Pathophysiology of

Cardiac diseases
Dr. Tooba Asif, PT
Lecturer
DPT (RIU), MS-OMPT (RIU)
Certification in Musculoskeletal Therapy
Certified Kinesio Taping Practitioner (CKTP)
THREE COMPONENTS

 Diseases affecting the heart muscle

 Diseases affecting heart valves
 Defects of the cardiac nervous system
Anatomy of the Coronary
Arteries
 Outer Layer: consists chiefly of collagenous fibers,
mostly fibroblasts, and provides the basic support
structure for the artery

 Middle Layer: consists of multiple layers of smooth

muscle cells

 Inner Layer: variable amounts of isolated smooth muscle

cells, as well as collagen and elastin fibers.
CARDIAC DISEASES

Heart muscle Heart valves Cardiac nervous

system
Coronary artery Rheumatic fever Arrhythmias
disease
Myocardial infarct Endocarditis Tachycardia
Pericarditis Mitral valve Bradycardia
prolapse
Congestive heart Congenital
failure prolapse deformities
Aneurysms
CORONARY HEART DISEASE
 The term coronary heart disease (CHD)
describes heart disease caused by
impaired coronary blood flow.
 In most cases, it is caused by
atherosclerosis.
 Diseases of the coronary arteries can
cause:
 Angina
 Myocardial infarction or heart attack
 Cardiac dysrhythmias
 Conduction defects
 Heart failure
 Sudden death
CORONARY HEART DISEASE

 CAD includes atherosclerosis (fatty

buildup), thrombus (blood clot), and
spasm (intermittent constriction).
 Susceptibility to CVD may be explained by
genetic factors, and it is likely that an
"atherosclerosis gene" or "heart attack
gene" will be identified.
ATHEROSCLEROSIS

 The term atherosclerosis, which comes

from the Greek words atheros (meaning
“gruel” or “paste”) and sclerosis
(meaning “hardness”), denotes the
formation of fibrofatty lesions in the
intimal lining of the large and medium-
size arteries such as the aorta and its
branches, the coronary arteries, and the
large vessels that supply the brain.
ATHEROSCLEROSIS

 It is most common in medium-sized arteries, such as

those of the heart, brain, kidneys, and legs.
 When fully developed, plaque can cause bleeding, clot
formation, and distortion or rupture of a blood vessel.
THROMBUS

 When plaque builds up on the artery walls, the blood

flow is slowed and a clot (thrombus) may form on the
plaque.
 Coronary thrombosis refers to the formation of a clot in
one of the coronary arteries, usually causing a heart
attack.
 LAD:
Thrombosis

LAD: Left Anterior

Descending Artery

Area of
Infarct
SPASM

 Sudden constriction of a coronary artery is called a

spasm; blood flow to that part of the heart is cut off or
decreased.
 Chemicals like nicotine and cocaine may lead to
coronary artery spasm; other possible factors include
anxiety and cold air.
RISK FACTORS
Angina

 The majority of patients with CHD first seek medical

attention because of angina (an Old English term
meaning “strangling”) pectoris.
 This sensation, most commonly described as a
substernal pressure, can occur anywhere from the
epigastric area to the jaw and is described as
squeezing, tightness, or crushing
 It is now known to be caused by an imbalance in supply
and demand of myocardial oxygen.
 ANGINA

• Pain patterns associated with angina in women

may differ from patterns in men. Many presenting
symptoms
are subjective such as extreme fatigue, lethargy,
breathlessness,
or weakness. Isolated pain in the right mid-biceps may
delay diagnosis.
Classic stable angina

 Described as tightness, pressure, indigestion anywhere

above waist (substernum, neck, left arm, right arm,
cervical, between shoulder blades) that develops with
exertional activity and diminishes with rest or
nitroglycerin (NTG).

 Women typically complain of nausea, indigestion,

discomfort between shoulder blades, or excessive
fatigue
CLINICAL SIGNS AND SYMPTOMS

 Angina Pectoris
 Gripping, viselike feeling of pain or pressure behind the
breast bone
 Pain that may radiate to the neck, jaw, back, shoulder, or
arms (most often the left arm in men)
 Toothache
 Burning indigestion
 Dyspnea (shortness of breath); exercise intolerance
 Nausea
 Belching
 Stable Angina
 Anginal pain is often associated with Depression of ST segment
 Exercise ECG showing typical severe down sloping ST segment :

Standing
1 min. 7 min. 9 min.
3 min.

In between attacks : ECG is entirely NORMAL

Unstable angina (UA):

Chest discomfort that is accelerating in frequency or severity and may occur

while at rest but does not result in myocardial necrosis. The discomfort may be
more severe and prolonged than typical angina pain or may be the first time a
person has angina pain

Prinzmetal angina:

Chest discomfort associated with ST-segment elevation instead of depression,

occurs at rest (typically in the early morning) instead of during a predictable
level of activity, and is not associated with any preceding increase in
myocardial oxygen demand.
The underlying cause is
Fissuring of atherosclerotic plaques

Platelet aggregation

Thrombosis

Coronary artery spasm

•Atheroscelerotic changes
 Variant Angina .
(Prinzmetal)

Chest pain at rest due to

coronary artery spasm
ECG
changes:

With chest pain , Return of the ST segment to

The baseline ECG marked ST segment the baseline after
elevation nitroglycerin administration

Acute elevation of ST
segment
MYOCARDIAL INFARCT

 Interruption of blood supply to part of the heart,

causing some heart cells to die

 Typical rise and gradual fall (troponin) or more rapid

rise and fall (CK-MB) of biochemical markers of
myocardial necrosis

 Electrocardiographic changes indicative of

ischemia (ST segment elevation or depression)

 CLINICAL SIGNS AND
SYMPTOMS
 May be silent (smokers, diabetics: reduced sensitivity
to pain)
 Sudden cardiac death
 Prolonged or severe substernal chest pain or
squeezing pressure
 Pain possibly radiating down one or both arms and/or
up to the throat, neck, back, jaw, shoulders, or arms
 Feeling of indigestion
 Angina lasting for 30 minutes or more
 Angina unrelieved by rest, nitroglycerin, or antacids
 CLINICAL SIGNS AND
SYMPTOMS
 Pain of infarct unrelieved by rest or a change in
position
 Nausea
 Sudden dimness or loss of vision or loss of speech
 Pallor
 Diaphoresis (heavy perspiration)
 Shortness of breath
 Weakness, numbness, and feelings of faintness
MYOCARDIAL INFARCT
LOCATION OF THE INFARCTION

 MIs can be located in the

anterior, septal, lateral,
posterior, or inferior walls of the
left ventricle.
CONGESTIVE HEART FAILURE
OR HEART FAILURE
Heart failure, also called cardiac decompensation and
cardiac insufficiency, can be defined as physiologic
state in which the heart is unable to pump enough blood
to meet the metabolic needs of the body (determined
as oxygen consumption) at rest or during exercise, even
though filling pressures are adequate.
CONGESTIVE HEART FAILURE
OR HEART FAILURE
 Results from any structural or functional abnormality
that impairs the ability of the ventricle to eject blood
(Systolic Heart Failure) or to fill with blood (Diastolic
Heart Failure).
 CLINICAL SIGNS AND
SYMPTOMS
Left-Sided Heart Failure Right-Sided Heart Failure
 Fatigue and dyspnea after mild
physical exertion or exercise  Increased fatigue
 Persistent spasmodic cough,  Dependent edema (usually
especially when lying down, while
fluid moves from the extremities to beginning in the ankles)
the lungs  Pitting edema (after 5 to 10
 Paroxysmal nocturnal dyspnea pounds of edema accumulate)
(occurring suddenly at night)
 Edema in the sacral area or
 Orthopnea (person must be in the
upright position to breathe) the back of the thighs
 Tachycardia  Right upper quadrant pain
 Fatigue and muscle weakness  Cyanosis of nail beds
 Edema (especially of the legs and
ankles) and weight gain
 Irritability/restlessness
 Decreased renal function or frequent
urination at night
Cardiac muscle
dysfunction
Cardiac muscle dysfunction
(CMD)
 most common cause of congestive heart failure (CHF).
 2 It develops as a result of some underlying abnormality
of cardiac
structure or function.
 Those presenting only with CMD (who are at risk of
heart failure) may present without symptoms..
Cardiomyopathy

 Definition

Cardiomyopathy is the term used to describe a syndrome of non-

inflammatory heart muscle damage, or changes, which affect the
heart's pumping performance (myo relates to muscles, and pathy refers
to damage). Although other forms of heart disease (e.g. coronary heart
disease) can eventually lead to cardiomyopathy, the term is generally
reserved for myocardial changes that are independent of other forms
of heart disease
Dilated Cardiomyopathy
(DCM)

Also known as congestive cardiomyopathy, DCM is most
notable for an enlarged heart that contracts poorly.
 Stretching, or dilatation, of the heart walls causes them
to become thin and flabby so that the heart becomes
weak and is unable to pump as well as it should. This is
indicated by a reduction in the ejection fraction
Hypertrophic Cardiomyopathy
(HCM)

 Excessive wall thickening (hypertrophy) can result in

problems with obstruction to outward flow and
problems with relaxation of the ventricles, and can
thereby affect the ability of the heart to fill.
 In hypertrophic cardiomyopathy, however, the muscle is
often stiff and relaxes poorly, requiring higher pressures
than normal to expand with the inflow of blood.
Ventricular end-diastolic volumes are therefore reduced
and this will limit the amount of blood that can be
ejected with the next contraction
Restrictive Cardiomyopathy
(RCM)

 The hallmark feature of RCM is ventricles with normal or near-normal

ventricular pumping function but abnormal filling due to fibrosis or scarring
of the myocardium. Because a stiff rigid ventricle has difficulty in filling,
damming of blood behind one or both AV valves ensues, and the atria
become distended and enlarged. The ventricles remain normal or near-
normal
in size.
Causes and Types of Cardiac Muscle
Dysfunction

Hypertension
Cardiac Arrhythmias
Coronary Artery Disease (Myocardial Infarction/Ischemia
Renal Insufficiency
Cardiomyopathy
Hypertrophic Cardiomyopathy
Heart Valve Abnormalities and Congenital/Acquired
Heart
Disease
Pericardial Effusion or Myocarditis
age