The document discusses the cardiovascular system and provides information about diseases of blood vessels and the heart. It covers topics like arteriosclerosis, atherosclerosis, aneurysms, vasculitis, and tumors of blood vessels. For diseases of the heart, it mentions mechanisms of cardiac dysfunction like pump failure, outflow obstruction, regurgitant flow, conduction defects, and disruption of circulation. Risk factors for atherosclerosis include age, sex, genetics, hyperlipidemia, hypertension, smoking, and diabetes. The pathogenesis of atherosclerosis involves chronic endothelial injury and inflammation.
23. participants had increases in HDL cholesterol
averaging about 2.5 mg/dL. This increase in
HDL cholesterol was only modest, but was
statistically significant. Furthermore, since
cardiac risk is thought to drop by two to three
percent for each 1 mg/dL increase in HDL, a
2.5 mg/dL rise in HDL amounts to a
substantial reduction in risk.
24. Exercise is involved in increasing the production and
action of several enzymes that function to enhance
the reverse cholesterol transport system (Durstine &
Haskell 1994). The precise mechanisms are unclear,
but evidence indicates that other factors including
diet, body fat, weight loss, and hormone and enzyme
activity interact with exercise to alter the rates of
synthesis, transport and clearance of cholesterol
from the blood (Durstine & Haskell 1994).
32. CARDIOVASCULAR SYSTEM
Macrophages
toxic oxygen species oxidation of lipids
GF smooth muscle cell proliferation
T lymphocytes cellular & humoral
3. Lipids:
cholesterol & its esters in atheromas
Oxidized LDL in macrophages
33. CARDIOVASCULAR SYSTEM
genetic defects hypercholesterolemia
AS
MI at young age with ↑ cholesterol
DM, hypothyroidism ↑ cholesterolAS
high cholesterol diet AS
severity of AS levels of cholesterol
↓ing cholesterol levels risk of AS ↓
38. CARDIOVASCULAR SYSTEM
Atheromatous plaque:
elastic & muscular arteries
lower abdominal aorta > thoracic aorta
ostia and branches
symptomatic AS disease
MI heart attack
cerebral infarction stroke
peripheral vascular gangrene
39. CARDIOVASCULAR SYSTEM
aorta > coronaries > popliteal > internal
carotid > circle of willis
white – white yellow
variable size
eccentric lesions
obstruction of lumen
70. CARDIOVASCULAR SYSTEM
AORTIC DISSECTION
“Dissection of blood between & along laminar
planes of media”
1. HTN 40-60 yrs males
2. CT defects young age
3. Iatrogenic
4. Pregnancy
75. CARDIOVASCULAR SYSTEM
rupture out pericardial, pleural, peritoneal
double barreled aorta
cystic medial degeneration
cystic medial necrosis
Classification:
Type A: Proximal
I
II
Type B: Distal
110. CARDIOVASCULAR SYSTEM
KAPOSI’S SARCOMA:
1. Chronic/Classic/European
Kaposi in 1872
older men
not associated with HIV
homosexual men
multiple red – purple skin plaques/nodules
arms & legs
111. CARDIOVASCULAR SYSTEM
gradual spread
asymptomatic & localized
visceral involvement 10%
2. Lymphadenopathic/African/Endemic:
Bantu children of SA
lymphadenopathy
aggressive
112. CARDIOVASCULAR SYSTEM
3. Transplant associated/immunosuppression
associated:
months-years post transplant
aggressive
lymph node, mucosa, viscera
internal involvement fatal
113. CARDIOVASCULAR SYSTEM
4. AIDS associated:
1/3rd AIDS patients
wide dissemination
Morphology:
3 stages:
Patch
pink-red-purple
single/multiple macules
136. CARDIOVASCULAR SYSTEM
“ Structure of hypertrophied heart is not normal.
It is a tight balance between adaptation and
deleterious alterations ( ↓ capillary-to-
myocyte ratio, ↑ fibrous tissue & synthesis of
abnormal proteins). Thus sustained cardiac
hypertrophy evolves into cardiac failure.”
137. CARDIOVASCULAR SYSTEM
Molecular & cellular changes that initially
mediate enhanced function later contributes to
heart failure.
Physiologic hypertrophy.
Pathologic hypertrophy.
153. CARDIOVASCULAR SYSTEM
4 clinical manifestations of IHD:
1. Myocardial Infarction
2. Angina Pectoris
3. Chronic IHD
4. Sudden cardiac death
Acute Coronary Syndromes (1, 2, 4)
154. CARDIOVASCULAR SYSTEM
Leading cause of death
50% reduction in IHD related mortality in USA
Prevention
Early diagnosis (advanced facilities)
Therapeutic intervention (effective, safer)
157. CARDIOVASCULAR SYSTEM
AS obstruction fixed / stable obstruction
plaque change ↓
↓ ↓
ISCHEMIA
75% obstruction symptomatic on ↑ demand
90% obstruction symptomatic at rest
158.
159. CARDIOVASCULAR SYSTEM
Role of acute plaque change:
Rupture/ulceration
Erosion/fissuring thrombosis
Haemorrhage
Intrinsic influences
structure & composition of plaque
extrinsic influences
blood pressure, Plt reactivity
160. CARDIOVASCULAR SYSTEM
Structure of plaque
Vulnerable plaque
↑ foam cells
↑ extracellular lipids
thin fibrous caps
few SMCs
inflammatory cell clusters
Junction of fibrous cap & adjacent endothelium
161.
162. CARDIOVASCULAR SYSTEM
Collagen deposition degradation
metalloproteinases by macrophages
Adrenergic stimulation systemic HTN & plt
reactivity stress on plaques
Early morning
Emotional stress
163. CARDIOVASCULAR SYSTEM
Role of inflammation:
All stages of AS
Macrophages & T lymphocytes
IL-1, IL-6, TNF, INF g
Metalloproteinses weaken plaque
Inflammation destabilizes plaque
164. CARDIOVASCULAR SYSTEM
Role of coronary thrombus:
Partial / total acute coronary syndromes
Mural branch thrombus embolize
Microinfarcts
Role of vasoconstriction:
Potentiate plaque change
165. CARDIOVASCULAR SYSTEM
ANGINA PECTORIS:
“A symptom complex of IHD cahracaterized by
recurrent attacks of substernal/precordial
chest discomfort caused by transient MC
ischemia that falls short of inducing
infarction.”
175. CARDIOVASCULAR SYSTEM
TRANSMURAL SUBENDOCARDIAL
Full thickness of MC Inner 1/3rd or half
AS plaque change As plaque change
thrombosis thrombosis recanalized
Hypotension / shock on
chronic stenosing AS
Limited to area of supply Can extend beyond
176. CARDIOVASCULAR SYSTEM
Incidence & risk factors:
Any age
Risk factors of AS
Pathogenesis:
Coronary artery occlusion
Acute plaque change thrombosis VC
↑ size of thrombus complete occlusion
177. CARDIOVASCULAR SYSTEM
10% MI not associated with AS plaque change.
Vasospasm
Emboli (paradoxical emboli)
Unexplained (vasculitis, Hg defects, amyloid)
179. CARDIOVASCULAR SYSTEM
FEATURE TIME
ATP depletion Seconds
Loss of contractility < 2 min
ATP reduced to 50% 10 min
10% 40 min
Irreversible cell injury 20 – 40 min
Microvascular injury > 1 hr
181. CARDIOVASCULAR SYSTEM
Factors influencing MI:
1. Site, size, rate of development of AS
2. Size of vascular bed
3. Duration
4. Mc demands
5. Collateral circulation
6. Coronary artery spasm
7. BP, HR, cardiac rhythm
182. CARDIOVASCULAR SYSTEM
Morphology:
Left ventricle > right
ventricle
Rim of subendocardium
preserved
LAD 40 – 50% Ant wall left vent, apex, ant septum
RCA 30 – 40% Inf-post wall lt vent, post septum,
post right vent
LCA 15 – 20% Lat wall left vent
183. CARDIOVASCULAR SYSTEM
TIME GROSS MICROSCOPIC
0 – ½ hr ----- myofibril relaxation, swelling
of mitochondria
½ - 4 hr ----- Wavy fibers
4 – 12 h Occ dark mottling Coag necrosis, edema, hge
12-24 h Dark mottling Necrosis, pyknosis,myocyte
eosinophilia, contraction
bands, neutrophils
184. CARDIOVASCULAR SYSTEM
1 -3 days Mottling + yellow Loss of nuclei & striations,
centre PMNs ++
3 – 7 days Red border, Disintegration, phagocytosis
yellow tan center
7 – 10 Max yellow soft Phagocytosis ++, granulation
days center, red borders tissue at margins
10-14 Red-gray Granulation tissue ++,
days depressed collagen +
2 – 8 wks Grey white scar ↑ collagen, ↓ cellularity
> 2 month Complete scar Dense collagenous scar
194. CARDIOVASCULAR SYSTEM
Reperfusion injury/Myocardial stunning:
Restoration of coronary flow reperfusion
Ischemia variable effects on MC
Reperfusion salvage
damage O2 free radicals
haemorrhage
apoptosis
195. CARDIOVASCULAR SYSTEM
Persistence of biochemical & functional changes
in reperfused MC stunned MC
CARDIAC ENZYMES:
CPK (MM, MB, BB)
AST
LDH
Troponins
196.
197.
198. CARDIOVASCULAR SYSTEM
Complication of MI:
1. Contractile dysfunction crdiogenic shock
2. Arrhythmias
3. MC rupture cardiac rupture syndrome
4. Pericarditis
5. Right ventricular infarction
6. Extension
7. Mural thrombosis
8. Ventricular aneurysm
9. Papillary muscle dysfunction
10. Progressive late heart failure
233. CARDIOVASCULAR SYSTEM
Fungal Endocarditis
larger vegetations
Systemic emboli Septic infarcts
SIE granulation tissue at base
LIBMAN-SACKS ENDOCARDITIS:
Endocarditis of SLE
261. CARDIOVASCULAR SYSTEM
HYPERTENSIVE HEART DISEASE (HHD)
An adaptive response
Systemic HTN left HHD
Pulmonary HTN right HHD
Systemic HHD:
1. Left ventricular hypertrophy
2. Evidence of HTN
262. CARDIOVASCULAR SYSTEM
Pressure overload = afterload concentric
Hypertrophy
↑ weight
Defective diastolic filling
Left atrial dilation
↑ transverse diameter of myocyte
Variation in cell size
Interstitial fibrosis
278. The mediocre teacher tells.
The good teacher explains.
The superior teacher demonstrates. SYSTEM
CARDIOVASCULAR
The great teacher inspires.
(William Arthur Ward)