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Pathophysiology of
Cardiovascular system
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Heart -gross anatomy
Apex
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Heart -internal anatomy
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Normal Features
Heart bomb about 6000 L of blood /day Heart weight: 250-300 grams
40% of all deaths are due to heart problems
Wall thickness ~ pressure (i.e., a wall is only asthick as it has to be)
LV= 1.5 cm
RV= 0.5 cm
Atria = 0.2 cm
Systole/Diastole
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Cardiac output (C.O.P)
It is the measure of the efficiency of the heart.
Increased COP due to increased physical
activity: exercise
Decreased COP due to decreased physical
activity: rest; sleep.
Normal COP = 5L\m
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Cardiac cycle
It consists of period of
contraction (systole)
during which the bloodis ejected from the
heart; and period of
relaxation (diastole)
during which the heartfills with blood.
Stroke volume
It is the amount of the
blood that is ejected
from the heart with each
heart beat
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Cardiac output
4.9 L/min
70 bpm 70 mls
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Common symptoms of cardiac diseases
Dyspnea:
congestive right side heart failure
pulmonary (lung) congestion
Cough stained with blood:
mitral stenosis
pulmonary venous congestion
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Chest pain:
myocardial infarction
angina
Cyanosis:bluish discoloration of skin and
mucus membranes
congenital heart diseasesaortic stenosis
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Symptoms of systemic venous congestion
- Edema of the lower limp
- Ascities: effusion in the peritoneal cavity
- GIT problems: dyspepsia
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Heart Beat Anatomy
Sinus Node (SA Node)
Atrioventricular Node (AV Node)
Bundle of His
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Valves
AV:
Tricuspid
Mitral Semilunar:
Pulmonary
Aortic
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Cardiac Aging
Chambers
Sigmoid-shaped
ventricular septum
Decreased left
ventricular cavity size
Increased left atrial
cavity size
Valves
Fibrous thickening of
leaflets
Mitral valve annular
calcific deposits
Aortic valve calcific
deposits
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Cardiac Aging
Coronary arteries
Atherosclerotic plaque
Calcific deposits
Increased cross-
sectional luminal area
Tortuosity
Myocardium
Brown atrophy
Increased
subepicardial fat
Increased mass
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Brow atrophy (aging) of the
heart
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Reflex control of heart rate
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Arrhythmias
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Conductivity of the Heart
Sinus Node(SA Node)
Atrioventricular Node (AV Node)
of His BundleBranches Purkinje Fibers
Bundle Branches
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Impulse Formation In SA Node
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Atrial Depolarization
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Delay At AV Node
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Conduction Through Bundle Branches
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Conduction Through Purkinje Fibers
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Ventricular Depolarization
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Plateau Phase of Repolarization
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Final Rapid (Phase 3) Repolarization
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Normal ECG Activation
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Reading ECGs
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Abnormal Heart Rhythms
Abnormal heart rhythms (arrhythmias) are sequences of
heart beats that are irregular, too fast, too slow, or
conducted via an abnormal electrical pathway through
the heart.
Disorders of impulse formation and conduction result in
brady-arrhythmias and tachy-arrhythmias
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Slow arrhythmias (brady-arrhythmias) may be
caused by pain, hunger, fatigue, digestive
disorders (such as diarrhea and vomiting), or
swallowing, which can stimulate the vagus
nerve excessively.
(With enough stimulation, which is rare, the
vagus nerve can cause the heart to stop).
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Fast arrhythmias (tachy-arrhythmias) may be
caused by exercise, emotional stress, fever,
excessive alcohol consumption, smoking, or
use of some drugs.
In most of these circumstances, the
arrhythmia tends to resolve on its own.
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Brady/Tachy Syndrome
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Examples of
ECGs seen with
abnormal
heart rhythms
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Abnormal Heart Rhythms
Atrial Fibrillation
Atrial Premature Beats
Bundle Branch Block
Heart Block
Paroxysmal Supra-ventricular Tachycardia
Ventricular Fibrillation
Ventricular Premature Beats
Ventricular Tachycardia
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Vascular diseases
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Aneurysms
Aneurysms Are localized abnormal dilations in ablood vessel or the wall of the heart. They could
be true, false, or dessicting aneurisms.
True aneurysm (limited by arterial wallcomponents or attenuated myocardial wall):
mediated by
Atherosclerotic
Congenital aneurysm (small BV, cerebral vesseles)
Ventricular (post-infarction)
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Vascular aneurysms are due to:
- Atherosclerosis - Traumatic
- Cystic medial necrosis - Congenital
- Inflammation
According to the size and/or shape it can be:
- Saccular (small portion of vessel)
- Fusiform
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Shape Of Aneurysm May Give Clue As To
Etiology
Saccular Aneurysm
Ostium
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Fusiform aneurysm:
dilated full circumference of artery
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Atherosclerosis
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Normal muscular artery
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Chronic inflammatory disorder of intima of
large blood vessels characterised by formation
of fibro-fatty plaques called atheroma.
Hardening-------------sclerosis
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Definition Of Atherosclerosis
A disease of the arterial intima affecting elastic
(large) & medium sized arteries that is
characterized by intimal plaques (lipid core
covered by a fibrous cap) that obstructs the
lumen, weakens the wall and may lead to
athero-embolism.
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Atherosclerosis is acondition in which patchy
deposits of fatty material called atheromas or
atherosclerotic plaques (consists of focal intimal
accumulations of lipids, complex carbohydrates,
blood & blood products, fibrous tissue & calcium
deposits, associated with changes in the media)
develop in the walls of arteries, leading to reduced
or blocked blood flow.
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Atherosclerosis can affect the medium-sized and
large arteries of the brain, heart, kidneys, other
vital organs, and legs.
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Atheroma Aorta:
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Introduction:
Large elastic arteries Starts in Intima
Fat deposits, Hardening and destruction.
Major cause of IHD, MI & Stroke.
Better understanding & Change in life style.
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Risk Factors:
Non modifiable
Age middle to late.
Sex Males,
complications
Genetic -Hyperchol.
Family history.
Potentially Modifiable
Hyperlipidemia:
Hypertension.
Smoking.
Diabetes
Life style, diet, exercises
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Pathogenesis:
Unknown etiology : Hyper-lipidemia, life style,
hypertension, smoking, genetic etc.
Starts with Initial intimal injury, inflammation, necrosis,
Lipid accumulation, Fibrosis -Atheroma.
Leads to Obstruction or destruction of vessel
Organ damage due to ischemia. Complications: Thrombosis, embolism, aneurism,
dissection & rupture.
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Common Sites:
Aorta, Carotid & Iliac. (large vessels)
Coronary
Renal
Abdominal
Limbs
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Morphology:
Fatty Dots
Fatty Streaks
AtheromatousSoft Plaque
FibrofattyHard Plaque
ComplicationsUlceration, Rupture, Hemorrhage, Thrombosis
Athero-emboli or cholesterol emboli.
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Complications:
Heart attack
Myocardial infarction.
StrokeCerebral infarction
Gangrenetissue infarction.
Kidney failureKidney infarction.
Aneurysms
Rupture
Thrombo-embolism.
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Fatty Streaks
Same aortastained with fat
stain
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MILD ADVANCED
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Fatty streak
Progressing
fatty streak
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Atherosclerotic Plaque Types
Stable
Unstable