Cardiovascular Disease

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Cardiovascular Disease
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• Atherosclerosis
• Hypertension
• Essential/Primary/Idiopathic
• Secondary
• Coronary Artery Disease
• Myocardial Infarct
• Rheumatic Heart Disease
• Congestive Heart Failure
• Thrombophlebitis
• Varicose Veins
• Congenital Heart Defects

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Atherosclerosis

• Atherosclerosis (AS) comes from the Greek athero
  Gruel and sclerosis hardening
• Atheromatous plaques are fatty deposits similar
  to the fat on a fresh chicken.
• The terms arteriosclerosis and atherosclerosis
  are used interchangeably, although AS a form of
  arteriosclerosis.
• Arteriosclerosis refers to the hardening and
  thickening of the arteries and loss of elasticity
  of the vessel walls.

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Arteriosclerosis and Atherosclerosis (AS)

• Several diseases can cause arteriosclerosis.
  Most of these diseases are rare.
• AS has become epidemic in economically developed
  countries and in the Western world and is now the
  disease that most often leads to illness and
  death.

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Preventable?

• Studies of native Japanese immigrate to the U.S.,
  they soon develop the same rates of ASwhen
  previously in Japan, the lived with an AS rate
  that was low.
• Lifestyle and societal factors must play a
  significant role in the incidence of death from
  this cardiovascular disease.

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MIs and CVAs

• Although atheromas can develop under the lining
  of any artery, the most common sites are the
  aorta and the coronary and cerebral arteries.
• As a result, myocardial infarctions (MIs), or
  heart attacks, and cerebrovascular accidents
  (CVAs), or strokes, are the major result of AS.
• AS can also affect other parts of the body, such
  as peripheral artery disease in the legs, due to
  low oxygen supply.

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Formation of Atheromas

• Atherogenisis, the formation of atheromas, is not
  an inanimate process and atheromas develop much
  differently than was once thought.
• A plaque begins to develop when low-density
  lipoproteins (LDLs) from the blood collect under
  the intima, the part of the artery wall closest
  to the blood flow.
• Normally, LDLs would pass through the intima, but
  the overabundance causes them to stick and
  collect into a matrix.

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Formation of Atheromas

• The LDLs begin to change as they accumulate and
  the body, sensing a danger, sends in monoocytes,
  which multiply and become macrophages (big
  eaters).
• The macrophages capture and feast on the modified
  LDL particles until the macrophages become so
  filled with lipids they look foamy under a
  microscope-hence the name foam cells.

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Formation of Atheromas

• T lymphocytes have also arrived from the immune
  system and, with the foam cells, form a fatty
  streak that is the first sign of an atheroma, or
  plaque formation.
• These streaks can be seen even in teens!
• While the plaque grows, the smooth muscle cells
  of the media (middle layer of the artery wall)
  create a cap over the intima plaques.
• The region under the cap is the lipid, or
  necrotic, core.

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Formation of Atheromas

• For most of its life, the plaque will grow
  outward, but if it gets too large, it will grow
  inward blocking the blood flow.
• When the cap breaks and blood seeps through, a
  clot may form causing an MI or CVA.
• The increased size of the artery wall due plaque
  growth is called arterial remodeling.

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Formation of Atheromas

• The adventitia (external elastic membrane), or
  exterior artery wall, is elastic.
• The discovery of arterial remodeling explains why
  large lesions were missed by angioplasty, which
  only focuses on stenosis, or narrowing of the
  arteries.
• The size of each lesion varies by consistency.
• The process begins in youth, but isnt apparent
  until the disease is far advanced.

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Formation of Atheromas

• As the plaques increase, the lumen of the
  arteries becomes more narrow and the blood flow
  decreases.
• If the plaque is in a coronary artery or the
  aorta and a thrombus (stationary clot) or a
  embolus (moving clot) develop to occlude the
  artery, the person may have a myocardial
  infarction (heart attack).
• If the thrombus or embolus develops in a cerebral
  artery, the person may have a cerebrovascular
  accident, or stroke.

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Risk Factors

• Age
• Gender
• Genetics
• Hyperlipidemia
• Hypertension
• Smoking
• Diabetes
• Inflammation
• Physical Inactivity
• Obesity

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Risk Factors

• Hyperlipidemia a higher than normal level of
  cholesterol in the blood, is supported by the
  Framingham Study which showed (1) lab animals
  fed on cholesterol-increasing diets developed AS,
  (2) genetic disorders that increase cholesterol
  levels lead to AS, (3) most populations with high
  levels of cholesterol have more deaths, and (4)
  when treated with diet, regular exercise, and
  cholesterol-reducing drugs, cardiovascular
  mortality is reduced

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Liproproteins

• Risk Male Female
• Very Low
• (½ average) under 3.4 under 3.3
• Average 4.0 3.5
• Moderate
• (2 x average) 9.5 7.0
• High
• (3 x average) over 23 over 11

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Symptoms
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• Angina pectoris
• Pain in the legs that is relieved by rest
• Dizziness
• Transient ischemic attacks (TIAs)
• Sever nausea
• Weakness
• Sudden perspiration
• Referred pain

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Hypertension
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• High blood pressure is another condition that is
  a strong risk factor.
• Normal BP is less than 120 systolic and 80
  diastolic.
• Hypertension is 140/90
• A high systolic reading is a risk factor
• In some, isolated systolic hypertension (ISH) may
  occur where the diastolic is normal.
• Essential (cause unknown) is the most common form
  of hypertension. In fact, one fourth of Americans
  suffers from it.

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Coronary Artery Disease (CAD)
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• CAD is a primary cause of insufficient blood flow
  to the heart.
• More common in white, middle-aged and the
  elderly.
• The difference between men and women with regard
  to CAD is unknown, but may be due to
  testosterone.
• AS is the usual cause of CAD.
• Angina pectoris is the classic symptom.
• It is treated with angioplasty, coronary artery
  bypass, or atherectomy.
• All treatments put the person at risk for
  restenosis, which is the return of particles from
  the plaque elsewhere.

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Myocardial Infarction

• Occurs when blood flow is reduced, by AS or clot,
  through one or more coronary arteries. Ischemia
  and necrosis occur.
• Almost ½ of all deaths occur within one hour of
  symptom onset.
• Death occurs with 4 to 6 minutes if the heart
  stops beating.
• CPR increases the chances of survival, but not as
  much as early automated external defibrillation
  (AED). Without an AED the survival rate with CPR
  alone is only 1 in 4 onsight and only 50 of
  those who actually make it to the hospital will
  survive.

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Myocardial Infarction

• Predisposing factors are the same as CAD, because
  the latter leads to MI.
• Family history, smoking, hypertension, elevated
  serum triglyceride and cholesterol levels,
  diabetes, obesity, sedentary lifestyle, and an
  inability to control stress.

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Myocardial Infarction

• A persistent crushing pain in the chest beneath
  the sternum.
• Radiating pain to the left arm, jaw, neck, or
  shoulder blades.
• May be accompanied by vomiting, sweating, heavy
  breathing, or fatigue.
• Indigestion is another possible sign.
• Increasing angina is a warning sign of an
  imminent MI.
• Victims sometimes report a feeling of impending
  doom.

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Myocardial Infarction
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• A persistent crushing pain in the chest beneath
  the sternum.
• Radiating pain to the left arm, jaw, neck, or
  shoulder blades.
• May be accompanied by vomiting, sweating, heavy
  breathing, or fatigue.
• Indigestion is another possible sign.
• Increasing angina is a warning sign of an
  imminent MI.
• Victims sometimes report a feeling of impending
  doom.

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Rheumatic Heart Disease

• A result of systemic inflammation in childhood
  (rheumatic fever) that is generally followed by a
  streptococcal infection.
• Inflammation of the heart (pancarditis,
  endocarditis, myocarditis, perdicaritis) can lead
  to damaged heart valves.
• Increase damage may lead to congestive heart
  failure.

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Rheumatic Heart Disease
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• A murmur is the most common symptom, but
  typically doesnt present until 1-5 weeks after
  the strep infection.
• Other symptoms may include chest pain, extra
  heart sounds, heart block, and atrial
  fibrillation.
• Early, consistent treatment of strep is essential.

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Congestive Heart Failure
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• Occurs when the heart cannot keep up its work
  load of pumping blood to the lungs and the rest
  of the body due to damage to the left, or right,
  ventricle.
• It may be acute, but is usually chronicleading
  to salt and water retention, which leads to
  swelling of the ankles and legs.
• Caused by MI, hypertension, mitral stenosis
  (narrowing of the mitral valve), secondary to
  rheumatic heart disease, and aortic stenosis.
• Symptoms include fatigue, dyspnea, enlarged neck
  veins, nocturia, enlarged liver.
• Treatment includes bed rest, digitalis, and
  vasodilators.

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Thrombophlebitis
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• Inflammation of a vein accompanied by formation
  of a thrombus. Most often occurs in legs.
• Anything that causes damage to the lining of the
  vein can lead to a thrombus.
• Symptoms include heat, pain, swelling, redness,
  tenderness, and hardness along the length of the
  affected vein.
• Treatment includes bed rest with elevation of the
  legs or arms.

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Varicose Veins
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• Varicose veins are dliated and twisted veins in
  which blood tends accumulate and stagnate because
  of defective valves. Because the veins are near
  the surface, the pressure produces a bluish
  raised area.
• Factors include obesity, hormonal changes due to
  pregnancy or at menopause, pelvic pressure during
  pregnancy, and standing for long periods.
• Symptoms are often mild and may include night
  cramps or a dull, aching, fatigued feeling in the
  feet and ankles.
• Exercise, rest, stockings, elevation, and in
  extreme cases, surgery, are advised.

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Congenital Heart Disease

• Present at birth affecting 6-8 babies per 1,000
  born.
• The most common defects are ventricular septal
  defect (VSD), patent ductus arteriosus (PDA),
  atrial septal defect (ASD), pulmonic stenosis,
  coarctation of the aorta, and tetralogy of
  Fallot.
• The most common symptom is difficulty breathing
  combined with rapid tiring.