricle is unable to reach the lungs for oxygenation. Left-sided heart failure occurs when the oxygenated blood pumped out by the left ventricle is unable to reach the other organs in the body.

Congestive heart failure may be due to plaque build-up in the blood vessels, high blood pressure and diabetes. Symptoms: Hematologic system • Hypercholesterolemia • Hyperlipidemia • High blood pressure • Elevated BNP levels During congestive heart failure, the blood pressure rises in order to help the heart pump the blood out further so that it can reach the other tissues. The heart releases an increased amount of BNP or B-type natriuretic peptide hormones during congestive heart failure. Respiratory system • Coughing • Shortness of breath or dyspnea

• Wheezing In congestive heart failure, complications such as pleural effusion and ascites can occur. Dyspnea, wheezes and shortness of breath is caused by the decrease in the ability of the lungs to expand either due to the amount of fluid in the lungs as well as the amount of fluid in the abdomen impinging the diaphragm. Coughing is caused by the conscious effort to clear up the airway passages. It may also be due to medications used to treat congestive heart failure such as angiotensin converting enzymes. Renal system • Dysuria

• Urinary Frequency • Urgency Congestive heart failure is treated with diuretic medications and these therapeutic drugs cause urinary frequency. The placement of urinary catheters for patients with congestive heart failure predisposes these patients to infections and thereby causes symptoms of dysuria and urgency. References: National Institutes of Health. U. S. Department of Health and Human Services. Retreived 25 June, 2009 available from: http://www. nhlbi. nih. gov/health/dci/Diseases/tof/tof_what. html>

National Institutes of Health. U. S. Department of Health and Human Services. Retreived 25 June, 2009 available from: http://www. nhlbi. nih. gov/health/dci/Diseases/Hf/HF_what. html National Institutes of Health. U. S. Department of Health and Human Services. Retreived 25 June, 2009 available from: http://www. nhlbi. nih. gov/health/dci/Diseases/pad/pad_what. html Salamon, M. (2009) Coughing and heart failure. About. com Retreived 25 June, 2009 available from: http://heartdisease. about. com/lw/Health-Medicine/Conditions-and-diseases/Coughing-and-Heart-Failure. htm

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