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Alterations of Cardiovascular Function

Alterations of Cardiovascular Function. Chapter 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. Varicose Veins. Diseases of the Veins. Chronic venous insufficiency

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Alterations of Cardiovascular Function

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  1. Alterations of Cardiovascular Function Chapter 23

  2. 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

  3. Varicose Veins

  4. Diseases of the Veins • Chronic venous insufficiency • Inadequate venous return over a long period due to varicose veins or valvular incompetence • Venous stasis ulcers

  5. Diseases of the Veins • Deep venous thrombosis • Obstruction of venous flow leading to increased venous pressure • Factors* • Venous stasis • Venous endothelial damage • Hypercoagulable states *Virchow’s triad

  6. Diseases of the Veins • Superior vena cava syndrome • Progressive occlusion of the superior vena cava that leads to venous distention of upper extremities and head • Oncologic emergency

  7. Diseases of the Arteries and Veins • Hypertension* • Primary hypertension • Essential or idiopathic hypertension • Genetic and environmental factors • Affects 92% to 95% of individuals with hypertension *Review Table 23-1

  8. Primary Hypertension

  9. Risk factors for Primary Hypertension • Family history • Advancing age • Cigarette smoking • Obesity • Heavy alcohol consumption • Gender(men>women before age 55, women> men after 55) • Black race • High dietary Na+ • Low dietary K+, Ca,++,Mg++ • Glucose intolerance

  10. Review Health Alerts The RAAS & Cardiovascular Disease-P.588 Obesity & HTN- P.589

  11. 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

  12. 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

  13. Results of Uncontrolled HTN* The 3 Cs • Coronary Artery Disease • Cerebral Vascular Disease • Chronic Renal Failure • *Table 23-2

  14. 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

  15. 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

  16. Aneurysms • Arterial

  17. AAA Apical Aneurysm

  18. Dissecting Thoracic Aneurysm

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

  20. Diseases of the Arteries and Veins • Embolism • Bolus of matter that is circulated in the bloodstream • Dislodged thrombus, air bubble, amniotic fluid, aggregate of fat, bacteria, cancer cells, or a foreign substance

  21. Peripheral Artery Disease • Thromboangiitisobliterans(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

  22. Peripheral Artery Disease • Thromboangiitisobliterans(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

  23. Peripheral Artery Disease • Raynaud phenomenonand Raynaud disease • Episodic vasospasm in arteries and arterioles of the fingers, less commonly the toes • Raynauddisease is a primary vasospasticdisorder of unknown origin

  24. Peripheral Artery Disease • Raynaud phenomenon and Raynauddisease • Raynaudphenomenon 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)

  25. Diseases of the Arteries and Veins • Arteriosclerosis • Chronic disease of the arterial system • Abnormal thickening and hardening of the vessel walls: loss ofelastacity • Smooth muscle cells and collagen fibers migrate to the tunica intima

  26. Arteriosclerosis

  27. 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

  28. KFC-Double Down520 calories,329g fat,1380mg Na

  29. USDA - 2011 • Recommendations Double Down • 1800 Cal diet: 40-70g fat329g fat • 20-35% Calories/day • Sodium: 1500mg/day 1380mg • 2300mg/day 1500mg/day-newly recommended

  30. 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

  31. Atherosclerosis

  32. Atherosclerosis

  33. Vessel-Blocking Plaques

  34. Diseases of the Arteries and Veins • Peripheral artery disease “PAD” • Atherosclerotic disease of the arteries that perfuse the limbs

  35. Peripheral Arterial Disease • Atherosclerotic disease of arteries that perfuse limbs • Intermittent claudication

  36. Coronary Artery Disease* • Any vascular disorder that narrows or occludes the coronary arteries • Atherosclerosis is the most common cause *Review Health Alert & Dyslipidemia – P 598

  37. Coronary Artery Disease • Risk factors: modifiable • Dyslipidemia • Hypertension • Cigarette smoking • Diabetes mellitus • Obesity/sedentary lifestyle • Atherogenic diet

  38. Low-density Lipoproteins(BAD)

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

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

  41. Myocardial Ischemia

  42. Coronary Artery Disease • Acute coronary syndromes • Transient ischemia • Unstable angina • Sustained ischemia • Myocardial infarction • STEMI or non-STEMI • Myocardial inflammation and necrosis

  43. Myocardial Infarction

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

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

  46. Myocardial Infarction

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