Chapter 24 PDF: Alterations of Cardiovascular Function

Chapter 24 Alterations of Cardiovascular Function  Diseases of the Veins  Varicose veins Vein in which blood has pooled Distended, tortuous, and palpable veins Caused by trauma or gradual venous distension Risk factors: Age...

Chapter 24 Alterations of Cardiovascular Function  Diseases of the Veins  Varicose veins Vein in which blood has pooled Distended, tortuous, and palpable veins Caused by trauma or gradual venous distension Risk factors: Age Female gender Family history Obesity Pregnancy Deep vein thrombosis Prior leg injury  Diseases of the Veins (Cont.)  Chronic venous insufficiency Inadequate venous return over a long period due to varicose veins or valvular incompetence Venous stasis ulcers  Diseases of the Veins (Cont.)  Thrombus formation in veins Obstruction of venous flow leading to increased venous pressure Factors: Triad of Virchow  Venous stasis  Venous endothelial damage  Hypercoagulable states Other (cancer, orthopedic surgery/trauma, heart failure, immobility)  Diseases of the Veins (Cont.)  Superior vena cava syndrome Progressive occlusion of the superior vena cava that leads to venous distension of upper extremities and head Caused by bronchogenic cancer (75%), lymphoma, and metastases of other cancers Oncological emergency  Diseases of the Arteries  Hypertension Consistent elevation of systemic arterial blood pressure Sustained systolic blood pressure of 140 mm Hg or greater or a diastolic pressure of 90 mm Hg or greater (nonautomated office BP measurement) Primary Secondary  Diseases of the Arteries (Cont.)  Primary hypertension Essential or idiopathic hypertension Genetic and environmental factors Affects 92 to 95% of individuals with hypertension Indigenous population more likely to have hypertension, other risk factors and comorbidities  Diseases of the Arteries (Cont.)  Primary hypertension Risk factors: High sodium intake Natriuretic peptide abnormalities Inflammation Obesity Insulin resistance  Diseases of the Arteries (Cont.)  Secondary hypertension Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output Renal vascular or parenchymal disease, adrenocortical tumours, adrenomedullary tumours, and medications  Diseases of the Arteries (Cont.)  Complicated hypertension Chronic hypertensive damage to blood vessels and tissues leading to target organ damage in the heart, kidney, brain, and eyes Myocardial hypertrophy  Diseases of the Arteries and Veins  Malignant hypertension Rapidly progressive hypertension Diastolic pressure is usually >140 mm Hg Life-threatening organ damage  Diseases of the Arteries and Veins (Cont.)  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 1. Severe and chronic hypertension can lead to which of the following? A. Anemia B. Glaucoma C. Coronary artery disease D. Chronic obstructive pulmonary disease  Diseases of the Arteries and Veins  Aneurysm Local dilation or outpouching of a vessel wall or cardiac chamber True aneurysms Fusiform Circumferential Saccular False aneurysms Extravascular hematoma that communicates with the intravascular space  Diseases of the Arteries and Veins (Cont.)  Aneurysm (cont.) Aorta most susceptible, especially abdominal Causes include atherosclerosis, hypertension Can lead to aortic dissection or rupture Aneurysm Aneurysm (Cont.)  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 Arterial thrombi  Diseases of the Arteries and Veins (Cont.)  Embolism Bolus of matter that is circulating in the bloodstream Dislodged thrombus Air bubble Amniotic fluid Aggregate of fat Bacteria Cancer cells Foreign substance  Peripheral Artery Disease  Thromboangiitis obliterans (Buerger’s disease) Inflammatory disease of the peripheral arteries Strongly associated with smoking Autoimmune Characterized by the formation of thrombi filled with inflammatory and immune cells Thrombi become organized and fibrotic and result in permanent occlusion and obliteration of portions of small- and medium-sized arteries in feet and sometimes hands Peripheral Artery Disease (Cont.) Causes pain, tenderness in the affected area Symptoms are caused by slow, sluggish blood flow Can often lead to gangrenous lesions and amputations  Peripheral Artery Disease (Cont.)  Raynaud’s phenomenon Episodic vasospasm in arteries and arterioles of the fingers, less commonly the toes Primary Vasospastic disorder of unknown origin  Peripheral Artery Disease (Cont.)  Secondary Raynaud’s phenomenon Secondary to other systemic diseases or conditions: Collagen vascular disease Smoking Pulmonary hypertension Myxedema Cold environment Manifestations include pallor, cyanosis, cold, pain  Diseases of the Arteries and Veins  Arteriosclerosis Chronic disease of the arterial system Abnormal thickening and hardening of the vessel walls  Diseases of the Arteries and Veins (Cont.)  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.) Progression Inflammation of endothelium Cellular proliferation Macrophage migration and adherence LDL oxidation (foam cell formation) Fatty streak Fibrous plaque Complicated plaque Risk factors include diabetes, smoking, dyslipidemia, hypertension Results in inadequate perfusion, ischemia, necrosis  Atherosclerosis Modified from Crawford, M.H., et al. (2010). Cardiology (3rd ed.). Mosby.  Peripheral Arterial Disease  Atherosclerotic disease of arteries that perfuse limbs  Intermittent claudication  Coronary Artery Disease  Any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia.  Atherosclerosis is the most common cause.  Coronary Artery Disease (Cont.)  Risk factors Nonmodifiable: Modifiable: Increased age Dyslipidemia Family history Hypertension Male gender, or female Cigarette smoking gender postmenopause Diabetes mellitus Obesity/sedentary lifestyle Atherogenic diet  Coronary Artery Disease (Cont.)  Nontraditional risk factors: Markers of inflammation and thrombosis High-density C-reactive protein, erythrocyte sedimentation rate, von Willebrand factor concentration, interleukin-6, interleukin-18, tumour necrosis factor, fibrinogen, and CD 40 ligand Troponin I Adipokines Infection Air pollution  Coronary Artery Disease (Cont.)  Myocardial ischemia Local, temporary deprivation of the coronary blood supply Stable angina Prinzmetal’s angina Silent ischemia  Coronary Artery Disease (Cont.)  Acute coronary syndromes Transient ischemia Unstable angina Sustained ischemia Myocardial infarction STEMI or non-STEMI Myocardial inflammation and necrosis Coronary Artery Disease (Cont.) Unstable angina Reversible myocardial ischemia Myocardial infarction Sudden and extended obstruction of the myocardial blood supply Subendocardial infarction Transmural infarction 2. A patient is complaining of having intermittent “chest pain” after exercise. This is most likely caused by which following condition? A. Mitral valve prolapse B. Infective endocarditis C. Inflammation of the pericardium D. Atherosclerotic plaque progression  Myocardial Infarction  Cellular injury  Cellular death  Structural and functional changes: Myocardial stunning Hibernating myocardium Myocardial remodelling  Repair  Myocardial Infarction (Cont.)  Manifestations: Sudden severe chest pain; may radiate Nausea, vomiting Diaphoresis Dyspnea  Complications: Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability Myocardial Infarction (Cont.) From Damjanov, I., & Linder, J. (Eds.). (1996). Anderson’s pathology (10th ed.). Mosby. Myocardial Infarction (Cont.) Myocardial Infarction (Cont.)  Disorders of the Heart Wall  Disorders of the pericardium: Acute pericarditis Pericardial effusion Tamponade Constrictive pericarditis  Pericarditis From Damjanov, I., & Linder, J. (2000). Pathology: a color atlas. Mosby.  Disorders of the Myocardium  Cardiomyopathies: Dilated cardiomyopathy (congestive cardiomyopathy) Hypertrophic cardiomyopathy Hypertensive hypertrophic cardiomyopathy Valvular hypertrophic cardiomyopathy Restrictive cardiomyopathy  Cardiomyopathy From Kissane, J.M. (Ed.). (1990). Anderson’s pathology (9th ed.). Mosby.  Disorders of the Endocardium  Valvular dysfunctions: Valvular stenosis Aortic Mitral Valvular regurgitation Aortic Mitral Tricuspid Mitral valve prolapse syndrome (MVPS) 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 If left untreated, rheumatic fever may cause rheumatic heart disease  Acute Rheumatic Fever and Rheumatic Heart Disease (Cont.) Common Major clinical manifestations: manifestations: Fever Carditis Lymphadenopathy Polyarthritis Arthralgia Chorea Nausea/vomiting Erythema marginatum Tachycardia Subcutaneous nodules Abdominal pain cutaneous nodules Epistaxis  Infective Endocarditis  Inflammation of the endocardium  Agents: Bacteria Viruses Fungi Rickettsiae Parasites  Infective Endocarditis (Cont.)  Inflammation of the endocardium (cont.)  Pathogenesis Damaged (prepared) endocardium Blood-borne microorganism adherence Proliferation of the microorganism (vegetations)  Infective Endocarditis (Cont.)  Manifestations Classic findings Fever New or changed cardiac murmur Petechial lesions of the skin, conjunctiva, and oral mucosa Characteristic physical findings: Osler nodes (painful erythematous nodules on the pads of the fingers and toes) Janeway lesions (nonpainful hemorrhagic lesions on the palms and soles) Other: weight loss, back pain, night sweats, and heart failure Infective Endocarditis (Cont.) Bacterial Endocarditis From Damjanov, I., & Linder, J. (2000). Pathology: a color atlas. Mosby.  Cardiac Complications of AIDS  Dilated cardiomyopathy  Myocarditis  Pericardial effusion  Endocarditis  Pulmonary hypertension  Nonantiretroviral medication related cardiotoxicity  Heart Failure  General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients  Heart Failure (Cont.)  Left ventricular failure Heart failure with reduced ejection fraction (HFrEF) Systolic heart failure Inability of the heart to generate adequate cardiac output to perfuse tissues Ventricular remodelling Causes include myocardial infarction, myocarditis, cardiomyopathy  Heart Failure (Cont.)  Left ventricular failure Heart failure with preserved ejection fraction (HFpEF) Diastolic heart failure Pulmonary congestion despite normal stroke volume and cardiac output Causes include myocardial hypertrophy and ischemia, diabetes, valvular and pericardial disease  Heart Failure (Cont.)  Manifestations of left heart failure: Result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation Include dyspnea, orthopnea, cough of frothy sputum, fatigue, decreased urine output, and edema Physical examination often reveals pulmonary edema (cyanosis, inspiratory crackles, pleural effusions), hypotension or hypertension, an S3 gallop, and evidence of underlying CAD or hypertension  Heart Failure (Cont.)  Right heart failure Most commonly caused by a diffuse hypoxic pulmonary disease Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation  Heart Failure (Cont.)  High-output failure Inability of the heart to supply the body with blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractility Causes include anemia, hyperthyroidism, septicemia, and beriberi Right Heart Failure High-Output Failure  Shock  Cardiovascular system fails to perfuse the tissues adequately  Leads to impaired cellular metabolism Impaired oxygen use Impaired glucose use  Manifestations vary based on stage but often include hypotension, tachycardia, increased respiratory rate  Types of Shock  Cardiogenic Heart failure  Hypovolemic Insufficient intravascular fluid volume  Neurogenic Neural alterations of vascular smooth muscle tone  Anaphylactic Immunological process  Septic Infection Types of Shock (Cont.) Types of Shock (Cont.) Types of Shock (Cont.) Types of Shock (Cont.) Types of Shock (Cont.) 3. A patient has adequate intravascular volume but is experiencing decreased cardiac output and tissue hypoxia. Which type of shock is occurring? A. Neurogenic B. Cardiogenic C. Hypovolemic D. Anaphylactic  Multiple Organ Dysfunction Syndrome  Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury  Causes:  Manifestations: Most common: Respiratory sepsis, septic shock Hepatic Other: any severe Renal injury (trauma, burns, GI major surgery) Myocardial failure  Multiple Organ Dysfunction Syndrome (Cont.)