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Alterations of Cardiovascular FunctionChapter 30

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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

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Arteriosclerosis

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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

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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

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Atherosclerosis

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Atherosclerosis

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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

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Primary Hypertension

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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

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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

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Treatment for Hypertension

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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

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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

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Aneurysm

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Aneurysm

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Diseases of the Arteries and Veins Thrombus formation

Blood clot that remains attached to the vessel wall

Thromboembolus Thrombophlebitis Arterial thrombi Venous thrombi

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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

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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

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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

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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

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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

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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

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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)

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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

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Coronary Artery Disease Nontraditional risk factors

Markers of inflammation and thrombosis C-reactive protein, fibrinogen, protein C, and

plasminogen activator inhibitor

Hyperhomocysteinemia Infection

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Coronary Artery Disease Myocardial ischemia

Local, temporary deprivation of the coronary blood supply

Stabile angina Prinzmetal angina Silent ischemia Angina pectoris

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Myocardial Ischemia

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Myocardial Ischemia

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Coronary Artery Disease Acute coronary syndromes

Transient ischemia Unstable angina Sustained ischemia Myocardial infarction Myocardial inflammation and necrosis

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Myocardial Infarction

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Coronary Artery Disease Myocardial infarction

Sudden and extended obstruction of the myocardial blood supply

Subendocardial infarction Transmural infarction

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Myocardial Infarction Cellular injury Cellular death Structural and functional changes

Myocardial stunning Hibernating myocardium Myocardial remodeling

Repair

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Disorders of the Heart Wall Disorders of the pericardium

Acute pericarditis Pericardial effusion

Tamponade

Constrictive pericarditis

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Pericarditis

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Disorders of the Myocardium Cardiomyopathies

Dilated cardiomyopathy (congestive cardiomyopathy)

Hypertrophic cardiomyopathy Asymmetrical septal hypertrophy Hypertensive (valvular hypertrophic) cardiomyopathy

Restrictive cardiomyopathy

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Cardiomyopathy

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Disorders of the Endocardium Valvular dysfunction

Valvular stenosis Aortic stenosis Mitral stenosis

Valvular regurgitation Aortic regurgitation Mitral regurgitation Tricuspid regurgitation

Mitral valve prolapse syndrome

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Valvular Dysfunction

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Valvular Dysfunction

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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

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Acute Rheumatic Fever and Rheumatic Heart Disease Rheumatic fever

Carditis Polyarthritis Chorea Erythema marginatum

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Acute Rheumatic Fever and Rheumatic Heart Disease

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Infective Endocarditis Inflammation of the endocardium Agents

Bacteria, viruses, fungi, rickettsiae, and parasites Pathogenesis

“Prepared” endocardium Blood-borne microorganism adherence Proliferation of the microorganism

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Infective Endocarditis

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Cardiac Complications of AIDS Myocarditis Endocarditis Pericarditis Cardiomyopathy

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Heart Failure General term used to describe several types of

cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients

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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

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Congestive Heart Failure

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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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Right Heart Failure

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Dysrhythmias Disturbance of the heart rhythm Range from occasional “missed” or rapid beats to

severe disturbances that affect the pumping ability of the heart

Can be caused by an abnormal rate of impulse generation or abnormal impulse conduction

Examples: Tachycardia, flutter, fibrillation, bradycardia, premature

ventricular contractions (PVCs), premature atrial contractions (PACs), asystole