Cardiovascular anatomy and pathology

1. ABB MD FACC©
Atherosclerotic Cardiovascular Disease
A Bornstein, MD, FACC
Assistant Professor of Public Health
Weill Cornell Medical College
New York, NY

2. ABB MD FACC©
Heart Viewed From Outside: Heart Muscle
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

3. ABB MD FACC©
Heart Viewed From Outside: Heart Muscle
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

4. ABB MD FACC©
Heart Viewed From Outside: Coronary Arteries
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

5. ABB MD FACC©
Heart Viewed From Outside: Coronary Arteries
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

6. ABB MD FACC©
First Inner Layer of the Heart (Heart Muscle)
ABB MD FACC©By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

7. ABB MD FACC©
First Inner Layer of the Heart (Heart Muscle)
ABB MD FACC©By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

8. ABB MD FACC©
ABB MD FACC©
View of the Heart from Inside Surrounding Heart Muscle
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

9. ABB MD FACC©
ABB MD FACC©
View of the Heart from Inside Surrounding Heart Muscle
By Patrick J. Lynch, medical illustrator https://creativecommons.org/licenses/by/2.5

10. ABB MD FACC©
Left Coronary Artery Circulation

11. ABB MD FACC©
Right Coronary Artery Circulation

12. ABB MD FACC©
What is Heart Disease?
 Heart disease also known as cardiovascular disorder, a term that
includes a number of different diseases which affect the heart
 Coronary artery disease (CAD) due to atherosclerosis is the most
common cause of heart disease in developed as well as developing
nations. CAD is the narrowing or blockage of the coronary arteries
which supply blood to the heart muscle; atherosclerosis occurs when
fatty material and a substance called plaque builds up in the walls of
the arteries
 Other causes of heart disease include hypertension (high blood
pressure), abnormal heart valve function, abnormal heart rhythm,
weakening of the pumping ability of the heart (heart failure) which
may be caused by progressive atherosclerosis, uncontrolled HTN,
valve disease, infection, or toxins

13. ABB MD FACC©
What is Coronary Artery Disease?
 CAD develops when the arteries that supply blood to heart muscle
become hardened & narrowed due to the buildup of cholesterol & fat
into plaque in the inner lining of the walls of the arteries, obstructing
normal blood flow
 As the buildup grows, less blood can flow through the arteries
resulting in the heart muscle not being able to get blood, nutrients,
and oxygen it needs to continue pumping effectively
 This can lead to chest pain (angina) or a heart attack (MI); most heart
attacks happen when a plaque ruptures causing a blood clot to form
which suddenly and totally cuts off the hearts' blood supply, causing
permanent heart muscle damage and less often sudden cardiac death.

14. ABB MD FACC©
What is Coronary Artery Disease?
Normal artery
Diseased artery

15. ABB MD FACC©
Heart Attack (MI) Due to Plaque Rupture
Triggering Acute Thrombus Formation

16. ABB MD FACC©
Atherosclerotic Development Over the Years

17. ABB MD FACC©
Symptoms of Coronary Artery Disease (Angina Pectoris)
Cold weather and cigarette smoking are 2
precipitants of a heart attack via 2 different
mechanisms: cold causes coronary artery
spasm (constricted coronary arteries), while
cigarettes cause the blood to coagulate more
readily thus increasing clot formation within
the coronary artery.

18. ABB MD FACC©
What is a Stroke?
A stroke is the rapidly developing loss of
brain functions due to a disturbance in the
blood vessels supplying blood to the brain

19. ABB MD FACC©
What is a Heart Attack?
 Over time, CAD (repeated heart attacks or
unstable angina) can also weaken the heart
muscle and contribute to heart failure and
arrhythmias
 It is difficult to estimate exactly how common
heart attacks are because as many as 200,000
to 300,000 people in the U.S. die each year
before medical help is sought or medical help
arrives (mortality rate: 200,000-300,000)
 Approximately 1 million patients visit the
hospital each year with a heart attack
 ~ 1 death out of every 5 deaths (20%) are due
to a heart attack
Without proper lifestyle and
care, some day you may be
right the first time!!!

20. ABB MD FACC©
Invasive Testing for Coronary Artery Disease

21. ABB MD FACC©
Percutaneous Coronary Intervention

22. ABB MD FACC©
Normal
Fatty
streak
Fibrous
plaque
Occlusive
atherosclerotic
plaque
Plaque
rupture/
fissure &
thrombosis
Clinically silent
Increasing age
Effort angina
Claudication
MI
Unstable
angina
Coronary
death
Stroke
Critical leg ischemia
Atherosclerosis: A Progressive Process
Courtesy of P Ganz

23. ABB MD FACC©
Libby P. Lancet. 1996;348:S4-S7.
Media
– T lymphocyte
– Macrophage
foam cell (tissue factor+)
– ‘Activated’ intimal SMC (HLA-DR+)
– Normal medial SMC
Fibrous cap
Intima
Lipid
core
Lumen
Anatomy of the Atherosclerotic Plaque

24. ABB MD FACC©
Libby P. Circulation. 1995;91:2844-2850.
Characteristics of Plaques Prone to Rupture
– T lymphocyte
– Macrophage
foam cell (tissue factor+)
– ‘Activated’ intimal SMC (HLA-DR+)
– Normal medial SMC
‘Stable’ plaque
‘Vulnerable’ plaque
Lumen
Area of
detail
Media
Fibrous cap
Lumen
Lipid
core
Lipid
core

25. ABB MD FACC©
1) Bad genes (hereditary factors, family history)
2) Age
3) Being male (MI at an earlier age)
4) Menopause in females
5) High blood pressure
6) Smoking
7) Diabetes
8) Obesity (Metabolic syndrome)
9) Low levels of physical activity
10) Too much unhealthy fat in your diet
11)  LDL (‘bad’) cholesterol &  HDL (‘good’) cholesterol
12)  Homocysteine, CRP, &/or fibrinogen (markers of inflammation and
increased clotting tendency)
CAD & Heart Attack Risk Factors