Alteration of Heart Function&

Smoking

Key Terms

• Hypertension• Thromboxane A2• Serotonin• Hyperlipidemia• Hyperhomocystemia• Hemodynamic Factors• Plaque• Angioplasty• Atherosclerosis• Hyperemia

• Anastomose• Infarction• Stenosis• Aneurysm• Beta Blocker• ACE Inhibitor• CCB• ARB

http://www.youtube.com/watch?v=hCp4hVC2fnM Heart Function

Monitoring Echo of Heart

Heart Echogram

ATHEROSCLEROSIS

• A form of arteriosclerosis in which soft deposits of intraarterial fat and fibrin on the vessels walls harden over time.

• It is the leading contributor to coronary artery and cerebrovascular disease.

• Begins with injury to the endothelial cells that line artery walls. – ENDOTHELIAL INJURY.– Smoking– Hypertension– Diabetes

There is a pink to red recent thrombosis in this narrowed coronary artery. The open, needle-like spaces in the atheromatous plaque are cholesterol clefts.

There is a severe degree of narrowing in this coronary artery. It is "complex" in that there is a large area of calcification on the lower right, which appears bluish on this H&E stain. Complex atheroma have calcification, thrombosis, or hemorrhage. Such calcification would make coronary angioplasty difficult.

This section of coronary artery demonstrates remote thrombosis with recanalization to leave only two small, narrow channels.

The coronary artery shown here has narrowing of the lumen due to build up of atherosclerotic plaque. Severe narrowing can lead to angina, ischemia, and infarction.

This cross section through the heart demonstrates the left ventricle on the left. Extending from the anterior portion and into the septum is a large recent myocardial infarction. The center is tan with surrounding hyperemia. The infarction is "transmural" in that it extends through the full thickness of the wall.

Put down that extra slice of pizza and look carefully at this aorta. The white arrow denotes the most prominent fatty streak in the photo, but there are other fatty streaks scattered over the aortic surface. Fatty streaks are the earliest lesions seen with atherosclerosis in arteries. Increased total cholesterol and decreased HDL cholesterol contribute to this process.

This coronary artery demonstrates yellowish atherosclerotic plaques grossly.

Here is the coronary thrombosis at higher magnification. The thrombus occludes the lumen and produces ischemia and/or infarction of the myocardium.

This patient underwent coronary artery bypass grafting with autogenous vein (saphenous vein) grafts. The largest of these runs down the center of the heart to anastomose with the left anterior descending artery distally. Another graft extends in a "Y" fashion just to the right of this to branches of the circumflex artery. A white temporary pacing wire extends from the mid left surface.

THE CARDIOMYOPATHIES

• The cardiomyopathies are a diverse group of diseases that primarily affect the myocardium itself and are not secondary to the usual cardiovascular disorders

• Categorized as dilated (formerly, congestive), hypertrophic, or restrictive, depending on their physiologic effects on the heart.

This is the left ventricular wall which has been sectioned lengthwise to reveal a large recent myocardial infarction. The center of the infarct contains necrotic muscle that appears yellow-tan. Surrounding this is a zone of red hyperemia. Remaining viable myocardium is reddish- brown.

One complication of a transmural myocardial infarction is rupture of the myocardium. This is most likely to occur in the first week between 3 to 5 days following the initial event, when the myocardium is the softest. Note the dark red blood clot forming the hemopericardium. The hemopericardium can lead to tamponade.

In cross section, the point of rupture of the myocardium is shown with the arrow. In this case, there was a previous myocardial infarction 3 weeks before, and another myocardial infarction occurred, rupturing through the already thin ventricular wall 3 days later.

This very large heart has a globoid shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile. This is an example of a cardiomyopathy. This term is used to denote conditions in which the myocardium functions poorly and the heart is large and dilated, but there is no specific histologic finding.

AORTIC STENOSIS • Aortic stenosis has 3 common causes:– Inflammatory damage caused by rheumatic heart

disease– Congenital malformation– Degeneration resulting from calcification.

• The orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta.

• Tends to develop gradually.• A crescendo-decrescendo systolic heart murmur develops.• LVH develops to compensate for the increased work load.

Total Cholesterol Level Category

Less than 200 mg/dL Desirable

200-239 mg/dL Borderline High

240 mg/dL and above High

LDL Cholesterol Level LDL-Cholesterol Category

Less than 100 mg/dL Optimal

100-129 mg/dL Near optimal/above optimal

130-159 mg/dL Borderline high

160-189 mg/dL High

190 mg/dL and above Very high

HYPERTENSION

• All stages of hypertension are associated with increased risk of cardiovascular disease events.

• Stage 1 is the most common form of high blood pressure in the adult population.

• Hypertension is caused by increases in cardiac output, total peripheral resistance, or both. – Cardiac output is increased by conditions that increase

heart rate or stroke volume, whereas peripheral resistance is increased by factors that increase blood viscosity or reduce vessel diameter, particularly the arterioles.

ANEURYSM

• Localized dilation or outpouching of a vessel wall or cardiac chamber.

• A ventricular wall aneurysm forms when intraventricular tension stretches the contracting infarcted muscle.

• The aorta is particularly susceptible to aneurysm formation because of constant stress on the vessel wall and the absence of penetrating vasavasorum in the adventitial layer. – ¾ of all aneurysms occur in the abdominal aorta.

This is coronary thrombosis, one of the complications of atherosclerosis. The dark red thrombus is seen in the anterior descending coronary artery.

The main pulmonary trunk and pulmonary arteries to right and left lungs are seen here opened to reveal a large "saddle" pulmonary thromboembolus. Such an embolus will kill your patient.

This pulmonary thromboembolus is occluding the main pulmonary artery. Persons who are immobilized for weeks are at greatest risk. The patient can experience sudden onset of shortness of breath. Death may occur within minutes.

HEART FAILURE • A general term used to describe several types of cardiac

dysfunction that result in inadequate perfusion of tissues with vital blood-borne nutrients.

• LEFT HEART FAILURE is commonly called CONGESTIVE HEART FAILURE.– SYSTOLIC HEART FAILURE is defined as an inability of

the heart to generate an adequate cardiac output to perfuse vital tissues.

– Contractility is reduced by diseases that disrupt myocyte activity.

HEART FAILURE – Myocardial infarction is the most common cause of

decreased contractility. – VENTRICULAR REMODELING causes progressive myocyte

contractile dysfunction over time. – When contractility is decreased, stroke volume falls and

left ventricular end-diastolic volume (LVEDV) increases. – Dilation of the heart occurs and preload is increased.– Increased afterload is most commonly a result of increased

peripheral vascular resistance (PVR). – With increased PVR, there is resistance to ventricular

emptying and more workload for the left ventricle.

HEART FAILURE • A general term used to describe several types of cardiac

dysfunction that result in inadequate perfusion of tissues with vital blood-borne nutrients.

• LEFT HEART FAILURE is commonly called CONGESTIVE HEART FAILURE.– SYSTOLIC HEART FAILURE is defined as an inability of

the heart to generate an adequate cardiac output to perfuse vital tissues.

– Contractility is reduced by diseases that disrupt myocyte activity.

Mitral stenosis. Mitral stenosis and clumps of vegetation (V) containing platelets and fibrin as shown in this micrograph. Mitral leaflets are thickened and fused.

HYPERTENSION• OPTIMAL BLOOD PRESSURE (Systolic <120, diastolic

<80) is associated with the lowest cardiovascular risk.• HIGH NORMAL (Systolic 130-139, diastolic 85-89) is at

significant risk of developing hypertension unless lifestyle modification is initiated.

• HYPERTENSION– STAGE 1 (mild): systolic 140-159, diastolic 90-99– STAGE 2 (moderate): systolic 160-179, diastolic 100-

109– STAGE 3 (severe): systolic > 180, diastolic > 110

Can Smoking Cause Heart Disease?

https://www.youtube.com/watch?v=gwuwrRK-I2Y