Pathophysiology of Cardiovascular system

Heart -gross anatomy

Apex

Heart -internal anatomy

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 as thick as it has to be)
LV= 1.5 cm RV= 0.5 cm Atria = 0.2 cm

Systole/Diastole

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

Cardiac cycle

Stroke volume

It consists of period of It is the amount of the contraction (systole) blood that is ejected during which the blood is ejected from the from the heart with each heart; and period of heart beat relaxation (diastole) during which the heart fills with blood.

Cardiac output
4.9 L/min

70 bpm

70 mls

Common symptoms of cardiac diseases

Dyspnea: congestive right side heart failure pulmonary (lung) congestion Cough stained with blood: mitral stenosis pulmonary venous congestion

 Chest pain: myocardial infarction angina Cyanosis: bluish discoloration of skin and mucus membranes congenital heart diseases aortic stenosis

Symptoms of systemic venous congestion

- Edema of the lower limp

- Ascities: effusion in the peritoneal cavity - GIT problems: dyspepsia

Heart Beat Anatomy

Sinus Node (SA Node)

Atrioventricular Node (AV Node) Bundle of His

Valves
AV: Tricuspid Mitral Semilunar: Pulmonary Aortic

Cardiac Aging
Chambers
Sigmoid-shaped Valves Fibrous thickening of leaflets Mitral valve annular calcific deposits Aortic valve calcific deposits

ventricular septum
Decreased left ventricular cavity size Increased left atrial cavity size

Cardiac Aging
Coronary arteries
Atherosclerotic plaque

Myocardium
Brown atrophy

Calcific deposits
Increased cross-

Increased
subepicardial fat Increased mass

sectional luminal area

Tortuosity

Brow atrophy (aging) of the

heart

Reflex control of heart rate

Arrhythmias

Conductivity of the Heart

Sinus Node(SA Node) Atrioventricular Node (AV Node) of His Bundle Branches Purkinje Fibers Bundle Branches

Impulse Formation In SA Node

Atrial Depolarization

Delay At AV Node

Conduction Through Bundle Branches

Conduction Through Purkinje Fibers

Ventricular Depolarization

Plateau Phase of Repolarization

Final Rapid (Phase 3) Repolarization

Normal ECG Activation

Reading ECGs

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

 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).

 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.

Brady/Tachy Syndrome

Examples of ECGs seen with abnormal

heart rhythms

Abnormal Heart Rhythms

Atrial Fibrillation Atrial Premature Beats Bundle Branch Block Heart Block Paroxysmal Supra-ventricular Tachycardia Ventricular Fibrillation Ventricular Premature Beats Ventricular Tachycardia

Vascular diseases

Aneurysms
Aneurysms Are localized abnormal dilations in a blood vessel or the wall of the heart. They could be true, false, or dessicting aneurisms. True aneurysm (limited by arterial wall components or attenuated myocardial wall): mediated by
Atherosclerotic Congenital aneurysm (small BV, cerebral vesseles) Ventricular (post-infarction)

 Vascular aneurysms are due to: - Atherosclerosis - Cystic medial necrosis - Inflammation - Traumatic - Congenital

According to the size and/or shape it can be:

- Saccular (small portion of vessel)

- Fusiform

Shape Of Aneurysm May Give Clue As To Etiology

Saccular Aneurysm

Ostium

Fusiform aneurysm: dilated full circumference of artery

Atherosclerosis

Normal muscular artery

 Chronic inflammatory disorder of intima of

large blood vessels characterised by formation

of fibro-fatty plaques called atheroma.

Hardening-------------sclerosis

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.

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.

Atherosclerosis can affect the medium-sized and large arteries of the brain, heart, kidneys, other vital organs, and legs.

Atheroma Aorta:

Introduction:
Large elastic arteries Starts in Intima
Fat deposits, Hardening and destruction. Major cause of IHD, MI & Stroke. Better understanding & Change in life style.

Risk Factors:
Non modifiable
Age middle to late.

Potentially Modifiable
Hyperlipidemia:

Sex Males,
complications Genetic -Hyperchol. Family history.

Hypertension.
Smoking. Diabetes Life style, diet, exercises

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.

Common Sites:
Aorta, Carotid & Iliac. (large vessels)
Coronary Renal

Abdominal
Limbs

Morphology:
Fatty Dots

Fatty Streaks
AtheromatousSoft Plaque FibrofattyHard Plaque

Complications
Ulceration, Rupture, Hemorrhage, Thrombosis Athero-emboli or cholesterol emboli.

Complications:
Heart attack Myocardial infarction.
Stroke Cerebral infarction Gangrene tissue infarction. Kidney failure Kidney infarction. Aneurysms

Rupture
Thrombo-embolism.

Fatty Streaks

Same aorta stained with fat stain

MILD

ADVANCED

Fatty streak

Progressing fatty streak

Atherosclerotic Plaque Types

Stable
Unstable

Ruptured