Cardiovascular disorders: an overview

1. Main groups

2. How most of it develops

• Endothelial injury and LDL retention in the vessel wall begin the process.
• Macrophages take up the lipid and become foam cells, and inflammation follows.
• A fibrous cap forms over a lipid core.
• A stable plaque causes fixed narrowing and exertional angina.
• Plaque rupture or erosion triggers thrombosis, which causes acute coronary syndrome, stroke, or limb ischemia.

• Pressure overload (hypertension, aortic stenosis) leads to hypertrophy and diastolic dysfunction.
• Volume overload (regurgitant valves) leads to dilation.
• Over time both end in heart failure.

• They include scar, fibrosis, atrial stretch, ion channel defects, and congenital malformations.
• They cause arrhythmias, sudden cardiac death, and congenital heart disease.

3. Risk factors

• Modifiable: hypertension, high LDL cholesterol, smoking, diabetes, obesity, physical inactivity, poor diet, and air pollution.
• Non-modifiable: age, male sex (risk in women rises after menopause), family history, and genetics.
• Burden data: a 2026 JAMA analysis of the Global Burden of Disease Study covers elevated LDL-C, and a 2024 systematic review covers air pollution. Both support these as major contributors. I did not find recent reviews that contradict the textbook picture.

4. Typical presentations

• Chest pain: pressure-like and exertional suggests ischemia. Sharp and positional suggests pericarditis. Tearing pain radiating to the back suggests aortic dissection.
• Dyspnea, orthopnea, edema, fatigue: suggest heart failure.
• Palpitations or syncope: suggest arrhythmia, or severe aortic stenosis or hypertrophic cardiomyopathy.
• Claudication: suggests peripheral artery disease.
• Asymptomatic: many patients have no symptoms (Goldman-Cecil), for example those with hypertension or early valve disease.

5. Evaluation

1. History and examination: blood pressure, JVP, heart sounds and murmurs, edema, pulses.
2. 12-lead ECG, which is also the first test for suspected acute coronary syndrome.
3. Blood tests: troponin, BNP or NT-proBNP, lipids, glucose or HbA1c, renal function, thyroid function, and a blood count.
4. Imaging:
   • Chest X-ray and echocardiography, which is the key test for structure, function, and valves.
   • Stress testing, coronary CT angiography, or cardiac MRI.
   • Invasive coronary angiography.
5. Rhythm monitoring (Holter or event monitor) when arrhythmia is suspected.

6. Principles of management

• Risk-factor control: blood pressure, statins and other lipid lowering, glucose control, smoking cessation, weight loss, exercise, and diet.
• Drugs by condition:
  • Antiplatelets, beta-blockers, and statins for coronary disease.
  • ACE inhibitors or ARNI, beta-blockers, MRAs, and SGLT2 inhibitors for HFrEF.
  • Anticoagulants and rate or rhythm control for atrial fibrillation.
• Procedures and devices: PCI, CABG, valve repair or replacement (surgical or transcatheter), ablation, pacemakers, ICDs, and CRT.
• Acute care: time-critical pathways for STEMI (reperfusion), acute decompensated heart failure, and aortic dissection.

Sources

Cardiovascular disorders: disease names with a one-line explanation

Coronary artery disease

• Stable angina: exertional chest pain from a fixed coronary narrowing.
• Unstable angina: chest pain at rest or with a crescendo pattern, caused by a ruptured plaque, with no myocardial necrosis.
• NSTEMI: partial coronary occlusion with troponin rise and no persistent ST elevation.
• STEMI: complete coronary occlusion with ST elevation and transmural infarction.

Heart failure

• HFrEF: heart failure with reduced ejection fraction (40% or below), a pumping problem.
• HFpEF: heart failure with preserved ejection fraction (50% or above), a stiff, poorly relaxing ventricle.
• Acute decompensated heart failure: sudden worsening with pulmonary congestion.
• Cardiogenic shock: pump failure causing hypotension and organ hypoperfusion.

Arrhythmias

• Atrial fibrillation: chaotic atrial activity with an irregularly irregular pulse and a risk of stroke.
• Atrial flutter: a regular atrial macro-reentry circuit, with a sawtooth pattern on ECG.
• SVT (AVNRT, AVRT): fast regular narrow-complex tachycardia.
• Ventricular tachycardia and fibrillation: life-threatening ventricular rhythms that cause sudden cardiac arrest.
• Heart block: delayed or failed conduction from the atria to the ventricles (first, second, or third degree).
• Long QT syndrome: a repolarization defect that predisposes to torsades de pointes.

Valvular heart disease

• Aortic stenosis: a narrowed aortic valve, causing angina, syncope, and dyspnea.
• Aortic regurgitation: a leaking aortic valve with a wide pulse pressure.
• Mitral stenosis: usually rheumatic, causing left atrial enlargement and atrial fibrillation.
• Mitral regurgitation: backflow into the left atrium.
• Mitral valve prolapse: billowing of the mitral leaflets into the left atrium.
• Infective endocarditis: infection of the valves or endocardium.
• Rheumatic heart disease: valve damage after group A streptococcal infection.

Myocardial and pericardial disease

• Dilated cardiomyopathy: a dilated ventricle with poor contraction.
• Hypertrophic cardiomyopathy: an inherited thickened septum or ventricle, a cause of sudden death in athletes.
• Restrictive cardiomyopathy: a stiff ventricle, as in amyloidosis.
• Myocarditis: inflammation of the heart muscle, usually viral.
• Acute pericarditis: pleuritic, positional chest pain with a friction rub and diffuse ST elevation.
• Pericardial effusion and tamponade: fluid compressing the heart, with Beck's triad (hypotension, raised JVP, muffled heart sounds).
• Constrictive pericarditis: a rigid, scarred pericardium that restricts filling.

Hypertension

• Primary (essential) hypertension: high blood pressure with no single cause.
• Secondary hypertension: caused by renal artery stenosis, primary aldosteronism, pheochromocytoma, and similar.
• Hypertensive emergency: severe hypertension with acute end-organ damage.
• Pulmonary hypertension: raised pulmonary artery pressure, leading to right heart failure.

Vascular disease

• Atherosclerosis: lipid-rich plaque in the arterial wall, the base of most cardiovascular disease.
• Peripheral artery disease: leg artery narrowing, causing claudication.
• Aortic aneurysm: abnormal aortic dilation, with a risk of rupture.
• Aortic dissection: a tear in the intima, with tearing chest or back pain.
• Deep vein thrombosis: clot in the deep veins, usually of the leg.
• Pulmonary embolism: a clot that travels to the pulmonary arteries.
• Vasculitis (for example giant cell arteritis, Takayasu arteritis): inflammation of vessel walls.

Congenital heart disease

• Atrial septal defect (ASD): a hole between the atria.
• Ventricular septal defect (VSD): a hole between the ventricles, the most common defect.
• Patent ductus arteriosus (PDA): the ductus arteriosus fails to close after birth.
• Tetralogy of Fallot: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy.
• Coarctation of the aorta: aortic narrowing, with a blood pressure difference between arms and legs.
• Transposition of the great arteries: the aorta and pulmonary artery arise from the wrong ventricles.
• Eisenmenger syndrome: a shunt reverses to right-to-left because of pulmonary hypertension.