Professional Documents
Culture Documents
Alterations of Cardiovascular
Function
Lymphatic System
Varicoseveins
A vein in which blood has
pooled
Distended, tortuous, and
palpable veins
Caused by trauma or gradual
venous distention
Risk factors:
Age
Female gender
Family history
Obesity
Pregnancy
Peep vein thrombosis
Prior leg injury
Diseases of the Veins (cont’d)
Chronicvenous insufficiency
Inadequate venous return over
a long period due to varicose
veins or valvular
incompetence
Venous stasis ulcers
Diseases of the Veins (cont’d)
Deep venous thrombosis
Obstruction of venous flow leading to
increased venous pressure
Factors:
Venous stasis
Venous endothelial damage
Hypercoagulable states
Other (cancer, orthopedic
surgery/trauma, heart failure,
immobility)
Diseases of the Veins (cont’d)
Hypertension
Isolatedsystolic hypertension—becoming
prevalent in all age groups
Elevations of systolic pressure are
caused by increases in cardiac output,
total systemic vascular resistance
(SVR), or both.
Review your Pharmacology Lecture on
Hypertension for details on HTN
Diseases of the Arteries and Veins
Primary hypertension
Essentialor idiopathic
hypertension
Genetic and environmental factors
Affects92% to 95% of individuals
with hypertension
Risk factors:
High sodium intake
Obesity
Insulin resistance
Primary Hypertension
Diseases of the Arteries and Veins
Secondary hypertension
Caused by a systemic disease
process that raises peripheral
vascular resistance or cardiac
output
Renal artery stenosis, renal
parenchymal disease,
pheochromocytosis, drugs
Diseases of the Arteries and Veins (cont’d)
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
Affects heart, kidneys, retina
Can result in transient ischemic
attack/stroke, cerebral thrombosis,
aneurysm, dementia
Diseases of the Arteries and Veins
(cont’d)
Malignant hypertension
Rapidly progressive
hypertension
Diastolic pressure is usually
>140 mm Hg
Life-threatening organ damage
Diseases of the Arteries and Veins cont’d
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
Diseases of the Arteries and Veins (cont’d)
Aneurysm
Local dilation or outpouching of a vessel
wall or cardiac chamber
True aneurysms
Fusiform aneurysms
Circumferential aneurysms
False aneurysms
Saccular aneurysms
Aorta most susceptible, especially
Aneurysm
Aneurysm
Aneurysm of Decending Aorta above Kidney
Diseases of the Arteries and Veins
Thrombus formation
Blood clot that remains attached to the
vessel wall
Risk factors include intimal
injury/inflammation, obstruction of flow,
pooling (stasis)
Thromboembolus
Thrombophlebitis
Arterial thrombi
Venous thrombi
Diseases of the Arteries and Veins –cont’d
Embolism—bolus of matter that is
circulating in the bloodstream
Dislodged thrombus
Air bubble
Amniotic fluid
Aggregate of fat
Bacteria
Cancer cells
Foreign substance
Diseases of the Arteries and Veins
(cont’d)
Peripheral artery disease
Atherosclerotic disease of the
arteries that perfuses the limbs
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
Peripheral Artery Disease (cont’d)
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
Arteriosclerosis
Diseases of the Arteries and Veins
Atherosclerosis
Form of arteriosclerosis
Thickening and hardening caused
by accumulation of lipid-laden
macrophages in the arterial wall
Plaque development
Diseases of the Arteries and Veins (cont’d)
Atherosclerosis –
Progression
Inflammation of endothelium
Cellular proliferation
Macrophage migration and adherence
LDL oxidation (foam cell formation)
Fatty streak
Fibrous plaque
Atherosclerosis-
Atheroscleroticdisease of arteries
that perfuse limbs
Intermittent claudication
Coronary Artery Disease
Major: Modifiable:
Increased age Dyslipidemia
Family history Hypertension
Male gender or Cigarette
female gender post smoking
menopause Diabetes mellitus
Obesity
Sedentary
Lifestyle
Coronary Artery Disease (cont’d)
Stable angina
Gradual narrowing and hardening of
arterial walls so that affected vessel
cannot dilation to increased demand
Prinzmetal angina
Also called variant angina
Occurs at rest
Often in response to vasospasm
Silentischemia and mental stress induced
ischemia
Assessment findings
Arcus senilis and xanthelasmas around
Eye lids indicate possible dyslipidemia
Peripheral or carotid bruit
Myocardial Ischemia
*ST depression
and T wave
inversion during
acute pain
Drug therapy - immediate
MONA
Morphine sulfate
Oxygen
Nitroglycerin
Aspirin
Then – antithrombotic therapy – aspirin
a day or Plavix, beta-blockers and ACE
inhibitors
Intervention
To Cardiac
Cath Lab-
Stent.
Or to
Surgery for
a CABG
Coronary
Artery Bypass
Graft
Coronary Artery Disease
Myocardial infarction
Suddenand extended obstruction of the
myocardial blood supply
LOCATION OF INFARCT-
Subendocardial infarction
(usually non-STEMI)
Transmural infarction
(usually STEMI)
Myocardial Infarction
Cellular ischemia- occurs first
Cellular injury – occurs if no treatment given
Cellular infarct (death)- final outcome
Structural and functional changes:
Myocardial stunning
Hibernating myocardium
Myocardial remodeling (use of collateral
veins –if developed- to compensate
Repair
Myocardial Infarction
Myocardial Infarction (cont’d)
Manifestations:
Sudden severe chest pain; may radiate to
left arm, shoulder, jaw, back.
Nausea, vomiting
Diaphoresis, Dyspnea
Complications:
Sudden cardiac arrest due to ischemia,
left ventricular dysfunction, and
electrical instability
Complications of MI
1. Dysrhythmia
2. Left ventricular failure (CHF)
3. Inflammation of pericardium
4. Dressler postinfarct syndrome – delayed form of
pericarditis
5. OBS
6. Rupture structure
7. Rupture of infarcted ventricle
8. Systemic thromboembolism
9. Pulmonary thromboembolism
10. Sudden death
Disorders of the pericardium (heart wall)
Acute pericarditis
Idiopathic, viral – most common CV of HIV
Pericardial effusion can develop
Sx – may follow several days of fever,
retrosternal CP, back pain, dysphagia,
restlessness, irritability, anxiety,
weakness and malaise
Friction rub –scratchy, grating sound
heard at apex and L sternal border
Continued-
EKG changes
Diffuse ST segment elevation
PR segment depression
Hypotension
Pulsus paradoxus – decrease in
systolic BP by > 10 with inspiration
is suggestive of tamponade
Pericardial effusion
Accumulation of the fluid in the
pericardial sac
Tamponade- “Beck’s Triad: Hypotension,
Jugular Vein Distension, Muffled Heart
sounds
Disorders of the Myocardium
Cardiomyopathies:
Dilatedcardiomyopathy
(congestive cardiomyopathy)
Hypertrophic cardiomyopathy
Asymmetrical septal
hypertrophy
Hypertensive (valvular
hypertrophic) cardiomyopathy
Restrictive cardiomyopathy
Cardiomyopathy
Disorders of the Endocardium
Valvular dysfunctions:
Valvular stenosis
Aortic stenosis
Mitral stenosis
Valvular regurgitation
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Mitral Valve Prolapse syndrome (MVP)
Valvular Dysfunction
Acute Rheumatic Fever and Rheumatic
Heart Disease
Rheumatic fever
Systemic, inflammatory disease caused
by a delayed immune response to
pharyngeal infection by the group A
beta-hemolytic streptococci
Febrile illness
Inflammation of the joints, skin,
nervous system, and heart
Ifleft untreated, rheumatic fever
causes rheumatic heart disease
Rheumatic fever (cont’d)
Myocarditis
Endocarditis
Pericarditis
Cardiomyopathy
Pericardial effusion
Pulmonary hypertension
Antiviral drug-related cardiotoxicity
Dysrhythmias (Arrhythmias)
Cardiogenic
Hypovolemic
Neurogenic
Anaphylactic
Septic
Cardiogenic Shock
Hypovolemic Shock
Neurogenic Shock
Anaphylactic Shock
Septic Shock
Multiple Organ Dysfunction Syndrome
Causes: Manifestations:
Most common: Respiratory
sepsis, septic Hepatic
shock
Renal
Other: any
GI
severe injury
Myocardial failure
(trauma,
burns, major
surgery)
Multiple Organ Dysfunction Syndrome