The document discusses various cardiovascular diseases and disorders. It covers topics like arteriosclerosis, atherosclerosis, hypertension, aneurysms, peripheral artery disease, coronary artery disease, myocardial infarction, cardiomyopathies, valvular dysfunction, infective endocarditis, heart failure, and dysrhythmias. For each topic, it provides details on pathogenesis, risk factors, symptoms, and progression. The document aims to provide an overview of alterations in cardiovascular function and related diseases of the arteries, veins, heart wall, and heart rhythm.

1. 1
Alterations of
Cardiovascular Function
Chapter 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