OVERVIEW

The

circulatory system consists of the heart and blood vessels The heart pumps blood The blood vessels consists of
Arterial system

Venous system
Capillaries

The arterial system

Distributes oxygenated blood to the tissues

The venous system

Colects deoxygenated blood from tissues and

returns it to the heart

The capillaries
Exchange of gases, nutrients and wastes take

place

Low-pressure pulmonary circulation

Linking circulation and exchange in the lungs

High-pressure systemic circulation

Providing oxygen and nutrients to the tissues

Delivers oxygen and nutrients needed for metabolic processes to the tissues Carries waste products from cellular metabolism to the kidneys and other excretory organs for elimination Circulates electrolytes and hormones Plays important role in body temperature regulation, which relies on the circulatory system for transport of core heat to the periphery Transport of various immune substances

Hypertension Murmur Edema Hypoxia Shock Cardiovascular collapse and sudden cadiac death

Hypertension represents an elevation in systolic and/or diastolic blood pressure

Essential hypertension is characterized by a chronic elevation in blood pressure that occurs without evidence of other disease Secondary hypertension is characterized by an elevation of blood pressure that results from some other disorder, such as kidney disease

Reside with
the kidney and its role regulating vascular volume

through salt and water elimination The renin-angiotensin-aldosterone system through its effects on blood vessel tone, regulation of renal blood flow and salt metabolism The sympathetic nervous system which regulates the tone of the resistance vessels

Heart

Left ventricular hypertrophy Angina or prior myocardial infarction Prior coronary revascularization Heart failure

Brain
Stroke or transient ischemic attack

Chronic kidney disease Peripheral vascular disease Retinopathy

The heart valves determine the direction of blood flow through the heart chambers Valvular heart defects exert their effects by obstructing flow of blood (stenotic valve disorder) or allowing backward flow of blood (regurgitant valve disorders)

Stenotic valvular defects produce distention of the heart chamber that empties blood through the diseased valve and impaired filling of the chamber that receives blood that moves through the valve

Regurgitant valves allow blood to move back through the valve when it should be closed. This produces distention and places increased work demands on the chamber ejecting blood through the diseased valve.

Stenotic and regurgitant valvular defects may cause murmurs Other conditons that produces murmur:
Ventricular septal defects Patent ductus arteriosus Hyperdynamic heart Other complex congenital heart disease

Edema can be defined as palpable swelling produced by expansion of the interstitial fluid volume. Edema does not become evident until the interstitial volume has been increased by 2.5 to 3 liters.

1. 2. 3. 4.

Increased capillary pressure Decreased colloidal osmotic pressure Increased capillary permeability Obstruction of lymphatic flow

Increased vascular volume

Venous obstruction

Heart failure Kidney disease Premenstrual sodium retention Pregnancy Environmental heat stress Thiazolidinedione (Glitazone) therapy

Decreased arteriolar resistance

Liver disease with portal vein obstruction Acute pulmonary edema Venous thrombosis (thrombophlebitis) Calcium channel-blocking drug responses

Increased loss of plasma proteins

Protein-losing kidney disease Extensive burns

Decreased production of plasma proteins

Liver disease Starvation, malnutrition

Inflammation Allergic reactions (e.g., hives, angioneurotic edema) Malignancy (e.g., ascites, pleural effusion) Tissue injury and burns

Malignant obstruction of lymphatic structures Surgical removal of lymph nodes

An abnormally reduced O2 supply to tissue.

1. Hypoxic hypoxia : an insufficient O2 supply reaches the blood due, for example, to decreased atmospheric PO2 at high altitudes , reduced alveolar ventilation, or impaired alveolar gas exchange. 2. Anemic hypoxia : reduced O2-carrying capacity of blood, e.g., due to decreased total Hb in iron deficiency anemia. 3. Stagnant or ischemic hypoxia : insufficient O2 reaches the tissue due to reduced blood flow.

4. Hypoxia can also occur when the diffusion distance is increased due to tissue thickening without a corresponding increase in the number of blood capillaries. 5. Histotoxic or cytotoxic hypoxia occurs due to impaired utilization of O2 by the tissues despite a sufficient supply of O2 in the mitochondria, as observed in cyanide poisoning. Cyanide (HCN) blocks oxidative cellular metabolism by inhibiting cytochromoxidase.

Cyanosis is a bluish discoloration of the skin,lips, nails, etc. due to excessive arterial deoxyhemoglobin ( > 50 g/L). Reduced hemoglobin =

saturation X [Hemoglobin] 100

Cyanosis is a sign of hypoxia in individuals with normal or only moderately reduced total Hb levels. When total Hb is extremely low, O2 deficiencies (anemic hypoxia) can be lifethreatening, even in the absence of cyanosis. Cyanosis can occur in absence of significant hypoxia when the Hb level is elevated.

Shock is characterized by acute or subacute progressive generalized failure of the circulatory system with disruption of the microcirculation and failure to maintain adequate blood flow to vital organs. In most cases, the cardiac output (CO) is insufficient due to a variety of reasons.

1)

2) 3)

Hypovolemic shock is characterized by reduced central venous pressure and reduced venous return, resulting in an inadequate stroke volume (FrankStarling mechanism). Cardiogenic shock Vasogenic shock

Bleeding (hemorrhagic shock) External loss of fluids from the gastro-intestinal tract (e.g., severe vomiting, chronic diarrhea), the kidneys (e.g., in diabetes mellitus, diabetes insipidus, high-dose diuretic treatment) or the skin (burns, profuse sweating without fluid intake). Internal loss of blood , e.g., due to bleeding into soft tissues, into the media-stinum or into the pleural and abdominal space.

Synonim :Acute heart failure Causes could be:

Acute myocardial infarction, Acute decompensation of heart failure or Impairment of cardiac filling, e.g. in pericardial

tamponade. The central venous pressure is higher than in hypovolemic shock.

Characterized by reduced cardiac output Causes:

peripheral vasodilatation (absence of pallor) and

a resultant drop of venous return. This occurs in Gram-positive septicemia (septic shock), anaphylactic shock, an immediate hypersensitivity reaction (food or drug allergy, insect bite/sting) in which vasoactive substances (e.g., histamines) are released.

Shock can occur due to hormonal causes, such as adrenocortical insufficiency, diabetic coma or insulin overdose (hypoglycemic shock).

Sudden cardiac death (SCD) accounts for up to 50% of cardiovascular-related deaths in the United States and other developed countries. By definition, SCD refers to the acute and natural death from cardiac causes within a short period (often within an hour of onset of symptoms).

The time and mode of death are unexpected, and often death occurs in patients without any prior potentially fatal conditions. Most cases of SCD are associated with underlying cardiac arrhythmias; however, other causes have been identified.

The mechanism of SCD is complex and is often associated with an interplay between anatomical substrates, functional substrates, and transient events that lead to the initiation of ventricular arrhythmias (VT or VF)

Electrophysiologic abnormalities Coronary artery disease Primary cardiomyopathies Myocarditis Valvular heart disease Arrhythmogenic right ventricular dysplasia Pulmonary hypertension Hypertensive heart disease Congenital heart disease Inflammatory and infiltrative disease of myocardium Neuromuscular disease Intracardiac obstruction Acute aortic dissection