Lecture: Cardiovascular System - Signs, Symptoms, Management, and Anaesthetic Considerations
Lecture: Cardiovascular System - Signs, Symptoms, Management, and Anaesthetic Considerations
Introduction
The cardiovascular system, comprising the heart and blood vessels, is essential for oxygen and nutrient delivery throughout the body. Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, encompassing conditions like coronary artery disease (CAD), hypertension, heart failure (HF), arrhythmias, and valvular heart diseases. This lecture covers common signs and symptoms, management strategies, and key anaesthetic considerations for patients with these conditions.
Common Cardiovascular Diseases: Signs, Symptoms, and Management
1. Hypertension
Signs and Symptoms: Often asymptomatic ("silent killer"), but may include headaches, dizziness, blurred vision, epistaxis, or signs of end-organ damage like retinopathy or left ventricular hypertrophy.
Management:
- Lifestyle modifications: Diet (DASH), exercise, weight loss, salt restriction.
- Pharmacological: ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics.
- Target BP: <130/80 mmHg for most adults.
2. Coronary Artery Disease (CAD) / Angina / Myocardial Infarction (MI)
Signs and Symptoms: Chest pain (angina: retrosternal, radiating to arm/jaw, relieved by rest/nitroglycerin), shortness of breath (SOB), fatigue, nausea, sweating (in MI). Atypical in women/elderly: jaw/back pain, epigastric discomfort.
Management:
- Acute MI: MONA (Morphine, Oxygen, Nitroglycerin, Aspirin), PCI/thrombolysis.
- Chronic: Antiplatelets (aspirin), statins, beta-blockers, ACEIs, revascularization (CABG/PCI).
- Lifestyle: Smoking cessation, diet, exercise.
3. Heart Failure (HF)
Signs and Symptoms: Dyspnea (orthopnea, paroxysmal nocturnal dyspnea), fatigue, edema (ankles, sacrum), S3 gallop, jugular venous distension, pulmonary rales.
Management:
- Diuretics (loop for congestion), ACEIs/ARBs, beta-blockers, aldosterone antagonists.
- Device therapy: ICD, CRT for select patients.
- Advanced: Transplant, LVAD.
4. Arrhythmias (e.g., Atrial Fibrillation, Ventricular Tachycardia)
Signs and Symptoms: Palpitations, syncope, dizziness, fatigue, irregular pulse. AF: Irregularly irregular rhythm; VT: Hemodynamic instability, chest pain.
Management:
- Rate/rhythm control: Beta-blockers, calcium channel blockers, amiodarone.
- Anticoagulation for AF (CHA2DS2-VASc score).
- Cardioversion, ablation, pacemakers/ICD.
5. Valvular Heart Disease (e.g., Aortic Stenosis, Mitral Regurgitation)
Signs and Symptoms: Murmurs, dyspnea, angina, syncope (AS triad), fatigue, palpitations.
Management:
- Medical: Symptom relief, endocarditis prophylaxis.
- Surgical: Valve repair/replacement, TAVR for AS.
Anaesthetic Considerations in Cardiovascular Disease
Patients with CVD require meticulous perioperative management due to risks of hemodynamic instability, ischemia, and arrhythmias. Key principles include thorough preoperative assessment, optimized medical therapy, invasive monitoring, and tailored anaesthetic techniques.
Preoperative Assessment
- History: Functional status (NYHA class), recent MI (<3 months high risk), symptoms.
- Exam: Vital signs, JVP, edema, murmurs.
- Investigations: ECG, echo, stress test, labs (BNP, troponin).
Intraoperative Management
| Condition | Anaesthetic Considerations |
|---|---|
| Hypertension | Maintain BP within 20% of baseline; avoid abrupt changes. Use short-acting agents like esmolol. |
| CAD | Avoid tachycardia/hypotension (ischemia risk). Opioid-based induction, maintain O2 delivery. Consider TEE for monitoring. |
| Heart Failure | Optimize volume status preop. Avoid fluid overload; use diuretics. Positive inotropes if low output. |
| Arrhythmias | Electrolyte correction (K+, Mg++). Antiarrhythmics continued. Cardioversion readiness. |
| Valvular Disease | AS: Avoid preload reduction, maintain HR 60-80 bpm. MR: Afterload reduction beneficial. |
Postoperative Care
- Monitor for hypotension, arrhythmias, ischemia (ECG, troponin).
- Pain control to minimize sympathetic surge.
- Early mobilization, thromboprophylaxis.
General Principles
Induction of anesthesia can cause 20-30% BP drop; intubation increases it similarly. Use balanced techniques, invasive lines (arterial, CVP/PA in severe cases), and regional anesthesia where feasible to reduce stress response.
Conclusion
Understanding CVD signs, symptoms, and management is crucial for effective treatment. Anaesthetic care demands individualized approaches to mitigate perioperative risks, ensuring better outcomes. Questions?
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