Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathophysiology The Cardiovascular System Part 1

2 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Heart Disease  Heart disease (which includes Heart Disease, Stroke and other Cardiovascular Diseases) is the No. 1 cause of death in the United States, killing nearly 787,000 people alone in  Heart disease is the leading cause of death for people of most racial/ethnic groups in the United States, including African Americans, Hispanics and Whites. For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer  More people die of heart disease than all forms of cancer combined.

3 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Symptoms of a Heart Attack  Dyspnea – difficulty in breathing.  Chest Pain – Pressure / pain  Left Arm/ shoulder pain –  Dizziness / Sweating  Tired / fatigue /insomnia

4 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Medical Treatment for Heart Attacks  First Aid: Maintain life with CPR / Defibrillation Defibrillation  Medical interventions:  Clot busting medications. Video Video  Stints inserted into the coronary arteries. Video Video  Coronary Artery by pass Surgery. Video Video

5 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chambers of Normal Heart

6 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Peripheral Vascular System

7 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Overview of Major Diseases   Congenital heart diseases- Birth defects linklink   Ischemic vascular disease - Ischemia means a "reduced blood supply". Ischemic Vascular Disease (IVD) is where a waxy substance called plaque (plak) builds up inside blood vessels, and restricts the normal flow of blood linklink   Hypertension-related disease. linklink

8 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Incidence of Fatal Cardiovascular Diseases

9 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Cardiac Diseases

10 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Congenital Heart Disease   Approximately 25,000 babies per year born with heart defects   Defect may be:   Minor: asymptomatic or related to only minor clinical symptoms   Major: associated with major clinical problems or may be lethal

11 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Causes of Congenital Heart Disease   Cause unknown (most often)   Viruses   Alcohol   Chromosomal abnormalities

12 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Most Common Congenital Heart Diseases   Ventricular septal defect   Atrial septal defect   Tetralogy of Fallot link videolinkvideo ____________________________________ Note: Isolated septal defects are initially acyanotic, but later may become cyanotic when direction of blood flow through a shunt is reversed. Tetralogy of Fallot presents with early cyanosis.

13 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Ventricular Septal Defect

14 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Tetralogy of Fallot Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve four anatomical abnormalities of the heart (although only three of them are always present). It is the most common cyanotic heart defect, and the most common cause of blue baby syndrome. [1] TOF is usually a right-to-left shunt, in which higher resistance to right ventricular outflow results in more severe cyanosis symptoms. [2] congenital heart defectcyanoticblue baby syndrome [1]right-to-left shuntcyanosis [2]

15 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Atherosclerosis   Generalized videovideo   Localized   Coronary heart disease   Cerebrovascular disease videovideo   Atherosclerosis of aorta   Peripheral vascular disease

16 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Forms of Atherosclerosis

17 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Atherosclerosis

18 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Atherosclerosis (Cont’d)

19 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Atheroma

20 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Risk Factors of Atherosclerosis Risk Factors That Cannot Be Changed Risk Factors That Can Be Changed Protective Factors AgeLipid metabolism- related factors: diet, obesity, hyperlipidemia, diabetes mellitus Exercise GenderHypertensionEstrogen HeredityClotting factors Cigarette smoking Behavior

21 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Endothelial Cell Injury Leading to Atherosclerosis

Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Atherosclerosis: Gross Appearance of Aorta 22 T = thrombi

23 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Aneurysms videovideo

24 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Peripheral Vascular Disease   Atherosclerosis of renal arteries   Atherosclerosis of intestinal arteries   Atherosclerosis of extremities   Dry gangrene   Wet gangrene

25 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Clinical Presentations of Coronary Heart Disease   Asymptomatic – No symptoms observed   Angina pectoris- heart pain videovideo   Congestive heart disease – heart failure. video video   Myocardial infarction- heart attack… blood flow blockage… heart muscle death. videovideo

26 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Artery Disease

27 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Distribution of Myocardial Infarcts

28 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Occlusion by Thrombus

29 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Myocardial Infarct

30 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Hematopericardium Due to heart attack or aneurysm the heart bleeds into the pericardial sack and squeezes the heart.

31 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Coronary Heart Disease: Clinical Features

32 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chronic Congestive Heart Disease

33 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Outcome of Myocardial Infarct (MI)

34 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Arterial Hypertension   Primary hypertension (>90%); cause unknown videovideo   Secondary hypertension   Renal; kidney blockage   Endocrine – hormonal changes - adrenaline   Neurogenic- psychological stress.   Drugs- legal and illegal drugs can increase BP

35 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Blood Pressure  Systolic pressure – the internal arterial pressure when the heart is compressing.  Diastolic pressure – the internal pressure of the arteries between heart beats.  Normal: 120/80 mm/Hg  Measured by soundings: video video  Heartbeat rate: How many beats / minute.  Normal: bpm  Tachycardia: rate > 100 bpm  Bradycardia: rate < 60 bpm

36 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Pathogenesis of Hypertension

37 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Complications of Hypertension   Cardiac hypertrophy- swelling of heart muscle due to chronic high pressure.   Congestive heart disease- decreased efficiency of heart pumping.   Renal insufficiency – kidney failure. VideoVideo   Hypertensive encephalopathy- brain swelling and pain due to high blood pressure. videovideo   Hypertensive retinopathy- eye damage due to high blood pressure. VideoVideo

38 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Rheumatic Heart Disease: Pathogenesis RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually monthly injections) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage. Consequences of rheumatic heart disease Acute rheumatic fever primarily affects the heart, joints and central nervous system. The major importance of acute rheumatic fever is its ability to cause fibrosis of heart valves, leading to crippling valvular heart disease, heart failure and death

39 Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chronic Rheumatic Endocarditis