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Understanding Cardiovascular Diseases: Arteries, Veins, and Hypertension

Explore alterations of cardiovascular function including arteriosclerosis, atherosclerosis, and hypertension. Learn about common diseases like aneurysms, orthostatic hypotension, and deep venous thrombosis. Discover insights on coronary artery disease.

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Understanding Cardiovascular Diseases: Arteries, Veins, and Hypertension

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  1. Alterations of Cardiovascular Function Chapter 30

  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

  3. Arteriosclerosis

  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

  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

  6. Atherosclerosis

  7. Atherosclerosis

  8. 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

  9. Primary Hypertension

  10. Diseases of the Arteries and Veins • Secondary hypertension • Caused by a systemic disease process that raises peripheral vascular resistance or cardiac output • Isolated systolic hypertension • Elevations of systolic pressure are caused by increases in cardiac output, total peripheral vascular resistance, or both • Complicated hypertension • Malignant hypertension

  11. 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 • Malignant hypertension • Rapidly progressive hypertension • Diastolic pressure is usually >140 mm Hg

  12. Treatment for Hypertension

  13. Diseases of the Arteries and Veins • 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

  14. Diseases of the Arteries and Veins • Aneurysm • Local dilation or outpouching of a vessel wall or cardiac chamber • True aneurysms • Fusiform aneurysms • Circumferential aneurysms • False aneurysms • Saccular aneurysms

  15. Aneurysm

  16. Aneurysm

  17. Diseases of the Arteries and Veins • Thrombus formation • Blood clot that remains attached to the vessel wall • Thromboembolus • Thrombophlebitis • Arterial thrombi • Venous thrombi

  18. 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

  19. Diseases of the Arteries and Veins • Peripheral artery disease • 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

  20. 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, ulnar, and palmar arteries • Obliterates the small and medium-sized arteries

  21. 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

  22. 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

  23. 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 • Chronic venous insufficiency • Inadequate venous return over a long period due to varicose veins or valvular incompetence • Venous stasis ulcers

  24. Diseases of the Veins • Deep venous thrombosis • Obstruction of venous flow leading to increased venous pressure • Factors • Venous stasis • Venous endothelial damage • Hypercoagulable states • Post-thrombotic syndrome (PTS)

  25. 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 • Diabetes mellitus • Obesity/sedentary lifestyle

  26. Coronary Artery Disease • Nontraditional risk factors • Markers of inflammation and thrombosis • C-reactive protein, fibrinogen, protein C, and plasminogen activator inhibitor • Hyperhomocysteinemia • Infection

  27. Coronary Artery Disease • Myocardial ischemia • Local, temporary deprivation of the coronary blood supply • Stabile angina • Prinzmetal angina • Silent ischemia • Angina pectoris

  28. Myocardial Ischemia

  29. Myocardial Ischemia

  30. Coronary Artery Disease • Acute coronary syndromes • Transient ischemia • Unstable angina • Sustained ischemia • Myocardial infarction • Myocardial inflammation and necrosis

  31. Myocardial Infarction

  32. Coronary Artery Disease • Myocardial infarction • Sudden and extended obstruction of the myocardial blood supply • Subendocardial infarction • Transmural infarction

  33. Myocardial Infarction • Cellular injury • Cellular death • Structural and functional changes • Myocardial stunning • Hibernating myocardium • Myocardial remodeling • Repair

  34. Disorders of the Heart Wall • Disorders of the pericardium • Acute pericarditis • Pericardial effusion • Tamponade • Constrictive pericarditis

  35. Pericarditis

  36. Disorders of the Myocardium • Cardiomyopathies • Dilated cardiomyopathy (congestive cardiomyopathy) • Hypertrophic cardiomyopathy • Asymmetrical septal hypertrophy • Hypertensive (valvular hypertrophic) cardiomyopathy • Restrictive cardiomyopathy

  37. Cardiomyopathy

  38. Disorders of the Endocardium • Valvular dysfunction • Valvular stenosis • Aortic stenosis • Mitral stenosis • Valvular regurgitation • Aortic regurgitation • Mitral regurgitation • Tricuspid regurgitation • Mitral valve prolapse syndrome

  39. Valvular Dysfunction

  40. Valvular Dysfunction

  41. Acute Rheumatic Fever and Rheumatic Heart Disease • Rheumatic fever • Diffuse, inflammatory disease caused by a delayed immune response to infection by the group A β-hemolytic streptococci • Febrile illness • Inflammation of the joints, skin, nervous system, and heart • If left untreated, rheumatic fever causes rheumatic heart disease

  42. Acute Rheumatic Fever and Rheumatic Heart Disease • Rheumatic fever • Carditis • Polyarthritis • Chorea • Erythema marginatum

  43. Acute Rheumatic Fever and Rheumatic Heart Disease

  44. Infective Endocarditis • Inflammation of the endocardium • Agents • Bacteria, viruses, fungi, rickettsiae, and parasites • Pathogenesis • “Prepared” endocardium • Blood-borne microorganism adherence • Proliferation of the microorganism

  45. Infective Endocarditis

  46. Cardiac Complications of AIDS • Myocarditis • Endocarditis • Pericarditis • Cardiomyopathy

  47. Heart Failure • General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients

  48. Heart Failure • Congestive heart failure • Systolic heart failure • Inability of the heart to generate adequate cardiac output to perfuse tissues • Diastolic heart failure • Pulmonary congestion despite normal stroke volume and cardiac output

  49. Congestive Heart Failure

  50. Heart Failure • 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 • 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

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