Cardiovascular patho s10
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  • Which means 5% is due to: renal (renal artery stenosis) and hyperaldosteronism. \n
  • AWESOME!!\n
  • Pheochromocytoma - very rare. Causes head aches and sweating. \nRenal vascular disease - triggar RAA system. \n
  • “lower the pressure, the better, as long as it is not symptomatic”.\n
  • ALWAYS start with life style modification. \nIf not at goal, then look at drugs. \nBeta blockers and diaretics as long as they are not opposed to them.\nIf diabetic, then use ACE inhibitors.\nSometimes ACEi don’t work as well as Ca channel blockers in AA.\n
  • acute corronary syndrom, Marfan’s with aneurism, AAA, worry about dissection through vessel wall. \n
  • Virchow’s triad. \nInflammation, infection, smokers, shock, cancer, extrogen, dis-rhythmia’s (a-fib), IBDU/drug use, vegitation from heart.\n
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  • Claudication - must refer. \n
  • Pain secondary to ischemia. \nUsually seen in youn men who smoke cigarrettes. \nTx - sessations, vasodilators\n
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  • May be due to decreased release of vasodilation chemicals. \nImmune complex, type III\nTips of fingers, top of phylanges. Can happen more with stress. \nWhite, blue, then red. \n\n
  • Can become painful and lower extremity edema. Can cause hyperpigmentation and ulceration due to venus stasis. \n
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  • Number one Killer in us Men and Women.\n\n
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  • Silent MI - diabete. Based on secondary neuropathy. No sensation of chest pain. \nWomen present with atypical presentations: tierd, vague abdominal pain, be sensitive.\nVessels decrease by 50% before symptoms. \nStart with exercise induced pain. \n
  • Some women will just have back pain. \nEcho’s and stress tests\nACE Inhib - actually prevents remodelling that predispose heart to “floppy sloppy”.\n\n
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  • Q-wave - with full-thickness (transmurral).\nBlood must be blocked for 20 minutes or more. \nDysrhythmia is the most common complication resulting from an MI. \nThen remodeling, then heart failure. \n
  • Myosite might be stunned for a couple days. \n
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  • Inflammation makes exudate. \nIf infectious, then cells like PMN’s will come in. \nTampanad - enough fluid to cause contraction on heart. \nFever, Chest pain that increases when lying down!!! Slight ST segment elevation with no Q. --> acute pericarditis. \n
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  • SUDDEN DEATH - \n
  • Dilated: viral, pregnancy, drugs and etoh.\nHypertrophic: valve regurg, fatigue, dry cough at night, \nRestrictive: least common. \n\nTx - diuretics, ACEi, \n
  • If it occurs during diastole, it is most likely a pathologic murmur.\n
  • Egophany - A to E changes. Sign of consolidation. \n
  • Balooning at leaflett’s. \nLate systolic murmer is a back-flow murmur. \n
  • Usually staph, need anti bact with dental.\nLess rheumatic, more drug use.\nUnexplaned feaver and new murmur. MOST IMPORTANT signs. \nCould become emboli, bacteremic, autoimmune predisposition. \n
  • Takes a long time for IV-antibiotics \n
  • RIght sidded - due to lung disease, core pulmonaly,\nIf bad enough, can lead to left sided. \nLeft sided - due to systemic HTN, Mitral stenosis, \n
  • Two types of failure. \n
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Cardiovascular patho s10 Presentation Transcript

  • 1. Cardiovascular PathophysiologyReference: Pathophysiology by Kathryn McCance Mindy Milton, MPA, PA-C July 13, 201 1Mosby items and derived items © 2006 by Mosby, Inc.
  • 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 2Mosby items and derived items © 2006 by Mosby, Inc.
  • 3. Arteriosclerosis 3Mosby items and derived items © 2006 by Mosby, Inc.
  • 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 4Mosby items and derived items © 2006 by Mosby, Inc.
  • 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 5Mosby items and derived items © 2006 by Mosby, Inc.
  • 6. 6Mosby items and derived items © 2006 by Mosby, Inc.
  • 7. 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 7Mosby items and derived items © 2006 by Mosby, Inc.
  • 8. Primary Hypertension 8Mosby items and derived items © 2006 by Mosby, Inc.
  • 9. Diseases of the Arteries and Veins Secondary hypertension – 5%  Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output Complicated hypertension  LVH, CHF, CAD, renal insuff, TIA, CVA, retinal damage, PAD, venous insuff Malignant hypertension - Rare  9Mosby items and derived items © 2006 by Mosby, Inc.
  • 10. 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  HEART FAILURE Malignant hypertension – 1%  Rapid progressive HTN with diastolic P > 140 mm Hg  Encephalopathy and other end organ damage  Anesthesia reaction  Younger patients  AA race  Kidney failure  Pregnant women - pre-eclampsia to eclampsia. 10Mosby items and derived items © 2006 by Mosby, Inc.
  • 11. Treatment for Hypertension 11Mosby items and derived items © 2006 by Mosby, Inc.
  • 12. Diseases of the Arteries and Veins Aneurysm  Local dilation or outpouching of a vessel wall or cardiac chamber  Aorta especially susceptible  Constant stress on wall – high pressure  Absence of support structure in the media layer  Complication  Dissection through vessel wall 12Mosby items and derived items © 2006 by Mosby, Inc.
  • 13. Diseases of the Arteries and Veins Thrombus formation  Blood clot that remains attached to the vessel wall  Thromboembolus  Thrombophlebitis  Arterial thrombi  Venous thrombi 13Mosby items and derived items © 2006 by Mosby, Inc.
  • 14. 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 14Mosby items and derived items © 2006 by Mosby, Inc.
  • 15. Diseases of the Arteries and Veins Peripheral artery disease (PAD)  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  Usually resolves with rest 15Mosby items and derived items © 2006 by Mosby, Inc.
  • 16. 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 arteries of the feet  Digital, ulnar, and palmar arteries of the hands  Obliterates the small and medium-sized arteries 16Mosby items and derived items © 2006 by Mosby, Inc.
  • 17. 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  Amputation 17Mosby items and derived items © 2006 by Mosby, Inc.
  • 18. 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 18Mosby items and derived items © 2006 by Mosby, Inc.
  • 19. 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  Prolonged standing Chronic venous insufficiency  Inadequate venous return over a long period due to varicose veins or valvular incompetence  Venous stasis ulcers 19Mosby items and derived items © 2006 by Mosby, Inc.
  • 20. Diseases of the Veins Deep venous thrombosis  Obstruction of venous flow leading to increased venous pressure  Factors  Venous stasis  Venous endothelial damage  Hypercoagulable states 20Mosby items and derived items © 2006 by Mosby, Inc.
  • 21. 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 - one third of the mortality we see.  Diabetes mellitus - increase LDL and lower HDL.  Obesity/sedentary lifestyle - truncal obesity is considered an endocrine gland. Chronic stress has a negative impact on your lipids. 21Mosby items and derived items © 2006 by Mosby, Inc.
  • 22. Coronary Artery Disease Nontraditional risk factors  Markers of inflammation and thrombosis  C-reactive protein, fibrinogen, protein C, and plasminogen activator inhibitor  Hyperhomocysteinemia - treatable  Assoc increase LDL  Decrease in endogenous vasodilators  Increase tendency for thrombosis  Take B vitamins and folate.  Infection ?  Microorganisms found in atherosclerotic lesions  Serum antibodies to microorganisms linked to CAD 22Mosby items and derived items © 2006 by Mosby, Inc.
  • 23. Coronary Artery Disease Myocardial ischemia  Local, temporary deprivation of the coronary blood supply  Stable angina  Prinzmetal angina - pain with exertion. (Just walk by the cold section or go to Tahoe).  Silent ischemia 23Mosby items and derived items © 2006 by Mosby, Inc.
  • 24. Coronary Artery Disease Acute coronary syndromes  Transient ischemia  Unstable angina  Sustained ischemia  Myocardial infarction - one experience of ACS.  Myocardial inflammation and necrosis - will be repaired with necrosis. 24Mosby items and derived items © 2006 by Mosby, Inc.
  • 25. Myocardial Infarction 25Mosby items and derived items © 2006 by Mosby, Inc.
  • 26. Coronary Artery Disease Myocardial infarction  Sudden and extended obstruction of the myocardial blood supply  Subendocardial infarction - may not always see Q wave.  Transmural infarction 26Mosby items and derived items © 2006 by Mosby, Inc.
  • 27. Myocardial Infarction  Cellular injury  Cellular death  Structural and functional changes  Myocardial stunning - may take a couple days after reperfusion.  Myocardial hibernating - adaptation, can come back to life.  Myocardial remodeling - angio II, Epi, NE, myocytes become hypertrophied, (even though not exposed to hypoxia) --> ACEi  Repair is not repair, it is scar tissue.  Repair - Repair is not repair, it is scar tissue. 27Mosby items and derived items © 2006 by Mosby, Inc.
  • 28. ECG Changes: Ischemia 28Mosby items and derived items © 2006 by Mosby, Inc.
  • 29. Disorders of the Heart Wall Disorders of the pericardium  Acute pericarditis  Connective tissue disease  Infection  Pericardial effusion  Tamponade  Constrictive pericarditis  RA - Rhumatoid Arthritis.  Radiation exposure  Scleraderma 29Mosby items and derived items © 2006 by Mosby, Inc.
  • 30. Pericarditis 30Mosby items and derived items © 2006 by Mosby, Inc.
  • 31. Disorders of the Myocardium Cardiomyopathies  Dilated cardiomyopathy (congestive cardiomyopathy - “floppy sloppy”) Most common.  Hypertrophic cardiomyopathy  Asymmetrical septal hypertrophy  Hypertensive (valvular hypertrophic) cardiomyopathy  Restrictive cardiomyopathy 31Mosby items and derived items © 2006 by Mosby, Inc.
  • 32. Cardiomyopathy 32Mosby items and derived items © 2006 by Mosby, Inc.
  • 33. Disorders of the Endocardium  Valvular dysfunction  Valvular stenosis  Aortic stenosis - must be fixed  Mitral stenosis  Valvular regurgitation  Aortic regurgitation  Mitral regurgitation  Tricuspid regurgitation  Mitral valve prolapse syndrome  Will hear mid-systolic clic.  Late systolic murmur.  Sometimes post MI  Endocarditis. 33Mosby items and derived items © 2006 by Mosby, Inc.
  • 34. Valvular Dysfunction 34Mosby items and derived items © 2006 by Mosby, Inc.
  • 35. Valvular Dysfunction 35Mosby items and derived items © 2006 by Mosby, Inc.
  • 36. Infective Endocarditis Inflammation of the endocardium Agents  Bacteria, viruses, fungi, rickettsiae, and parasites Pathogenesis  “Prepared” endocardium  Damaged endothelium  Microorganism colonization  Blood-borne microorganism adherence  Proliferation of the microorganism 36Mosby items and derived items © 2006 by Mosby, Inc.
  • 37. Infective Endocarditis 37Mosby items and derived items © 2006 by Mosby, Inc.
  • 38. Heart Failure General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients 38Mosby items and derived items © 2006 by Mosby, Inc.
  • 39. Heart Failure Congestive heart failure  Systolic heart failure - decrease of myocardial contractility, left EF, LVH. Remodeling lead to back up, to BI-failure. Hypertrophic cardiomyopathy. EJ < 40 (nl - 60)  Inability of the heart to generate adequate cardiac output to perfuse tissues  MI – DCM  HTN - HCM  Diastolic heart failure - Filling defect. Left EJ will be GREATER than 40.  Pulmonary congestion despite normal stroke volume and cardiac output  Mitral stenosis - decreased left ventricular filling.  HCM  RCM  Swelling in feet, hands and legs. 39Mosby items and derived items © 2006 by Mosby, Inc.
  • 40. Congestive Heart Failure 40Mosby items and derived items © 2006 by Mosby, Inc.
  • 41. Heart Failure Right heart failure  Most commonly caused by a diffuse hypoxic pulmonary disease - Core pulmanoly.  Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation (left sided heart failure). High-output failure - heart can’t keep up with the demand.  Inability of the heart to supply the body with blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility  Ex - anemia, septicemia, beri beri (B1), hyperthyroidism. 41Mosby items and derived items © 2006 by Mosby, Inc.
  • 42. Right Heart Failure 42Mosby items and derived items © 2006 by Mosby, Inc.
  • 43. Questions? Thanks again. 43Mosby items and derived items © 2006 by Mosby, Inc.