Cardiovascular and Cerebrovascular Diseases

1. Cardiovascular and Cerebrovascular Diseases Chapter 12

2. Physiology of the Cardiovascular System • Cardiovascular system • Heart • Blood vessels • Lymphatics

3. Conduction System • Specialized conducting tissue • Sinoatrial node • The pacemaker • Initiates electrical contraction in the heart • Atrioventricular node (AV node) • Atrioventricular bundle • Purkinhe fibers

4. Conduction System cont. • Abnormal rhythms • Cardiac arrhythmias • Cardiac dysrhythmias • Disturbance of the heart’s electrical conduction and amount of blood pumped from the heart • Ventricular fibrillation

5. Prevention of Cardiovascular Disease • Heredity • Environment • Lifestyle • Good nutritional habits • Abstention from smoking • Regular activity • Weight control • Stress management

6. Types of Cardiovascular Disease • Atherosclerosis (AS) • Hardening and thickening of the arteries • Loss of elasticity of the vessel walls • Lifestyle is a significant contributer • Myocardial infarcts (MIs) • Heart attacks • Cerebrovascular accidents (CVAs) • strokes

7. Types of Cardiovascular Disease cont. • Formation of Atheromas • Atherogenesis • Overabundance of LDLs • Accumulation • Macrophages foam cells • T lymphocytes • Atheroma (plaque formation)

8. Types of Cardiovascular Disease cont. • Atheromas (cont.) • Atherosclerotic plaque expands outward • Little effect • Expands inward • Restricts blood flow • Arterial remodeling • Predisposing factors

9. Types of Cardiovascular Disease cont. • Atheromas (cont.) • Predisposing factors: • Age • Gender • Familial hyperlipoproteinemias • Inborn abnormalities in lipid metabolism • hypercholesterolemia • Socially supported lifestyle habits

10. Types of Cardiovascular Disease cont. • Atheromas (cont.) • Predisposing factors (preventable): • Hyperlipidemia • Diet high in cholesterol • Lipoproteins: HDL vs. LDL • Hypertension, High Blood Pressure • Smoking • Diabetes Mellitus • Inflammation • Physical Inactivity • Obesity and Overweight • Miscellaneous Factors • Stressful lifestyle • Hyperuricemia

11. Types of Cardiovascular Disease cont. • Atheromas (cont.) • Symptoms • Don’t appear until disease is very advanced • Severe pain near heart and down left arm • Leg pain when walking • Dizziness • Nausea, weakness, sudden perspiration • Prevention • Treatment

12. Types of Cardiovascular Disease cont. • Atheromas (cont.) • Prevention • Controlling or eliminating risk factors • Treatment • Depends on severity and location of diseased arteries • Lifestyle adjustments • Diet, exercise, weight control, quitting smoking • Drugs to decrease lipidemia

13. Types of Cardiovascular Disease cont. • Hypertension • Multiple readings of 140/90 or higher • Essential Hypertension • Primary or idiopathic hypertension • Most common • Predisposing factors • Family history, race, stress, obesity, high intake of saturated facts or sodium, tobacco use, oral contraceptives, insufficient physical activity

14. Types of Cardiovascular Disease cont. • Primary Hypertension (cont.) • Symptoms • Nothing until it causes changes in the blood vessels • Severely elevated blood pressure • Damaged vessel in the brain: Stroke • Damaged vessel in the retina: Blindness • Damaged vessel in the kidneys: proteinuria • Prevention • Eliminate preventable risk factors • Annual checkup • Treatment • Eliminate/reduce preventable risk factors • Annual checkup

15. Types of Cardiovascular Disease cont. • Secondary Hypertension • Results from identifiable causes • Renal disease • Endocrine, vascular, and neurogenic disorders

16. Types of Cardiovascular Disease cont. • Coronary Artery Disease (CAD) • Insufficient blood supply to the heart • Predisposing Factors • Atheromas • Narrowing of a vessel slows the movement of blood

17. Types of Cardiovascular Disease cont. • Coronary Artery Disease (CAD) (cont.) • Symptoms • Angina pectoris • Prevention • Same as for atheromas • Treatment • Lifestyle changes • Drugs to reduce oxygen consumption or increase oxygen supply to the heart • Angioplasty • Atherectomy

18. Types of Cardiovascular Disease cont. • Myocardial Infarct (Heart Attack) • Coronary artery blood flow is reduced by AS or a clot • Predisposing Factors • Family history of MI, hypertension, smoking, elevated serum triglyceride and cholesterol levels, obesity…

19. Types of Cardiovascular Disease cont. • Myocardial Infarct (Heart Attack) • Symptoms • Persistent crushing pain beneath the sternum • Prevention • Same as for AS • Treatment • CPR • Drugs to relieve chest pain, stabilize heart rhythm • Aspirin

20. Types of Cardiovascular Disease cont. • Rheumatic Heart Disease • Inflammation of the heart • A result of a systemic inflammatory disease of childhood (Rheumatic Fever) • Antibiotic treatment has decreased the incidence of rheumatic fever

21. Types of Cardiovascular Disease cont. • Rheumatic Heart Disease • Predisposing Factors • Rheumatic fever • Symptoms • Murmur (valve dysfunction) • Chest pain, extra heart sounds, heart block, atrial fibrillation • Prevention • Early treatment of streptococcal infections • Treatment • surgery

22. Types of Cardiovascular Disease cont. • Congestive Heart Failure (CHF) • Usually damage to left ventricle • Right sided heart failure • cor pulmonale • Predisposing Factors • Hypertension, mitral stenosis, aortic stenosis

23. Types of Cardiovascular Disease cont. • Congestive Heart Failure (CHF) • Symptoms • Fatigue, dyspnea, nocturia, liver enlargement • Coldlike symptoms • Prevention • Same as for AS • Treatment • Bed rest with diuretics • Digitalis • vasodilators

24. Types of Cardiovascular Disease cont. • Thrombophlebitis • Inflammation of a vein PLUS • Formation of a thrombus • Can become an embolism in deep veins • Predisposing factors • Alteration of the epithelial lining of the vein • Surgery or trauma • Prolonged bed rest, oral contraceptives, heredity, obesity…

25. Types of Cardiovascular Disease cont. • Thrombophlebitis • Symptoms • Superficial • Chemicals are released causing pain, heart, swelling, redness, tenderness, hardness • Deep • Pain, fever, chills, malaise, swelling, cyanosis • Prevention • Reducing risk factors for AS • Treatment • Pain relief • Bed rest and elevation

26. Types of Cardiovascular Disease cont. • Varicose Veins • Dilated and twisted veins • Predisposing factors • Obesity, hormonal changes during pregnancy or menopause, extended standing • Symptoms • Cramps, dull aching, pain in feet and ankles • Prevention • Lifestyle choices to avoid obesity • Avoiding long periods of standing • Treatment • Antiembolism stockings, exercise, rest, elevation of the extremity • Surgery in severe cases

27. Types of Cardiovascular Disease cont. • Congenital Heart Defects • Abnormality of the heart that is present at birth • Ventricular septal defect (VSD) • Patent ductus arteriosus (PDA) • Artial septal defect (ASD) • Pulmonic stenosis • Coarctation of the aorta • Tetralogy of Fallot

28. Types of Cardiovascular Disease cont. • Congenital Heart Defects • Symptoms • May not appear until adulthood • Difficulty breathing • May tire rapidly with activity • Predisposing Factors • 90% of the cases have an unknown cause • Environmental • During pregnancy: Rubella, smoking, alcoholism, other drug use • Age of the mother

29. Types of Cardiovascular Disease cont. • Congenital Heart Defects • Prevention • Pregnant or possibly pregnant women • Abstain from alcohol • Avoid contact with anyone with rubella • Only doctor approved drugs should be taken • Treatment • Rest, oxygen, various drugs • Surgery • valvuloplasty

30. Cerebrovascular Disease Accidents that are caused by disorders in or of the blood vessels that affect the brain

31. Cerebrovascular Disease cont. • Cerebrovascular Accident (CVA or Stroke) • Sudden impairment of cerebral circulation • Thrombus • Most common cause in older people • Embolus • Second most common cause • Likely among people with a history of heart disease • Hemorrhage • Chronic hypertension or aneurysms

32. Cerebrovascular Disease cont. • Cerebrovascular Accident (CVA or Stroke) • Over half who survive are permanently disabled • Predisposing factors • History of transient ischemic attacks, gout, postural hypotension

33. Cerebrovascular Disease cont. • Cerebrovascular Accident (CVA or Stroke) • Symptoms • Transient ischemic attack • Progressive stroke • Completed stroke • Unconsciousness, heavy breathing, partial paralysis… • Prevention • Elimination or reduction of controllable predisposing factors • Treatment • Anticonvulsants, stool softeners, corticosteroids, analgesics • Surgery • Neurogenesis