Transcript Cellular Biology

Alterations of
Cardiovascular Function
Chapter 30
1
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
2
Mosby items and derived items © 2006 by Mosby, Inc.
Arteriosclerosis
3
Mosby items and derived items © 2006 by Mosby, Inc.
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
4
Mosby items and derived items © 2006 by Mosby, Inc.
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
5
Mosby items and derived items © 2006 by Mosby, Inc.
Atherosclerosis
6
Mosby items and derived items © 2006 by Mosby, Inc.
Atherosclerosis
7
Mosby items and derived items © 2006 by Mosby, Inc.
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
8
Mosby items and derived items © 2006 by Mosby, Inc.
Primary Hypertension
9
Mosby items and derived items © 2006 by Mosby, Inc.
Diseases of the Arteries and Veins

Secondary hypertension


Isolated systolic hypertension



Caused by a systemic disease process that raises
peripheral vascular resistance or cardiac output
Elevations of systolic pressure are caused by
increases in cardiac output, total peripheral
vascular resistance, or both
Complicated hypertension
Malignant hypertension
10
Mosby items and derived items © 2006 by Mosby, Inc.
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
11
Mosby items and derived items © 2006 by Mosby, Inc.
Treatment for Hypertension
12
Mosby items and derived items © 2006 by Mosby, Inc.
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
13
Mosby items and derived items © 2006 by Mosby, Inc.
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
14
Mosby items and derived items © 2006 by Mosby, Inc.
Aneurysm
15
Mosby items and derived items © 2006 by Mosby, Inc.
Aneurysm
16
Mosby items and derived items © 2006 by Mosby, Inc.
Diseases of the Arteries and Veins

Thrombus formation





Blood clot that remains attached to the vessel wall
Thromboembolus
Thrombophlebitis
Arterial thrombi
Venous thrombi
17
Mosby items and derived items © 2006 by Mosby, Inc.
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
18
Mosby items and derived items © 2006 by Mosby, Inc.
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
19
Mosby items and derived items © 2006 by Mosby, Inc.
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
20
Mosby items and derived items © 2006 by Mosby, Inc.
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
21
Mosby items and derived items © 2006 by Mosby, Inc.
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
22
Mosby items and derived items © 2006 by Mosby, Inc.
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
23
Mosby items and derived items © 2006 by Mosby, Inc.
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)
24
Mosby items and derived items © 2006 by Mosby, Inc.
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
25
Mosby items and derived items © 2006 by Mosby, Inc.
Coronary Artery Disease

Nontraditional risk factors

Markers of inflammation and thrombosis



C-reactive protein, fibrinogen, protein C, and
plasminogen activator inhibitor
Hyperhomocysteinemia
Infection
26
Mosby items and derived items © 2006 by Mosby, Inc.
Coronary Artery Disease

Myocardial ischemia





Local, temporary deprivation of the coronary
blood supply
Stabile angina
Prinzmetal angina
Silent ischemia
Angina pectoris
27
Mosby items and derived items © 2006 by Mosby, Inc.
Myocardial Ischemia
28
Mosby items and derived items © 2006 by Mosby, Inc.
Myocardial Ischemia
29
Mosby items and derived items © 2006 by Mosby, Inc.
Coronary Artery Disease

Acute coronary syndromes





Transient ischemia
Unstable angina
Sustained ischemia
Myocardial infarction
Myocardial inflammation and necrosis
30
Mosby items and derived items © 2006 by Mosby, Inc.
Myocardial Infarction
31
Mosby items and derived items © 2006 by Mosby, Inc.
Coronary Artery Disease

Myocardial infarction



Sudden and extended obstruction of the
myocardial blood supply
Subendocardial infarction
Transmural infarction
32
Mosby items and derived items © 2006 by Mosby, Inc.
Myocardial Infarction



Cellular injury
Cellular death
Structural and functional changes




Myocardial stunning
Hibernating myocardium
Myocardial remodeling
Repair
33
Mosby items and derived items © 2006 by Mosby, Inc.
Disorders of the Heart Wall

Disorders of the pericardium


Acute pericarditis
Pericardial effusion


Tamponade
Constrictive pericarditis
34
Mosby items and derived items © 2006 by Mosby, Inc.
Pericarditis
35
Mosby items and derived items © 2006 by Mosby, Inc.
Disorders of the Myocardium

Cardiomyopathies


Dilated cardiomyopathy (congestive
cardiomyopathy)
Hypertrophic cardiomyopathy



Asymmetrical septal hypertrophy
Hypertensive (valvular hypertrophic) cardiomyopathy
Restrictive cardiomyopathy
36
Mosby items and derived items © 2006 by Mosby, Inc.
Cardiomyopathy
37
Mosby items and derived items © 2006 by Mosby, Inc.
Disorders of the Endocardium

Valvular dysfunction

Valvular stenosis



Valvular regurgitation




Aortic stenosis
Mitral stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse syndrome
38
Mosby items and derived items © 2006 by Mosby, Inc.
Valvular Dysfunction
39
Mosby items and derived items © 2006 by Mosby, Inc.
Valvular Dysfunction
40
Mosby items and derived items © 2006 by Mosby, Inc.
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
41
Mosby items and derived items © 2006 by Mosby, Inc.
Acute Rheumatic Fever and
Rheumatic Heart Disease

Rheumatic fever




Carditis
Polyarthritis
Chorea
Erythema marginatum
42
Mosby items and derived items © 2006 by Mosby, Inc.
Acute Rheumatic Fever and
Rheumatic Heart Disease
43
Mosby items and derived items © 2006 by Mosby, Inc.
Infective Endocarditis


Inflammation of the endocardium
Agents


Bacteria, viruses, fungi, rickettsiae, and parasites
Pathogenesis



“Prepared” endocardium
Blood-borne microorganism adherence
Proliferation of the microorganism
44
Mosby items and derived items © 2006 by Mosby, Inc.
Infective Endocarditis
45
Mosby items and derived items © 2006 by Mosby, Inc.
Cardiac Complications of AIDS




Myocarditis
Endocarditis
Pericarditis
Cardiomyopathy
46
Mosby items and derived items © 2006 by Mosby, Inc.
Heart Failure

General term used to describe several types of
cardiac dysfunction that result in inadequate
perfusion of tissues with blood-borne
nutrients
47
Mosby items and derived items © 2006 by Mosby, Inc.
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
48
Mosby items and derived items © 2006 by Mosby, Inc.
Congestive Heart Failure
49
Mosby items and derived items © 2006 by Mosby, Inc.
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
50
Mosby items and derived items © 2006 by Mosby, Inc.
Right Heart Failure
51
Mosby items and derived items © 2006 by Mosby, Inc.
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
52
Mosby items and derived items © 2006 by Mosby, Inc.