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CARDIOVASCULAR PATHOPHYSIOLOGY

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DISORDERS OF THE CIRCULATION: GENERAL SYSTEMIC AND CORONARY. BLOOD PRESSURE DISORDERS: ... coarctation of the aorta. septal defect. valvular defects ... – PowerPoint PPT presentation

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Title: CARDIOVASCULAR PATHOPHYSIOLOGY


1
CARDIOVASCULAR PATHOPHYSIOLOGY PHARMACOLOGY
  • Week 8
  • Lecture Outline

2
CARDIOVASCULAR PATHOPHYSIOLOGY PHARMACOLOGY
  • DISORDERS OF THE CIRCULATION GENERAL SYSTEMIC
    AND CORONARY
  • BLOOD PRESSURE DISORDERS hypertension,
    hypotension and circulatory shock
  • MYOCARDIAL INFARCTION AND
  • HEART FAILURE
  • CARDIOVASCULAR DRUGS 1
  • antihypertensive drugs
  • CARDIOVASCULAR DRUGS 2
  • drugs for angina and heart failure

3
DISORDERS OF THE CIRCULATION GENERAL SYSTEMIC
AND CORONARY
  • Blood flow interruption
  • Alterations to arterial blood flow
    (atherosclerosis, aneurysms, acute arterial
    occlusion)
  • Alterations to venous blood flow (thrombus
    formation, varicose veins)

4
BLOOD PRESSURE DISORDERS HYPERTENSION,
HYPOTENSION, CIRCULATORY SHOCK
  • Assessment of hypertension
  • Effects of hypertension on body organs
  • Orthostatic hypotension
  • Definition of circulatory shock, causes
  • Signs and symptoms of compensatory mechanisms in
    circulatory shock
  • Complications of shock

5
MYOCARDIAL INFARCTION AND HEART FAILURE
  • Pathophysiology of myocardial infarction
  • Acute complications
  • Congestive heart failure as a chronic
    complication
  • Other causes of CHF (CHD, angina, valvular
    disease, congenital heart defects, increased
    volume work, increased pressure work)
  • Definition of CHF
  • Consequences of CHF
  • right and left-sided consequences

6
CARDIOVASCULAR DRUGS 1 antihypertensive drugs
  • Objectives of antihypertensive therapy
  • Lifestyle modification
  • Use of pharmacotherapy
  • ?-blockers,
  • ACE inhibitors
  • Ca2antagonists,
  • thiazide diuretics
  • ?1-antagonists

7
CARDIOVASCULAR DRUGS 2 drugs for angina and
heart failure
  • Causes and treatment of angina
  • Treatment of CHF treat correctable underlying
    causes
  • reduce cardiac workload (vasodilators)
  • reduce fluid overload (diuretics)
  • increase force of contraction (digoxin)

8
ANATOMY PHYSIOLOGY
9
CARDIOVASCULAR SYSTEM Brief review
  • THE HEART - pulmonary and sytemic circulation
  • differentiate atria from ventricles, diastole
    from systole?
  • how are heart sounds produced? - valves lub,dub
  • describe the electrical activity - (P, QRS,
    T)(SA, AV, Bundle of His, r l bundle branches,
    Purkinje fibres)
  • describe the cardiac cycle
  • when does blood flow through coronary arteries?
    Peak?
  • how is heart rate controlled?
  • State Starlings law of the heart and input
    pressure
  • define the relationship bet venous return, CO and
    blood pressure
  • define stroke volume, cardiac output (HR 70/min,
    SV70 ml, CO4.9 L/min)

10
CARDIOVASCULAR SYSTEM Brief review
  • Blood vessels
  • why are arterioles important? ANS, peripheral
    resistance, autoregulation
  • differentiate arteries from veins?
  • Walls, lumen, pressure, arteriosclerosis, loss of
    elasticity, valves, blood reservoir
  • what is the normal blood pressure range?
  • What are the determinants of blood pressure? CO
    and peripheral resistance
  • how is BP controlled? baroreceptors

11
ACTIVITY 1
  • Differentiate between preload afterload.
  • How will the following affect BP?
  • Adrenaline
  • elevating the feet
  • hypoxia
  • RA A system
  • Draw a diagram of the conducting system.

12
CV DISORDERS
13
DISORDERS OF CARDIOVASCULAR SYSTEM An Overview
  • Abnormal valves - Heart murmur (whoosh sound,
    leakage of valve, rheumatic fever, stenosis)
  • Abnormal rhythms - AV block (ectopic
    pacemaker),dysrhythmias - fibrillation
  • Ischaemic heart disease - diminished blood supply
    to the heart (arteriosclerosis, angina, MI, CAD)

14
DISORDERS OF CARDIOVASCULAR SYSTEM An Overview
  • CONGENITAL DEFECTS
  • coarctation of the aorta
  • septal defect
  • valvular defects
  • Diminished contractility - heart failure -
    hypertension, renal response (angiotensin
    aldosterone)
  • Alterations in flow (DVT, shock, haemorrhage,
    blood viscosity, aneurism)

15
ALTERATIONS IN ARTERIAL VENOUS FLOW
16
DISORDERS OF THE CIRCULATION GENERAL SYSTEMIC
AND CORONARY
  • aneurysms
  • weakness of arterial wall
  • cause - arteriosclerosis, trauma, infections,
    etcbl
  • several forms - berry, fusiform, sac, dissecting
  • acute arterial occlusion
  • thrombus or emboli originating from the heart
  • occlusion in extremity
  • thrombolytic/anticoagulant
  • atherosclerosis
  • fibrofatty lesions arteries
  • insidious, risk factors
  • intra-extracellular lipids, vascular smooth
    muscle cells, scar tissue/connective tissue
    proteins
  • occlude vessel, thrombus formation, decreased
    blood flow

17
DISORDERS OF THE CIRCULATION GENERAL SYSTEMIC
AND CORONARY
  • thrombus formation or thrombophlebitis
  • DVT --- PE
  • Virchow triad - stasis of blood,
    hypercoagulability, vessel wal injury
  • manifestations related to inflammatory response
  • diagnosis and treatment
  • varicose veins
  • prolonged dilatation and stretching of vessel
    wall as a result of increased venous pressure
  • incompetent valves, deformed venous structures

18
BLOOD PRESSURE
19
BLOOD PRESSURE DISORDERS HYPERTENSION
  • Sustained elevation of systemic arterial
    pressure, asymptomatic
  • Control of BP (sympathetic and renin-angiotensin
    system) BPCOxPR COHRxSV
  • Causes - adrenocortical disease, tumours JG cells
    / pheocromocytomas, narrowing of renal arteries /
    aorta, renal diseases, severe polycythemia, oral
    contraceptives, toxaemia of pregnancy, unknown
  • Primary (Essential) or Secondary types
  • Assessment of hypertension
  • Effects of hypertension on body organs - heart
    hypertrophies, increased O2 consumption,
    increased incidence of atherosclerosis, heart
    disease, thromboses of cerebral vessels
    haemorrhage, renal disease / failure, blindness

20
BLOOD PRESSURE DISORDERS HYPOTENSION,
CIRCULATORY SHOCK
  • Orthostatic hypotension
  • abnormal drop of BP on standing
  • absence of normal circulatory reflexes or blood
    volume
  • dizziness/syncope
  • causes - fluid, meds, aging, bedrest
  • diagnosis treatment
  • CIRCULATORY SHOCK
  • Definition- failure of CV to adequately perfuse
    vital organs - anaerobic metabolism -
    irreversible cell damage ( low CO,low BP)
  • Causes - insufficient cardiac filling, impaired
    ejection of blood, inadequate heart rate,
    increased demand for blood flow, blood loss
  • 3 stages - compensated ( negative feedback),
    uncompensated (positive feedback), irrev
  • Signs and symptoms - thirst, cool, moist, pale
    skin, increase HR, weak/tready pulse, decreased
    urine, restlessness to apathy
  • Complications of shock - shock lung, renal
    failure, GI ulceration, DIC, multiple-organ
    failure

21
OTHER DISORDERS
22
MYOCARDIAL INFARCTION
  • Irreversible muscular changes following severe
    prolonged myocardial ischaemia
  • Cause - obstruction of at least 75 of the
    coronary artery lumen by a thrombus in a region
    narrowed by plaques other events precipitating a
    thrombosis
  • Pathophysiology of myocardial infarction - heart
    muscle receives inadequate blood because of
    interruption with supply, fatty plaques obstruct
    flow or cause thrombus or embolus
  • Signs symptoms - squeezing central pain gt10-15
    mins, radiating to shoulders, neck or arms,
    associated with sweating, SOB and a sick feeling
    in the stomach
  • Diagnosis - history, ECG changes and enzyme
    changes
  • Acute complications - sudden death, heart
    failure, pericarditis, thromboemboli, heart
    rupture and ventricular aneurysms
  • Treatment - coronary angioplasty, streptokinase,
    rehabilitation, reduce risk

23
HEART FAILURE
  • Congestive heart failure - CO is insufficient for
    the needs of the body, inability to pump
    sufficiently to meet tissue requirements
  • Manifestations - tachycardia, cardiac
    enlargement, weakness, fatigue, oedema, wt gain,
    hepatic enlargement, SOB suffocation,
    distension of jugular veins, dysnnoea,
    orthopnoea, pulmonary / peripheral oedema
  • PATHOLOGY - homeostatic response (sympathetic NS
    and RA system) compensatory mechanisms
  • Consequences of CHF
  • right and left-sided consequences

24
MEDICATIONS
25
CARDIOVASCULAR DRUGS 1 antihypertensive drugs
  • Objectives of antihypertensive therapy
  • Lifestyle modification
  • weight reduction
  • sodium restriction
  • alcohol restriction
  • cease tobacco use
  • relaxation / stress therapies
  • Pharmacotherapy -
  • thiazide diuretics
  • ?-blockers - decrease HR, contraction renin
    bradycardia, increased lipids, (bronchoconstrictio
    n)
  • ACE inhibitors - suppress formation of
    angiotensin II, vasodilation cough, dysguesia,
    depress renal function
  • Ca2antagonists - block Ca channels of the heart,
    dilate arterioles veins modestly odema
    constipation
  • ?1-antagonists - vasodilation ortho hypotension,
    syncope, tachycardia, syncope, LOC

26
CARDIOVASCULAR DRUGS 2 drugs for angina
  • Treatment of angina
  • treat pathology
  • avoid trigger factors
  • implications on diet, weight, smoking exercise
  • organic nitrates (vasodilators)
  • beta-blockers (decrease HR and force of
    contractions)
  • calcium channel blockers (coronary and peripheral
    vasodilators)
  • Chest pain from ischaemia of myocardium
  • Causes - classic (CAD, atherosclerosis) and
    variant (coronary artery spasm)
  • Pathophysiology

27
CARDIOVASCULAR DRUGS 2 drugs for heart failure
  • vasodilators - decrease peripheral resistance
    against which the heart must pump arteriolar,
    veno-, combined acting vasodilators, diuretic
    (ACE inhibitors)
  • diuretics - removal of retained salt water,
    reduce blood volume, diminished venous congestion
    (thiazides loop), rapid relief, K-sparing to
    protect against digitalis-induced arrhythmias
  • inotropic agents (digoxin) - increase
    contractility of failing heart (without elevating
    oxygen requirement), reverses all CHF
    manifestations, inhibition of Na-K activated ATP
    pump, increase intracellular calcium increase
    force of contraction, electrical effects,
    aglyconesugars, from foxglove, nursing
    implications
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