macrophage damage endothelial cells and secrete growth factors that stimulate proliferation of smooth muscle cells and disrupt tight junctions between cells. Platelets interact and aggregate to form plaques.
gender (females have higher level of HDL and lower level of LDL due to estrogen production)
Atherosclerotic lesions affect medium and liarge-sized arteries
Abdominal aorta, coronary arteries
occlusion of vessel (infarction, arteriosclerosis)
formation of microthrombi (stroke, thromboembolism)
control blood pressure
control blood lipid levels
Disorders of the Heart
Ischemic Heart Disease (Coronary Heart Disease)
myocardial infarction => interruption of blood supply to heart and death of cardiac muscle.
occlusion of coronary vessels
complication of surgery or result of excess exertion
severe chest pain
may have slight elevation in temperature
dyspnea, sweating and nausea
hypotension and bradycardia
ventricular tachycardia and or fibrillation
abnormalities in conduction through AV nodes
cardiogenic shock and circulatory failure
administer oxygen and/or anticoagulant therapy
control blood pressure
surgery or angioplasty
Congestive Heart Failure
excessive filling of heart which results in increased volume in pulmonary vessels or increased volume on venous side of systemic circulation.
high or low cardiac output
right or left-sided failure of the ventricles
most commonly due to hypertension (increased peripheral resistance) => this can result in a back-up of blood in the left atrium and congestion of the pulmonary vascular system.
Caused by Aortic Stenosis or Coarctation of the Aorta
Caused by mitral regurgitation.
Pulmonary stenosis or Pulmonary hypertension
Atrial septal defect => blood flow from left to right atria
Dilation or enlargement of a heart chamber
need more tension to contract & increased oxygen needs
Hypertrophy of muscle wall
decreased contractile force
increase norepinephrine and epinephrine
increase renin, aldosterone and angiotensin and ADH
Initially cay involve one side of heart but as progresses involves both sides of heart.
pulmonary edema, nonproductive cough, pleural effusion, rales and wheezing
Cardiac asthma, Cardiomagaly, Cardiac arrhythmias
Jugular vein distension
Treatment of contributing or aggravating factors
Congenital Heart Defects
Patent Ductus Arteriosus
Ductus Arteriosis carries blood from the bifurcation of the pulmonary artery directly to the aorta just distal to the left subclavian artery (bypass lungs because blood is oxygenated in placenta)
Vessel normally closes within 24 hours of birth
more common in females
premature hypoxia or birth at high altitudes
consequences depend on size of defect and extent of pulmonary vascular resistance
blood flow from aorta to lungs
pulmonary vascular engorgement
increased volume returned to left heart
blood flow from pulmonary artery to aorta
lower body cyanosis
aorta somewhat enlarged in older patients
Ventricular Septal Defect
opening in the septum that separates the right and left ventricles
most common congenital heart abnormality seen in children
2) Physiological effects
If pulmonary vascular resistance in normal => left-to-right shunt that increases right ventricular pressure
As pulmonary resistance falls => increased right ventricular pressure and left ventricular volume overload => left and right ventricular hypertrophy and cardiac failure
Large defects => frequent pulmonary infections, growth retardation and cardiac failure in infancy.
Moderate shunts => exercise intolerance and fatigue and pulmonary hypertension develops over time.