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Alterations of Cardiovascular Function

Alterations of Cardiovascular Function. Chapter 30. Diseases of the Arteries and Veins. Arteriosclerosis Chronic disease of the arterial system Abnormal thickening and hardening of the vessel walls Smooth muscle cells and collagen fibers migrate to the tunica intima. Arteriosclerosis.

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Alterations of Cardiovascular Function

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  1. Alterations of Cardiovascular Function Chapter 30

  2. Diseases of the Arteries and Veins • Arteriosclerosis • Chronic disease of the arterial system • Abnormal thickening and hardening of the vessel walls • Smooth muscle cells and collagen fibers migrate to the tunica intima

  3. Arteriosclerosis

  4. Diseases of the Arteries and Veins • Atherosclerosis • Form of arteriosclerosis • Thickening and hardening is caused by accumulation of lipid-laden macrophages in the arterial wall • Plaque development

  5. Diseases of the Arteries and Veins • Atherosclerosis • Progression • Inflammation of endothelium • Cellular proliferation • Macrophage migration • LDL oxidation (foam cell formation) • Fatty streak • Fibrous plaque • Complicated plaque

  6. Atherosclerosis

  7. Atherosclerosis

  8. Diseases of the Arteries and Veins • Hypertension • Primary hypertension • Essential or idiopathic hypertension • Genetic and environmental factors • Affects 90% to 95% of individuals with hypertension

  9. Primary Hypertension

  10. Diseases of the Arteries and Veins • Secondary hypertension • Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output • Isolated systolic hypertension • Elevations of systolic pressure are caused by increases in cardiac output, total peripheral vascular resistance, or both • Complicated hypertension • Malignant hypertension

  11. Diseases of the Arteries and Veins • Complicated hypertension • Chronic hypertensive damage to the walls of systemic blood vessels • Smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis of the tunica intima and media • Malignant hypertension • Rapidly progressive hypertension • Diastolic pressure is usually >140 mm Hg

  12. Treatment for Hypertension

  13. Diseases of the Arteries and Veins • Orthostatic (postural) hypotension • Decrease in both systolic and diastolic blood pressure upon standing • Lack of normal blood pressure compensation in response to gravitational changes on the circulation • Acute orthostatic hypotension • Chronic orthostatic hypotension

  14. Diseases of the Arteries and Veins • Aneurysm • Local dilation or outpouching of a vessel wall or cardiac chamber • True aneurysms • Fusiform aneurysms • Circumferential aneurysms • False aneurysms • Saccular aneurysms

  15. Aneurysm

  16. Aneurysm

  17. Diseases of the Arteries and Veins • Thrombus formation • Blood clot that remains attached to the vessel wall • Thromboembolus • Thrombophlebitis • Arterial thrombi • Venous thrombi

  18. Diseases of the Arteries and Veins • Embolism • Bolus of matter that is circulation in the bloodstream • Dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance

  19. Diseases of the Arteries and Veins • Peripheral artery disease • Atherosclerotic disease of the arteries that perfuse the limbs • Intermittent claudication • Obstruction of arterial blood flow in the iliofemoral vessels resulting in pain with ambulation

  20. Peripheral Artery Disease • Thromboangiitis obliterans (Buerger disease) • Occurs mainly in young men who smoke • Inflammatory disease of peripheral arteries resulting in the formation of nonatherosclerotic lesions • Digital, tibial, plantar, ulnar, and palmar arteries • Obliterates the small and medium-sized arteries

  21. Peripheral Artery Disease • Thromboangiitis obliterans (Buerger disease) • Causes pain, tenderness, and hair loss in the affected area • Symptoms are caused by slow, sluggish blood flow • Can often lead to gangrenous lesions

  22. Peripheral Artery Disease • Raynaud phenomenon and Raynaud disease • Episodic vasospasm in arteries and arterioles of the fingers, less commonly the toes • Raynaud phenomenon is secondary to other systemic diseases or conditions • Collagen vascular disease (scleroderma), smoking, pulmonary hypertension, myxedema, and environmental factors (cold and prolonged exposure to vibrating machinery) • Raynaud disease is a primary vasospastic disorder of unknown origin

  23. Diseases of the Veins • Varicose veins • A vein in which blood has pooled • Distended, tortuous, and palpable veins • Caused by trauma or gradual venous distention • Chronic venous insufficiency • Inadequate venous return over a long period due to varicose veins or valvular incompetence • Venous stasis ulcers

  24. Diseases of the Veins • Deep venous thrombosis • Obstruction of venous flow leading to increased venous pressure • Factors • Venous stasis • Venous endothelial damage • Hypercoagulable states • Post-thrombotic syndrome (PTS)

  25. Coronary Artery Disease • Any vascular disorder that narrows or occludes the coronary arteries • Atherosclerosis is the most common cause • Risk factors • Dyslipidemia • Hypertension • Cigarette smoking • Diabetes mellitus • Obesity/sedentary lifestyle

  26. Coronary Artery Disease • Nontraditional risk factors • Markers of inflammation and thrombosis • C-reactive protein, fibrinogen, protein C, and plasminogen activator inhibitor • Hyperhomocysteinemia • Infection

  27. Coronary Artery Disease • Myocardial ischemia • Local, temporary deprivation of the coronary blood supply • Stabile angina • Prinzmetal angina • Silent ischemia • Angina pectoris

  28. Myocardial Ischemia

  29. Myocardial Ischemia

  30. Coronary Artery Disease • Acute coronary syndromes • Transient ischemia • Unstable angina • Sustained ischemia • Myocardial infarction • Myocardial inflammation and necrosis

  31. Myocardial Infarction

  32. Coronary Artery Disease • Myocardial infarction • Sudden and extended obstruction of the myocardial blood supply • Subendocardial infarction • Transmural infarction

  33. Myocardial Infarction • Cellular injury • Cellular death • Structural and functional changes • Myocardial stunning • Hibernating myocardium • Myocardial remodeling • Repair

  34. Disorders of the Heart Wall • Disorders of the pericardium • Acute pericarditis • Pericardial effusion • Tamponade • Constrictive pericarditis

  35. Pericarditis

  36. Disorders of the Myocardium • Cardiomyopathies • Dilated cardiomyopathy (congestive cardiomyopathy) • Hypertrophic cardiomyopathy • Asymmetrical septal hypertrophy • Hypertensive (valvular hypertrophic) cardiomyopathy • Restrictive cardiomyopathy

  37. Cardiomyopathy

  38. Disorders of the Endocardium • Valvular dysfunction • Valvular stenosis • Aortic stenosis • Mitral stenosis • Valvular regurgitation • Aortic regurgitation • Mitral regurgitation • Tricuspid regurgitation • Mitral valve prolapse syndrome

  39. Valvular Dysfunction

  40. Valvular Dysfunction

  41. Acute Rheumatic Fever and Rheumatic Heart Disease • Rheumatic fever • Diffuse, inflammatory disease caused by a delayed immune response to infection by the group A β-hemolytic streptococci • Febrile illness • Inflammation of the joints, skin, nervous system, and heart • If left untreated, rheumatic fever causes rheumatic heart disease

  42. Acute Rheumatic Fever and Rheumatic Heart Disease • Rheumatic fever • Carditis • Polyarthritis • Chorea • Erythema marginatum

  43. Acute Rheumatic Fever and Rheumatic Heart Disease

  44. Infective Endocarditis • Inflammation of the endocardium • Agents • Bacteria, viruses, fungi, rickettsiae, and parasites • Pathogenesis • “Prepared” endocardium • Blood-borne microorganism adherence • Proliferation of the microorganism

  45. Infective Endocarditis

  46. Cardiac Complications of AIDS • Myocarditis • Endocarditis • Pericarditis • Cardiomyopathy

  47. Heart Failure • General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients

  48. Heart Failure • Congestive heart failure • Systolic heart failure • Inability of the heart to generate adequate cardiac output to perfuse tissues • Diastolic heart failure • Pulmonary congestion despite normal stroke volume and cardiac output

  49. Congestive Heart Failure

  50. Heart Failure • Right heart failure • Most commonly caused by a diffuse hypoxic pulmonary disease • Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation • High-output failure • Inability of the heart to supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility

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