Alterations of

Cardiovascular Function
Chapter 30

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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
 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
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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
 Aortic stenosis
 Mitral stenosis
 Valvular regurgitation
 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 β-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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