Hardening / lesions of arteries due to accumulation along intima in lumen of vessels of: - smooth muscle cells - connective tissue - macrophages - lipids - -> Calcification - -> Impairs blood flow Stages: 1. Initiation/Formation 2. Adaptation 3. Clinical Could lead to: - MI - Cerebral infarct - Gangrene - Aneurysm - Occlusion / Ischemia - Thromboembolism

Arterial wall remodeling --> area of thickened intima Can break off / rupture Stages: 1. Initiation/Formation 2. Adaptation 3. Clinical

Cardiovascular Pathophysiology Flashcards by Kate Hope

Atherosclerosis

Hardening / lesions of arteries due to accumulation along intima in lumen of vessels of:

smooth muscle cells
connective tissue
macrophages
lipids
- -> Calcification
  - -> Impairs blood flow

Stages:

Initiation/Formation
Adaptation
Clinical

Could lead to:
- MI
- Cerebral infarct
- Gangrene
- Aneurysm
- Occlusion / Ischemia
- Thromboembolism

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Lesion

Abnormality in tissue – Atherosclerotic:

- Plaque
- Atheromas
- Fibrous plaques
- Fibro-fatty lesions

Contributing factors:

- Cytokines
- T lymphocytes
- Endothelium
- Thrombosis

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Atheroma

Arterial wall remodeling
–> area of thickened intima

*Can break off / rupture

Stages:

Initiation/Formation
Adaptation
Clinical

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Hyperplasia

Excessive cell growth

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Regression

Body fixes itself

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Infarct

Cell death caused by restricted blood supply to area

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Angiogenesis

New vascular formation / regeneration

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Risk Factors for Development of Atherosclerosis / CAD

Smoking
HTN
Family Hx
Sedentary lifestyle
Obesity
Diabetes
Dyslipidemia (high LDL, low HDL)
Age / Sex / Race
Hot reactor
High Homocysteine
High C-Reactive protein

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CAD

(Coronary Artery Disease) - Ischemic Heart Disease
Deficit in O2 blood to myocardium

*Leading cause of death

Could lead to:

Angina
MI
CHF
Death

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HTN

(Hypertension)
Persistent elevation of blood pressure
*Risk factor for CAD

Stage I:
Systolic BP > 140mmHg
Diastolic BP > 90mmHg

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Obesity

BMI > 30kg/m2

*Risk factor for CAD

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Diabetes

Impaired fasting glucose > 100mg/dL

*Risk factor for CAD

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Hypercholesterolemia

High blood cholesterol > 200mg/dL
LDL > 130mg/dL
HDL < 40mg/dL

*Risk factor for CAD

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Lipid Metabolism

Cholesterol is insoluble, so must be transported in blood bound to lipoproteins

Normal < 200mg/dL

VLDL
LDL - target of therapeutic treatment
HDL

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HDL

(High Density Lipoproteins) = Good cholesterol
Remove cholesterol from blood
–>liver for removal from body

Normal > 40mg/dL

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LDL

(Low Density Lipoproteins) = Bad cholesterol
Oxidized and taken up by macrophages to lesions

Normal < 130mg/dL

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Framingham Heart Study

Study to ID common factors contributing to CVD

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Raynaud Phenomenon

Intermittent, bilateral attacks of ischemia caused by cold and emotions

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Aneurysm

Weakening / bulge in wall of vessel

DVT

(Deep Venous Thrombosis) *ACUTE
Blood clot formed in vessel of lower extremity
-Inflammatory response
-Constant pain

PAD / PVD

(Peripheral Artery / Vascular Disease) *CHRONIC
Complication of atherosclerosis
-Pain with exertion, goes away with rest

Coronary Arteries

Right: off anterior aorta
-In right AV sulcus

Left: off posterior aorta

LAD
Circumflex

Angina

Most common symptom of CAD
- Caused by ischemia (75-90% occlusion)

Symptoms:

Substernal pressure (feels like indigestion)
Pain in L arm, jaw (toothache), scapula
Ltd duration
Worse with exertion, better with rest

ACS

(Acute Coronary Syndrome)

Umbrella term for CAD symptoms

``` (Myocardial Infarction) Death of tissue due to prolonged ischemia, commonly from advanced atherosclerosis --> Decreased effectiveness and efficiency of the pump -Dec ventricular function (EF) -Dec contractility -Abnormal wall motion -Inc ESV / EDV -Inc LV ED pressure ``` Symptoms: - Prolonged angina - Cyanosis - Dyspnea (SOB) - Nausea - Diaphoresis - EKG changes *40% females - no angina

Diaphoresis

Excessive sweating / perspiration

MI: Immediate Mgmt

Dial 911, Chew aspirin ``` In ER: -EKG -Meds: Nitrates Morphine Antiarrhythmics Anticoagulants = bleed -Thrombolytics -Blood Labs -O2 ```

Ischemic Heart Disease

Coronary Artery Disease (CAD)

Alphabet Approach to Patient Management

A -antiplatelet - anticoagulant - ACE Inhibitor - Angiotensin receptor blocker B -beta blocker -BP control C -Cholesterol tx -Cig smoking cessation D -Diabetes mgmt -Diet E -Exercise

ACE

(Angiotensin Converting Enzyme)

Arrhythmia

Irregular heartbeat

Physiological Controls of SV

(Stroke Volume) 1. Preload 2. Contractility 3. Afterload

mVO2

Myocardial oxygen uptake (WORKLOAD of heart) = How much O2 needs to be delivered to myocardium for adequate function at any given time

Preload

Physiological control of SV Degree of stretch of myocardial fibers prior to contraction -Dependent on venous return ^preload = ^mVO2 = ^SV

Contractility

Physiological control of SV Increased interaxns of myofilaments at cross-bridges Increased Ca Increased SNS input ^Contractility = ^mVO2 = ^SV

Afterload

Physiological control of SV Amount of pressure ventricles must overcome during systole to open semilunar valves and eject blood -If arterial pressure increases, so does afterload ^Afterload = ^mVO2 = Dec SV

CHF

(Congestive Heart Failure) Heart unable to maintain adequate output to meet metabolic needs *Abnormally high atrial filling pressures * CO maintained by compensatory mech: - ^LV EDP - ^EDV - ^SNS stimulation

Hypertensive Heart Disease

Cardiac hypertrophy secondary to prolonged systemic pressure overload

Endocardial / Valvular Disease

Damage to valves, impairing their function --> Regurgitation (retrograde blood flow) Ex: MVP

MVP

(Mitral Valve Prolapse) | Most common valvular disease

Infective Endocarditis

Inflammation of the endocarditis with vegetations on valves --> Erosion --> Valvular Impotence *Bacterial or viral, IV drugs, catheters

Cardiomyopathy

Primary noninflammatory myocardial disease *NOT attributable to pressure or volume overload 1. Dilated / Congestive --> CHF 2. Hypertrophic / ASH / IHSS --> thickened myocardium 3. Restrictive / Infiltrative --> ltd EDV --> CHF

ASH

(Asymmetric Septal Hypertrophy)

IHSS

(Idiopathic Hypertrophic Subaortic Stenosis)

Congenital Heart Disease

Major heart disease within first decades 1. Acyanotic Group (No sys/pulm mixing) 2. Cyanotic Tardive Group (Sys/pulm shunt reversal 3. Cyanotic Group (Mixing of sys/pulm)