diseases of the arteries and veins:

• arteriosclerosis

  • chronic disease of the arterial system characterized by:

    • abnormal thickening and hardening of the vessel walls

  • smooth muscle cells and collagen fibers migrate to the tunica intima (causing thickness and stiffness of tunica intima)

    • this leads to narrowing of the artery lumen

• atherosclerosis

  • atherosclerosis is a form of arteriosclerosis

  • thickening and hardening is caused by accumulation of lipid-laden macrophages in the arterial wall

    • this leads to formation of lesion called plaque

  • atherosclerosis is an inflammatory disease, that progresses from endothelial injury to formation of the plaque

  • the possible cause of injury could be smoking, diet, hypertension, diabetes, high levels of ldl… (… == etc.?)

  • erythrocyte sedimentation rate is an indirect measure of atherosclerotic plaque

  • progression

    • once endothelial cells are injured they become inflamed and cannot make normal amount of antithrombotic and vasodilating cytokines and leads to formation of atherosclerosis

      • macrophages adhere to injured endothelium and release enzymes and toxic oxygen radicals

      • oxygen radicals (oxidative stress) oxidize ldl and further injure vessel

    • oxidized ldl causes smooth muscle proliferation and activate further immune and inflammatory response

    • oxidized ldl penetrates into the intima of artery and (is) engulfed by macrophages

    • macrophage filled with oxidized ldl are called foam cell

    • foam cells form lesion called fatty streak

    • fatty streak produce more toxic oxygen and leads to fibrous plaque formation

    • raptor of plaque called complicated plaque can lead to formation of thrombus

  

• hypertension

  • sustained elevation of arterial blood pressure

  • hypertension could lead to ischemia of the tubule in kidney, where ischemia of tubule will lead to dysfunction of glomeruli

  • primary hypertension

    • aka essential or idiopathic hypertension

    • genetic and environmental factors

    • affect 90-95% of individuals with hypertension

    • in healthy individual the renin angiotensin system provides important homeostatic balance

  • angiotensin 2 is responsible for the hypertrophy of myocardium associated with hypertension

    

  • 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

• aneurysm

  • local dilation or outpouching of a vessel wall or cardiac chamber

  • plaque formation (in atherosclerosis) erodes the vessel wall and could cause aneurysms

  

• thrombus formation

  • blood clot that remains attached to the vessel wall

  • roughening, inflammation, and traumatic injuries of the endothelium, and low blood pressure of the vein or artery promote clot formation

  • thromboembolus is a detached thrombus

• embolism

  • bolus of matter that is circulating in the bloodstream

    • dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance

  • deep vein thrombosis is the usual source of pulmonary emboli

• 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

peripheral artery disease:

• thromoboangiitis obliterans (buerger disease) is an inflammatory disorder of small and medium sized arteries in the feet and sometimes in the hands

  • mainly in young men who smoke

  • resulting in the formation of nonatherosclerotic lesions

  • causes pain, tenderness, and hair loss in the affected area

  • symptoms are caused by slow, sluggish blood flow

  • can often lead to gangrenous lesions

• raynaud phenomenon and raynaud disease

  • a vasospastic disorder of the small arteries and arterioles of the fingers and less commonly the toes

diseases of the veins:

• varicose veins

  • a vein in which blood has pooled

  • distended, tortuous (twisted, elongated, or abnormally curved), and palpable veins

  • caused by

    • trauma or gradual venus distention

    • damage to the valves with veins

coronary artery disease:

• any vascular disorder that narrows or occludes the coronary arteries

• atherosclerosis is the most common cause

• coronary artery disease can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia

• cardiac cells can withstand ischemic conditions and still return to a viable state for 20 min

  • (im assuming they can withstand it for 20 min)

• risk factors

  • dyslipidemia- elevated plasma lipoproteins

  • hypertension- increases the risk by 2-3 fold

  • cigarette smoking- nicotine stimulates release of epinephrine and norepinephrine

    • epinephrine and norepinephrine stimulate release of free fatty acid

    • epinephrine and norepinephrine increases heart rate and blood pressure

    • smoking also increases ldl and decreases hdl- indicator of atherosclerosis formation

      • hdl is protective for the development of atherosclerosis

      • ldl is manufactured by the liver and primarily contains cholesterol and protein

  • diabetes mellitus increases the risk by 2 fold for death and 6 fold for stroke

  • obesity/sedentary lifestyle

• myocardial ischemia

  • local, temporary deprivation of the coronary blood supply

  • develops if the supply of coronary blood cannot meet the demand of myocardium for oxygen and nutrients

  • caused most commonly by formation of atherosclerotic plaque in the coronary circulation

    • some plaque are unstable and rupture resulting thrombus formation

  • myocardial ischemia can also be caused by hypotension or low oxygen delivery

  • if the vessel obstruction is not reversed, myocardial ischemia leads to myocardial infarction

  • manifestation

    • stable angina- chronic coronary obstruction that causes reoccurring pain

    • prinzmetal angina- occurs bc of vasospasms of one or more coronary arteries and often during sleep. causes unpredictable pain

    • silent ischemia- myocardial ischemia that does not cause detectable symptoms

    • angina pectoris- chest discomfort (pain) caused by myocardial ischemia

  • the pain is presumably caused by lactic acid build up

  • the pain is usually relieved by rest

  • diagnosis

    • ecg during the attack of angina (most individuals will have normal ecg in the absence of pain)

    • ecg could give indication of coronary artery involved

    • exercise stress testing

    • spect (single photon emission computed tomography)

  • treatment

    • coronary angiography

    • coronary artery bypass graft

• progression of atherosclerosis plaque could be sudden and lead to acute coronary syndrome

• acute coronary syndromes

  • myocardial infarction

    

    • results from prolonged ischemia

      • prolonged ischemia leads to cellular injury- cardiac cells can withstand ischemic condition for about 20 min before necrosis or cellular death takes place

      • anaerobic respiration leads to accumulation of lactic acid leads to acidosis

        • myocardial tissue have poor buffering system

      • acidosis makes myocardial tissue more vulnerable to damage

      • mi causes both structural and functional damage

      • repair- mi causes severe inflammation response that ends w wound repair (synthesis of scar tissue)

      • when scar tissue replaces the myocardium after a mi, the forming scar tissue is very mushy and vulnerable to injury at about day 10-14 after mi

    • manifestation

      • sudden, severe chest pain

      • symptoms as angina but pain is severe and prolonged in mi

      • radiation of pain to the left side (arms, jaw, back)

      • catecholamine causes sympathetic stimulation (causing vasoconstriction- cool and clammy skin)

    • diagnosis

      • clinical symptoms: elevated levels of troponin, creatine kinase (ck), and lactic dehydrogenase (ldh)

      • mi can occur in various regions of heart well

      • identification of q wave and changes in st segments and t wave can localize the affected area

      • st elevation of electrocardiogram pattern indicate that thrombus in a coronary artery lodged permanently in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium

    • treatment

      • immediate admission to hospital

      • aspirin, heparin, pain killer, (sublingual nitroglycerine and morphine sulfate)

      • oxygen administration is surgery is not available immediately

disorders of the heart wall:

• disorders of the pericardium

  • acute pericarditis: a sudden onset of severe chest pain that radiates to the back and worsens w respiratory movement and when laying down

    • (isnt that inflammation bc itis??? symptoms ig?)

disorders of the myocardium:

• cardiomyopathies- diverse group of disease that primarily affect myocardium

  • develops as a result of cardiovascular disorder such as ischemic heart

  • cardiopathy are classified as

    • dilated cardiomyopathy (congestive cardiomyopathy)- characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure

    • hypertrophic cardiomyopathy- thickening of myocardium (disproportionate thickening of the interventricular septum)

    • restrictive cardiomyopathy- usually caused by an infiltrative disease of the myocardium, such as amyloidosis, hemochromatosis, or glycogen storage disease

  

disorders of the endocardium:

• disorders of the endocardium (innermost lining of the heart) are damages to the heart valves

• valvular dysfunction- rheumatic fever is the primary cause of aortic and mitral regurgitation and stenosis

  • valvular stenosis- the orifice is constricted and narrowed - increasing the workload of cardiac chamber behind the diseased valve - increasing the pressure to overcome the resistance

    • aortic stenosis- dyspnea on exertion

    • mitral stenosis

  • valvular regurgitation- the valve cusps fail to shut completely permitting back flow of blood

    • aortic regurgitation

    • mitral regurgitation

    • tricuspid regurgitation

  • mitral valve prolapse syndrome- cusps of valve billow upward (prolapse) during atrium systole

    

• diagnosis

  • echocardiography

  • cardiac catheterization prior to surgery

• treatment

  • temp: diuretics and vasodilators

  • surgery to repair or replace the valve

cardiac complication of aids:

• endocarditis- infective endocarditis is most often caused by bacteria due to genitourinary instrumentation, dental procedure, hemodialysis, and intravenous drug use

• cardiomyopathy- dilated cardiopathy is the most common cardiac disorder associated with aids, resulting from myocarditis and infective endocarditis

• myocarditis

• pericarditis

heart failure:

• general term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues w blood borne nutrients

• congestive heart failure

  • systolic heart failure

    • angiotensin 2 increases preload and increases afterload stroke volume

      • im guessing theres not enough?

    • inability of the heart to generate adequate cardiac output to perfuse tissues

  • diastolic heart failure

    • pulmonary congestion despite normal stroke volume and cardiac output

• right heart failure

  • most commonly caused by a diffuse hypoxic w pulmonary disease and elevated pulmonary vascular resistance

  • 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

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

• ex.

  • tachycardia, flutter, fibrillation, bradycardia, premature ventricular contractions (pvcs), premature atrial contractions (pacs), asystole