1. Cardiovascular
Pathophysiology
Reference: Pathophysiology by Kathryn McCance
Mindy Milton, MPA, PA-C
July 13, 201
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2. 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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3. Arteriosclerosis
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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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8. Primary 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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11. Treatment for Hypertension
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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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25. Myocardial Infarction
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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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28. ECG Changes: Ischemia
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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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34. Valvular Dysfunction
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35. Valvular Dysfunction
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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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37. Infective Endocarditis
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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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40. Congestive Heart Failure
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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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42. Right Heart Failure
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43. Questions?
 Thanks again.
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