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CARDIOVASCULAR DISEASE (Overview)

CARDIOVASCULAR DISEASE (Overview). Toni Mustahsani Aprami , dr., Sp.PD , Sp.JP Department of Cardiology and Vascular Medicine Cardiovascular Subdivision, Department of Internal Medicine Hasan Sadikin Hospital/Medical School, Padjadjaran University. Understanding the Cardiovascular System.

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CARDIOVASCULAR DISEASE (Overview)

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  1. CARDIOVASCULAR DISEASE(Overview) Toni MustahsaniAprami, dr., Sp.PD, Sp.JP Department of Cardiology and Vascular Medicine Cardiovascular Subdivision, Department of Internal Medicine HasanSadikin Hospital/Medical School, Padjadjaran University

  2. Understanding the Cardiovascular System • The Heart: A Mighty Machine • Four chambers • Two upper chambers are called atria • Two lower chambers are called ventricles • Valves regulate the flow of blood.

  3. Conduction System of the Heart

  4. The Heartbeat Is Controlled • Each heartbeat is referred to as a cardiac cycle. • Takes a total of 0.85 seconds / cycle on the average when at rest. . . . . • That’s ~70 X/minute, range 60-80 beats/ minute. • Systole - Contraction of heart muscle. • Diastole - Relaxation of heart muscle.

  5. Blood Flow within the Heart

  6. Blood Vessels

  7. Capillary Bed Anatomy

  8. Capillary Exchange

  9. Functions of the Cardiovascular System • Contractions of the heart generates blood pressure, which moves blood through blood vessels. • Blood vessels transport blood, which moves from the heart into arteries, capillaries, and veins, before returning to the heart. • Exchanges at the capillaries (smallest vessels) refreshes blood and then tissue fluid (interstitial fluid). • The heart and blood vessels regulate blood flow, according to the needs of the body.

  10. CARDIOVASCULAR DISEASE Congenital Heart Disease (ASD, VSD, PDA, TOF) Rheumatic Heart Disease (MS/MR, AS/AR) Hypertensive Heart Disease Coronary Artery Disease Cardiomyopathies Pericarditis Peripheral Artery Disease Aneurysm and DisectieAortae Deep Vein Thrombosis Cardiac Tumor

  11. Coronary Artery Disease 90% Atherosclerosis Process

  12. Atherosclerosiscan, and does, occur in almost any artery in the body. But in the heart it’s effects can be crucial. “The body depends on a strong pumping heart to circulate life-giving blood, and this includes to the heart muscle itself. If the coronary arteries become blocked, the cardiac muscle begins to fail, and so the blood circulation decreases, which includes the circulation to the heart muscle itself.” (Thibodeau, 494)

  13. Atherosclerosis is a disease of large (elastic) and medium sized (muscular) arteries characterized pathologically by smooth muscle proliferation, lipid accumulation, cell necrosis, fibrosis, and calcification. Most commonly involved : Aorta Coronary Carotid Iliac Mesentric

  14. Predict Risk Uncontrollable Controllable • High blood pressure • High blood cholesterol • Smoking • Physical activity • Obesity • Diabetes • Stress and anger • Sex • Hereditary • Race • Age Diagnostic/Screening test : EST, CRP, Echocardiography , CACS

  15. Atherogenesis

  16. Normal Artery Endothelium Intima Internal elastic lamina Media External elastic lamina Adventitia

  17. Response to Injury

  18. Endothelial Dysfunction

  19. Initiation of Fatty Streak

  20. Fatty Streak

  21. Fibro-fatty Atheroma

  22. FIBROUS CAP (smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, revascularization) NECROTIC CENTER (cells debris, cholesterol crystals, foam cells, calcium) MEDIA

  23. The Evolution of Atherosclerosis Endothelial Dysfunction • Foam • Cells • Fatty • Streak • Intermediate • Lesion • Atheroma • Fibrous • Plaque • Complicated • Lesion/Rupture • oxidized LDL • homocysteine • smoking • aging • hyperglycemia • hypertension 35-45 yrs 45-55 yrs 55-65 yrs >65 yrs • Endothelial injury • nitric oxide • endothelin-1 • vasodilation • Lipid accumulation • adhesion molecules (ICAM, VCAM) • monocyte adhesion • macrophage LDL uptake • Inflammation • continued macrophage/lipid accumulation • leukocyte accumulation • cytokines (IL-6,TNFa, IFNg) • MMP's • CRP (hepatic)

  24. Common Consequences of Atherosclerosis in Vessels

  25. Vessel change Plaque narrows lumen Wall weakened Thrombosis Breaking loose of plaque Loss of elasticity Consequence Ischemia, turbulence Aneurysms, vessel rupture Narrowing, ischemia, embolization Athero-embolization Increase systolic blood pressure Altered Vessel Function

  26. Burden and causes of cardiovascular diseases:with an emphasis on Asia

  27. Changing patterns of deathWorldwide: 1990-2020 Chronic diseases and injuries Infectious, maternal, perinatal and nutritional conditions Millions of deaths Global Burden of Disease Project, 1996

  28. Leading causes of deathWorldwide: 1990-2020 1990 2020 RankCause % Rank Cause % 1 Coronary Artery disease 12.4 1 Coronary Rtery disease 16.3 2 Cerebrovascular disease 8.72Cerebrovascular disease 11.2 3 Lower respiratory infections 8.53 COPD 6.9 4 Diarrhoeal diseases 5.84 Lower respiratory infections 3.7 5 Perinatal conditions 4.45 Respiratory tract cancers 3.5 6 COPD 3.9 6 Road traffic accidents 3.4 7 Tuberculosis 2.17 Tuberculosis 3.4 8 Measles 2.18 Stomach cancer 2.3 9 Road traffic accidents 1.99 HIV 1.8 10 Respiratory tract cancers 1.910 Self inflicted injuries 1.8 Global Burden of Disease Study, 1996

  29. Deaths from cardiovasculardisease Worldwide: 1990-2020 Reported in 1990 • 14 million deaths worldwide • 5 million in developed countries • 9 million in developing countries Predicted for 2020 • 25 million deaths worldwide • 6 million in developed countries • 19 million in developing countries Global Burden of Disease Study, 1996

  30. World population change 10 8 6 World population (billions) 4 2 0 1700 1800 1900 2000 2100 United Nations 1999

  31. Population (billions) 2000 2050 Change Developing world 4.9 7.93.0 Developed world 1.0 1.0 0.0 Total 5.9 8.9 3.0 Regional population change United Nations 1999

  32. Trends in per capita cigarette consumption: 1971-1991 3500 3000 High income countries 2500 Low & middle income countries Per capita cigarette consumption 2000 China 1500 1000 500 0 1971 1991 1981 The World Health Report, 1999: Making a Difference

  33. 1990 2020 Deaths (millions) 3.0 8.4 India 0.1 1.5 China 0.8 2.2 DALYS (%) 2.6 9.0 Tobacco-related death and disability Global Burden of Disease Project, Lancet 1997

  34. Trends in overweight/obesity (BMI 25+ kg/m2)

  35. Global distribution of diabetes 350 1995 300 2025 Projected 250 200 150 100 50 0 Asia-Pacific 350 300 250 200 Millions 150 100 50 0 Developed Developing World King et al. Diabetes Care 1998; 21:1414-31

  36. Prevalence of smokingin the AsiaPacific Indonesia APCSC, 2006

  37. Indonesia 11 27 Prevalence of hypertension 140/90mmHg +

  38. Prevalence of obesity and overweight

  39. Prevalence of, and predictions for, diabetes

  40. Summary I • Global epidemic of CVD; the leading cause of death and disability • About 11 million new cardiovascular deaths each year by 2020 • By 2020, 80% of cardiovascular deaths will occur in low and middle income countries • About half of these deaths will occur in the Asia-Pacific region

  41. Summary II • Classic CVD risk factors act similarly in different populations • These risk factors are already common in many low/middle-income countries, and are often increasing (e.g. Asia)

  42. TerimaKasih AtasPerhatiannya

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