Mais conteúdo relacionado Semelhante a Cardiovascular patho s10 (20) Cardiovascular patho s102. Diseases of the Arteries and Veins
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
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4. Diseases of the Arteries and Veins
Atherosclerosis
Form of arteriosclerosis
Thickening and hardening is caused by
accumulation of lipid-laden macrophages in the
arterial wall
Plaque development
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5. Diseases of the Arteries and Veins
Atherosclerosis
Progression
Inflammation of endothelium
Cellular proliferation
Macrophage migration
LDL oxidation (foam cell formation)
Fatty streak
Fibrous plaque
Complicated plaque
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7. Diseases of the Arteries and Veins
Hypertension
Primary hypertension
Essential or idiopathic hypertension
Genetic and environmental factors
Affects 90% to 95% of individuals with hypertension
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9. Diseases of the Arteries and Veins
Secondary hypertension – 5%
Caused by a systemic disease process that raises
peripheral vascular resistance or cardiac output
Complicated hypertension
LVH, CHF, CAD, renal insuff, TIA, CVA, retinal
damage, PAD, venous insuff
Malignant hypertension - Rare
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10. Diseases of the Arteries and Veins
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
HEART FAILURE
Malignant hypertension – 1%
Rapid progressive HTN with diastolic P > 140 mm Hg
Encephalopathy and other end organ damage
Anesthesia reaction
Younger patients
AA race
Kidney failure
Pregnant women - pre-eclampsia to eclampsia.
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12. Diseases of the Arteries and Veins
Aneurysm
Local dilation or outpouching of a vessel wall or
cardiac chamber
Aorta especially susceptible
Constant stress on wall – high pressure
Absence of support structure in the media layer
Complication
Dissection through vessel wall
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13. Diseases of the Arteries and Veins
Thrombus formation
Blood clot that remains attached to the vessel
wall
Thromboembolus
Thrombophlebitis
Arterial thrombi
Venous thrombi
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14. Diseases of the Arteries and Veins
Embolism
Bolus of matter that is circulation in the
bloodstream
Dislodged thrombus, air bubble, amniotic fluid,
aggregate of fat, bacteria, cancer cells, or a foreign
substance
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15. Diseases of the Arteries and Veins
Peripheral artery disease (PAD)
Atherosclerotic disease of the arteries that perfuse
the limbs
Intermittent claudication
Obstruction of arterial blood flow in the iliofemoral
vessels resulting in pain with ambulation
Usually resolves with rest
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16. 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 arteries of the feet
Digital, ulnar, and palmar arteries of the hands
Obliterates the small and medium-sized arteries
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17. Peripheral Artery Disease
Thromboangiitis obliterans (Buerger disease)
Causes pain, tenderness, and hair loss in the
affected area
Symptoms are caused by slow, sluggish blood
flow
Can often lead to gangrenous lesions
Amputation
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18. Peripheral Artery Disease
Raynaud phenomenon and Raynaud disease
Episodic vasospasm in arteries and arterioles of the
fingers, less commonly the toes
Raynaud phenomenon is secondary to other systemic
diseases or conditions
Collagen vascular disease (scleroderma), smoking, pulmonary
hypertension, myxedema, and environmental factors (cold and
prolonged exposure to vibrating machinery)
Raynaud disease is a primary vasospastic disorder of
unknown origin
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19. Diseases of the Veins
Varicose veins
A vein in which blood has pooled
Distended, tortuous, and palpable veins
Caused by trauma or gradual venous distention
Prolonged standing
Chronic venous insufficiency
Inadequate venous return over a long period due
to varicose veins or valvular incompetence
Venous stasis ulcers
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20. Diseases of the Veins
Deep venous thrombosis
Obstruction of venous flow leading to increased
venous pressure
Factors
Venous stasis
Venous endothelial damage
Hypercoagulable states
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21. Coronary Artery Disease
Any vascular disorder that narrows or occludes the
coronary arteries
Atherosclerosis is the most common cause
Risk factors
Dyslipidemia
Hypertension
Cigarette smoking - one third of the mortality we see.
Diabetes mellitus - increase LDL and lower HDL.
Obesity/sedentary lifestyle - truncal obesity is considered
an endocrine gland. Chronic stress has a negative impact
on your lipids. 21
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22. Coronary Artery Disease
Nontraditional risk factors
Markers of inflammation and thrombosis
C-reactive protein, fibrinogen, protein C, and
plasminogen activator inhibitor
Hyperhomocysteinemia - treatable
Assoc increase LDL
Decrease in endogenous vasodilators
Increase tendency for thrombosis
Take B vitamins and folate.
Infection ?
Microorganisms found in atherosclerotic lesions
Serum antibodies to microorganisms linked to CAD
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23. Coronary Artery Disease
Myocardial ischemia
Local, temporary deprivation of the coronary
blood supply
Stable angina
Prinzmetal angina - pain with exertion. (Just walk
by the cold section or go to Tahoe).
Silent ischemia
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24. Coronary Artery Disease
Acute coronary syndromes
Transient ischemia
Unstable angina
Sustained ischemia
Myocardial infarction - one experience of ACS.
Myocardial inflammation and necrosis - will be
repaired with necrosis.
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26. Coronary Artery Disease
Myocardial infarction
Sudden and extended obstruction of the
myocardial blood supply
Subendocardial infarction - may not always see Q
wave.
Transmural infarction
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27. Myocardial Infarction
Cellular injury
Cellular death
Structural and functional changes
Myocardial stunning - may take a couple days
after reperfusion.
Myocardial hibernating - adaptation, can come
back to life.
Myocardial remodeling - angio II, Epi, NE, myocytes become
hypertrophied, (even though not exposed to hypoxia) --> ACEi
Repair is not repair, it is scar tissue.
Repair - Repair is not repair, it is scar tissue.
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29. Disorders of the Heart Wall
Disorders of the pericardium
Acute pericarditis
Connective tissue disease
Infection
Pericardial effusion
Tamponade
Constrictive pericarditis
RA - Rhumatoid Arthritis.
Radiation exposure
Scleraderma
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30. Pericarditis
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31. Disorders of the Myocardium
Cardiomyopathies
Dilated cardiomyopathy (congestive
cardiomyopathy - “floppy sloppy”) Most
common.
Hypertrophic cardiomyopathy
Asymmetrical septal hypertrophy
Hypertensive (valvular hypertrophic) cardiomyopathy
Restrictive cardiomyopathy
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32. Cardiomyopathy
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33. Disorders of the Endocardium
Valvular dysfunction
Valvular stenosis
Aortic stenosis - must be fixed
Mitral stenosis
Valvular regurgitation
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse syndrome
Will hear mid-systolic clic.
Late systolic murmur.
Sometimes post MI
Endocarditis. 33
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36. Infective Endocarditis
Inflammation of the endocardium
Agents
Bacteria, viruses, fungi, rickettsiae, and parasites
Pathogenesis
“Prepared” endocardium
Damaged endothelium
Microorganism colonization
Blood-borne microorganism adherence
Proliferation of the microorganism
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38. Heart Failure
General term used to describe several types of
cardiac dysfunction that result in inadequate
perfusion of tissues with blood-borne
nutrients
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39. Heart Failure
Congestive heart failure
Systolic heart failure - decrease of myocardial contractility, left
EF, LVH. Remodeling lead to back up, to BI-failure. Hypertrophic
cardiomyopathy. EJ < 40 (nl - 60)
Inability of the heart to generate adequate cardiac
output to perfuse tissues
MI – DCM
HTN - HCM
Diastolic heart failure - Filling defect. Left EJ will be
GREATER than 40.
Pulmonary congestion despite normal stroke volume
and cardiac output
Mitral stenosis - decreased left ventricular filling.
HCM
RCM
Swelling in feet, hands and legs.
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41. Heart Failure
Right heart failure
Most commonly caused by a diffuse hypoxic pulmonary
disease - Core pulmanoly.
Can result from an increase in left ventricular filling
pressure that is reflected back into the pulmonary
circulation (left sided heart failure).
High-output failure - heart can’t keep up with the demand.
Inability of the heart to supply the body with blood-borne
nutrients, despite adequate blood volume and normal or
elevated myocardial contractility
Ex - anemia, septicemia, beri beri (B1), hyperthyroidism.
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43. Questions?
Thanks again.
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Notas do Editor \n \n \n \n \n \n Which means 5% is due to: renal (renal artery stenosis) and hyperaldosteronism. \n AWESOME!!\n Pheochromocytoma - very rare. Causes head aches and sweating. \nRenal vascular disease - triggar RAA system. \n &#x201C;lower the pressure, the better, as long as it is not symptomatic&#x201D;.\n ALWAYS start with life style modification. \nIf not at goal, then look at drugs. \nBeta blockers and diaretics as long as they are not opposed to them.\nIf diabetic, then use ACE inhibitors.\nSometimes ACEi don&#x2019;t work as well as Ca channel blockers in AA.\n acute corronary syndrom, Marfan&#x2019;s with aneurism, AAA, worry about dissection through vessel wall. \n Virchow&#x2019;s triad. \nInflammation, infection, smokers, shock, cancer, extrogen, dis-rhythmia&#x2019;s (a-fib), IBDU/drug use, vegitation from heart.\n \n Claudication - must refer. \n Pain secondary to ischemia. \nUsually seen in youn men who smoke cigarrettes. \nTx - sessations, vasodilators\n \n May be due to decreased release of vasodilation chemicals. \nImmune complex, type III\nTips of fingers, top of phylanges. Can happen more with stress. \nWhite, blue, then red. \n\n Can become painful and lower extremity edema. Can cause hyperpigmentation and ulceration due to venus stasis. \n \n Number one Killer in us Men and Women.\n\n \n Silent MI - diabete. Based on secondary neuropathy. No sensation of chest pain. \nWomen present with atypical presentations: tierd, vague abdominal pain, be sensitive.\nVessels decrease by 50% before symptoms. \nStart with exercise induced pain. \n Some women will just have back pain. \nEcho&#x2019;s and stress tests\nACE Inhib - actually prevents remodelling that predispose heart to &#x201C;floppy sloppy&#x201D;.\n\n \n Q-wave - with full-thickness (transmurral).\nBlood must be blocked for 20 minutes or more. \nDysrhythmia is the most common complication resulting from an MI. \nThen remodeling, then heart failure. \n Myosite might be stunned for a couple days. \n \n Inflammation makes exudate. \nIf infectious, then cells like PMN&#x2019;s will come in. \nTampanad - enough fluid to cause contraction on heart. \nFever, Chest pain that increases when lying down!!! Slight ST segment elevation with no Q. --> acute pericarditis. \n \n SUDDEN DEATH - \n Dilated: viral, pregnancy, drugs and etoh.\nHypertrophic: valve regurg, fatigue, dry cough at night, \nRestrictive: least common. \n\nTx - diuretics, ACEi, \n If it occurs during diastole, it is most likely a pathologic murmur.\n Egophany - A to E changes. Sign of consolidation. \n Balooning at leaflett&#x2019;s. \nLate systolic murmer is a back-flow murmur. \n Usually staph, need anti bact with dental.\nLess rheumatic, more drug use.\nUnexplaned feaver and new murmur. MOST IMPORTANT signs. \nCould become emboli, bacteremic, autoimmune predisposition. \n Takes a long time for IV-antibiotics \n RIght sidded - due to lung disease, core pulmonaly,\nIf bad enough, can lead to left sided. \nLeft sided - due to systemic HTN, Mitral stenosis, \n Two types of failure. \n \n \n \n \n