Cardiac Pathophysiology Lecture Notes 2025 (Student Version)

Cardiac Pathophysiology January 28 – February 3, 2025 Golda Widawski, PT, DPT  The Numbers According to the CDC: – About 702,880 Americans died from heart disease in 2022—that’s 1 in every 5 deaths – Coronary heart disease is the most comm...

Cardiac Pathophysiology January 28 – February 3, 2025 Golda Widawski, PT, DPT  The Numbers According to the CDC: – About 702,880 Americans died from heart disease in 2022—that’s 1 in every 5 deaths – Coronary heart disease is the most common type of heart disease, killing more than 375,476 people in 2021 ~20.1 million adults age 20 and older have CAD – Heart disease is the leading cause of death for both men and women- of most racial and ethnic groups in the US. – Heart disease costs the United States $252.2 billion each year (2019- 2020). This total includes the cost of health care services, medications, and lost productivity due to death – Heart disease is the leading cause of death for people of most racial/ethnic groups in the United States, including African Americans, America Indian, Alaska Native, Hispanic, and White men. For women of Asian American or Pacific Islander, American Indian, Alaska Natives, or Hispanic descent, heart disease is second only to cancer from https://www.cdc.gov/heart-disease/data-research/facts-stats/?CDC_AAref_Val=https://www.cdc. gov/heartdisease/facts.htm -Here is an additional link to the AHA document: 2024 Herat Disease and Stroke Sttistics: A Report of US and Global Data from the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209  Percentage breakdown of deaths attributable to CVD, US, 2021 Seth S. Martin. Circulation. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association, Volume: 149, Issue: 8, Pages: e347-e913, DOI: (10.1161/CIR.0000000000001209) © 2024 American Heart Association, Inc.  Medicine Admission Note: – Pt is a 93 y/o male with ICM (EF 30-35%), severe pHTN, 3+MR who presents with dyspnea x 1 day Recent admission for CHF exacerbation with d/c to SAR Reports dtr sets up meds, but he often forgets to take his lasix – PMH: CAD, systolic HF, AF, severe pHTN, ITP, HTN, prostate Ca, LGIB, s/p CABG x 2 (svgLAD & 1st diagonal), s/p repair of aortic dissection – PT referral to Eval and Treat What do you think the reason for this admission is? Treat or NOT to treat…any special considerations?  Objectives Explain basics of Coronary Heart Disease and how atherosclerotic plaques are formed (possibly) Identify types of angina Clearly explain myocardial infarction including types and zones of infarction Identify how MI is diagnosed and basic treatment Explain difference between cardiac pump dysfunction and failure Explain clearly differences between right and left heart failure, as well as systolic and diastolic heart failure. Identify consequences of CHF and ventricular remodeling Identify how CHF is diagnosed and basic treatment Effectively describe types of cardiomyopathy Accurately describe valvular heart disease (including types), sudden cardiac death, aneurysms (including types), endocarditis, pericarditis, and cardiac tumors  Pathophysiology Ischemic Heart Valve Disease Disease Sudden Cardiac – ASHD/CAD/CHD Death – Angina Aneurysms – MI – Vascular Disease Cardiac Muscle Endocarditis Dysfunction Pericarditis – Heart failure – Cardiomyopathy Tumors Coronary Heart Disease (CHD) “Build-up of plaque in the heart’s arteries that can cause a heart attack.” CAD: Coronary Artery Disease CHD: Coronary Heart Disease Is there a difference between CHD and CAD? – Terms are used interchangeably – CHD is actually caused by CAD Ischemia Infarction  Atherosclerotic Heart Disease a.k.a. Coronary Artery Disease Athero: gruel, soft deposit Sclerosis: hardening Characterized by nodular deposits of fatty material that line the walls of the artery (plaques) The vessel walls may also lose their elasticity and become sclerotic “Hardening of the Arteries”  Risk Factors for CAD Modifiable and Non-modifiable Lifestyles – Tobacco – Diet high in saturated fat, cholesterol, calories – Excess alcohol consumption – Physical activity Biochemical or Physiologic Characteristics – Blood lipid abnormalities – Cholesterol produced – Elevated blood triglycerides – Hyperglycemia / DM – Obesity – HTN Personal Characteristics – Gender – Age – Family history of CAD – Personal history of CAD  Cholesterol What is it? – Essential compound used by the body Cell membrane structure Enzymatic activity – Transports fatty acids and lipids – Comes from 2 sources Our bodies (75%) Food sources (25%), animal products only LDL Low-Density Lipoprotein Cholesterol HDL High-Density Lipoprotein (“bad” cholesterol) (“good” cholesterol) Higher number = Higher number = Higher risk Lower risk 60 optimal 100-129 near optimal