1. Cardiac Failure

It is described as a condition in which the heart’s cardiac output is unable to satisfy the need of the body. In mild cases, the heart provides sufficient cardiac output at rest and becomes insufficient when the work of body tissues is increased like during the exercise. Failure can be either on one side of the heart or on both sides of the but heart; even when the failure occurs in one side, work load increases on the other side which leads to increased strain on the other side and eventually the other side also fails. In most of the cases, left side is most affected than right side due to greater work load of left ventricle.
In case of acute heart failure, the body gets very little time to make changes, but if the heart fails over a period of time certain changes are made by in order to maintain the cardiac output like-
• The cardiac muscle mass increases (hypertrophy), makes the walls of the chamber thicker
• Heart chamber enlarge
• The rennin-angiotensin mechanism, increases the blood volume and cardiac output.
Cardiac heart failure are of two types
1. Acute heart failure-if the heart failure occurs suddenly and there is no time for compensation.
2. Chronic heart failure- the heart failure occurs gradually and during early stages it may not show symptoms and the condition can be improved.

Causes include- a heart attack, heart valve diseases, high BP, diabetes, emphysema( a lung disease) etc. 

Treatment :- This disease can be cured by following types of drugs like- Aldosterone antagonist, Beta-blockers, blood vessel dilators, ARBs( angiotensin II receptor blockers) etc.

2. Ischemic heart disease

This is due to ischemia, generally caused due to narrowing or blocking one or more branches of coronary arteries. The overall effect depends upon the size of coronary artery that whether is has become narrow or completely blocked. If the artery have become narrow, it leads to angina pectoralis and blocking leads to myocardial infractions. When sudden severe narrowing or blocking of an artery occurs, the anastomotic arteries dilate but may not be able to supply enough blood to meet the heart’s need.

Causes include-

• heredity of coronary artery disease,
• high cholesterol, obesity,
• high BP,
• diabetes mellitus,
• last stage kidney disease etc.

Treatment is done with the help of following drugs like:-

• Aspirin,
• nitrates,
• beta-blockers,
• calcium channel blockers,
• cholesterol lowering medicines,
• ACE inhibitors.

3. Angina pectoris

It is sometimes also known as angina of effort because the increased cardiac output required during extra exercise causes severe chest pain which also passes to arms, neck and jaw. During angina pectoris, the coronary artery becomes narrower and a narrowed coronary artery can supply sufficient blood during rest and less physical work but when physical load increases, it heart starts showing the above symptoms. The thick inflexible artery is unable to dilate to allow the increased blood flow and leads to ischemic.

Causes include- 

• reduced blood blow to heart muscle,
• heart muscles not provided with enough oxygen.

Treatment:- It requires almost same drugs as required for ischemic heart disease.

• nitrates,
• beta-blockers,
• calcium channel blockers,
• cholesterol lowering medicines,
• ACE inhibitors.

4. Myocardial infraction

When the branch of coronary artery is blocked, the myocardium may infract. This damage is permanent because cardiac muscle cannot be regenerated and they are replaced by non- functional fibrous tissue. To restore the blood flow through the coronary artery clot-dissolving drugs are used to improve the damage, but treatment should start within the few hours of infraction and the complications become worse when the myocardium of left ventricle is also damaged.
The symptoms include severe chest pain behind the sternum and in angina the chest pain occur mostly during extensive physical work but in this disease, chest pain is severe even during rest and can even lead to death.

Causes:-

• coronary trauma,
• ventricular hypertrophy etc.

Treatment is done with the help of drugs like

• beta blockers
• glyceryl trinitrate
• ACE inhibitors.

5. Rheumatic heart disease

It is an inflammatory disorder which mostly occurs in adults and children. It is an autoimmune disorder. Death rarely occurs in acute phase, but even after recovery they may be permanent damage to the heart valves which eventually leads to cardiac failure. It is of two types
• Acute rheumatic heart disease
• Chronic rheumatic heart disease

Causes- this disease is mainly caused due to rheumatic fever, an inflammatory disease that can affect many connective tissue especially in heart, joints, skin and brain.

Treatment  :- drugs like

• aspirin,
• steroids and non-steroidal medications are given which all are anti-inflammatory doses.

6. Cardiac arrhythmia

It is a disorder of heart rate or rhythm, and is a result of abnormal generation of impulses. The normal cardiac cycle gives rise to normal sinus rhythm which is between 60-100 bpm
• Sinus bradycardia- in this the normal sinus rhythm is below 60bpm this is common in athletes
• Sinus tachycardia- in this normal sinus rhythm is above 100bpm
• Asystole- this occurs when there is no electrical activity in the ventricles, therefore no cardiac output. The ECG shows the flat line. and ultimately leads to death
• Fibrillation- in this contraction of cardiac muscle fibers occurs in a disorderly sequence. The chambers do not work in coordination and pumping action is disturbed.

The common causes includes-

• heart attack,
• change in the structure of heart,
• coronary artery diseases,
• high BP etc.

TREATMENT:- it is done by

• anti-arrhythmic  drugs,
• calcium channel blockers,
• beta-blockers,
• blood vessel dilators etc.

7. Heart block

This occurs when normal impulse transmission is blocked. This happens when the impulses from AV node are not transmitted accurately.

Causes for this disease are-

• Acute ischemic heart disease

• Drugs used to treat heart diseases, eg digitalis etc.

• Myocardial fibrosis following repeated infractions

Treatment:– is done with the help of drugs like

• beta-blockers,
• calcium channel blockers,
• anti-arrhythmic drugs, digoxin etc.

Multiple choice questions(MCQs)

1. What happens in cardiac failure?
A. The cardiac output is unable to satisfy the need of blood in body
B. disturbed heart rate
C. blockage of coronary artery
D. narrowing of coronary arteries

2. what happens in the Ischemic heart disease?
A. The cardiac output is unable to satisfy the need of blood in body
B.. blockage of coronary artery
C. narrowing of coronary arteries
D. both B and C

3. What happens in angina pectoris?
A. The cardiac output is unable to satisfy the need of blood in body
B. disturbed heart rate
C. blockage of coronary artery
D. narrowing of coronary arteries

4. Which of the following disorders does NOT come under cardiac arrhythmias?
A. asystole B. fibrillation
C. sinus tachycardia D. none of the above

5. What happens during sinus bradycardia?
A. sinus rhythm is above 100bpm                         B. ECG shows flat line
C. chambers do not work in co-ordination        D. sinus rhythm is below 60bpm

6. which of the following statement is true?
A. during asystole chambers do not work in coordination
B. during myocardial infraction, coronary arteries are blocked
c. during cardiac arrhythmias, coronary artery is narrowed
d. during heart block, impulses from SA node are not transmitted properly.

7. what is the cause for heart block?
A. acute ischemic heart diseases
B. drugs used like digitalis
C. myocardial fibrosis following repeated infractions
D. all of the above

8. What happens during fibrillation?
A. sinus rhythm is above 100bpm                    B. ECG shows flat line
C. chambers do not work in co-ordination      D. sinus rhythm is below 60bpm

9. Match the following-
A. asystole                             1. Rhythm above 100bpm
B. fibrillation                        2. Rhythm below 60bpm
C. sinus tachycardia            3. ECG is flat line
D. sinus bradycardia           4. Chambers works in no
coordination

10. During heart block, from where impulses are not transmitted accurately?
A. SA node                                       B. AV node
C. bundle of his                               D. purkinje fibers

 ANSWERS:-

1. cardiac output is unable to satisfy the need of body
2. both B nad C
3. narrowing of coronary arteries
4. none of the above
5. sinus rhythm below 60bpm
6. during myocardial infraction, coronary arteries are blocked
7. all of the above
8. chambers o not work In coordination
9. A – 3 B – 4 C – 1 D – 2
10. AV node

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REFERENCE: 1. Ross and Wilson-Anatomy and physiology in health and illness; 12th edition; page no.-: 126-130.