Chapter 53: Adult Cardiovascular Problems

The heart's structural organization—comprising the epicardium, myocardium, endocardium, and protective pericardial sac—is essential for understanding how alterations in cardiac function lead to disease. The conduction system, originating from the sinoatrial node as the primary pacemaker, generates the electrical impulses necessary for coordinated heart rhythm, while blood pressure regulation involves baroreceptors, hormonal systems including the renin-angiotensin-aldosterone pathway, and antidiuretic hormone. Diagnostic evaluation relies on cardiac biomarkers such as troponin for detecting myocardial injury and b-type natriuretic peptide for assessing heart failure severity, supplemented by invasive cardiac catheterization when coronary patency requires assessment. Dysrhythmias range from benign sinus variations to life-threatening ventricular fibrillation, each requiring distinct interventions from pharmacological management to defibrillation and pacemaker insertion. Coronary artery disease manifests as angina in its various presentations and progresses to acute myocardial infarction when tissue necrosis occurs, necessitating immediate oxygen administration and pain control. Heart failure, whether affecting the left or right ventricle, produces characteristic pulmonary or systemic congestion patterns and may precipitate acute pulmonary edema requiring aggressive intervention. Additional cardiac pathologies include inflammatory conditions such as pericarditis and endocarditis, valvular stenosis or regurgitation, and aneurysmal disease. Vascular disorders encompassing peripheral arterial disease, venous insufficiency, and deep vein thrombosis demand specific preventive measures and anticoagulation strategies. Hypertension, classified into stages and hypertensive crises, requires tailored pharmacological and lifestyle management to prevent end-organ damage and acute complications.