Pathophysiology Non-Modifiable Factors Age Gender Familial Tendencies Modifiable factors Smoking Lack of exercise Diet high in Cholesterol

Stress Hypertension Elevated Serum Cholesterol Alcohol

Insulin Resistance Increase in beta cell secretion Dec. Glucose Uptake Intracellular Hypoglycemia Extracellular hyperglycemia Inc. Lipolysis Inc. Glucose production

Hyperglycemia Hypercoagulability

Glucogenesis and Gluconeogenesis Breakdown of fats High level of ketones Diabetic Ketoacidosis

Blood glucose> renal threshold Non-specific injury to arterial wall Glycosuria Desquamation of endothelial lining

Osmotic diuresis Polyuria, Polydipia Polyphagia

Inc. permeability or adhesion of molecules LDL and platelets assimilate in the area

Oxidized LDL attracts monocytes and macrophages to the site Plaques begins to form from cells w/c imbibed into the endothelium Lipids are engulfed by the foam cells and smooth muscle cells develops Disruption of plaque leads to continuous aggregation of platelets Thrombus formation Rapid increase in size of the thrombus in coronary artery Dec. blood supply in the myocardium

Dec. myocardial oxygen supply

Myocardial Ischemia

Anaerobic metabolism

Myocardial cell necrosis

More lactic acid production Chest pain Acidosis

Inflammatory response Release of endogenous pyrogens

Inc. WBC

Conduction System Disorder

Pyrogens will stimulate the release of prostaglandin

Dec. Myocardial contractility Dec. Cardiac Output Inadequate cerebral Perfusion Dec. systemic circulation

Prostaglandin will set the hypothalamic thermostat to high Fever

Loss of consciousness Fatigue, dizziness

Activation of baroreceptors in the LV, aortic arch, carotid sinus

Dec. perfusion of organs of the body

Activation of the SNS

Dec. Renal perfusion

Inc. in pumping action as a compensatory mech.

Dec. GFR Inc. Urea Inc. Creatinine Dec. RBC

Stimulation of RAS

Na and water Retention Deterioration of hearts ability to pump Vasoconstriction Moderate left ventricular failure

LV is unable to fully eject the returning blood to the systemic circulation

Blood returns to the pulmonary circulation Pulmonary congestion (Dyspnea, cough, Crackles)

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