Alterations of

Cardiovascular Function
Chapter 30

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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Arteriosclerosis

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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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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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Atherosclerosis

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Atherosclerosis

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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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Primary Hypertension

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Diseases of the Arteries and Veins

Secondary hypertension

Isolated systolic hypertension

Caused by a systemic disease process that raises

peripheral vascular resistance or cardiac output
Elevations of systolic pressure are caused by
increases in cardiac output, total peripheral
vascular resistance, or both

Complicated hypertension
Malignant hypertension

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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

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Treatment for Hypertension

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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

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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

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Aneurysm

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Aneurysm

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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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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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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

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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

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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

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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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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

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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)

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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

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Coronary Artery Disease

Nontraditional risk factors

Markers of inflammation and thrombosis

C-reactive protein, fibrinogen, protein C, and

plasminogen activator inhibitor

Hyperhomocysteinemia
Infection

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Coronary Artery Disease

Myocardial ischemia

Local, temporary deprivation of the coronary

blood supply
Stabile angina
Prinzmetal angina
Silent ischemia
Angina pectoris

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Myocardial Ischemia

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Myocardial Ischemia

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Coronary Artery Disease

Acute coronary syndromes

Transient ischemia
Unstable angina
Sustained ischemia
Myocardial infarction
Myocardial inflammation and necrosis

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Myocardial Infarction

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Coronary Artery Disease

Myocardial infarction

Sudden and extended obstruction of the

myocardial blood supply
Subendocardial infarction
Transmural infarction

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Myocardial Infarction

Cellular injury
Cellular death
Structural and functional changes

Myocardial stunning
Hibernating myocardium
Myocardial remodeling

Repair

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Disorders of the Heart Wall

Disorders of the pericardium

Acute pericarditis
Pericardial effusion

Tamponade

Constrictive pericarditis

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Pericarditis

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Disorders of the Myocardium

Cardiomyopathies

Dilated cardiomyopathy (congestive

cardiomyopathy)
Hypertrophic cardiomyopathy

Asymmetrical septal hypertrophy

Hypertensive (valvular hypertrophic) cardiomyopathy

Restrictive cardiomyopathy

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Cardiomyopathy

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Disorders of the Endocardium

Valvular dysfunction

Valvular stenosis

Valvular regurgitation

Aortic stenosis
Mitral stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation

Mitral valve prolapse syndrome

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Valvular Dysfunction

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Valvular Dysfunction

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Acute Rheumatic Fever and

Rheumatic Heart Disease

Rheumatic fever

Diffuse, inflammatory disease caused by a

delayed immune response to infection by the
group A -hemolytic streptococci
Febrile illness

Inflammation of the joints, skin, nervous system, and

heart

If left untreated, rheumatic fever causes

rheumatic heart disease

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Acute Rheumatic Fever and

Rheumatic Heart Disease

Rheumatic fever

Carditis
Polyarthritis
Chorea
Erythema marginatum

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Acute Rheumatic Fever and

Rheumatic Heart Disease

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Infective Endocarditis

Inflammation of the endocardium

Agents

Bacteria, viruses, fungi, rickettsiae, and parasites

Pathogenesis

Prepared endocardium
Blood-borne microorganism adherence
Proliferation of the microorganism

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Infective Endocarditis

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Cardiac Complications of AIDS

Myocarditis
Endocarditis
Pericarditis
Cardiomyopathy

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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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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

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Congestive Heart Failure

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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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Right Heart Failure

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Dysrhythmias

Disturbance of the heart rhythm

Range from occasional missed or rapid beats to
severe disturbances that affect the pumping ability of
the heart
Can be caused by an abnormal rate of impulse
generation or abnormal impulse conduction
Examples:

Tachycardia, flutter, fibrillation, bradycardia, premature

ventricular contractions (PVCs), premature atrial
contractions (PACs), asystole

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