Cardiovascular System – Heart and Blood VesselsTopics in Human Pathophysiology Fall 2011Gilead Drug Safety and Public Health

Outline Heart

Conduction System and ECGs Coronary Circulation Cardiovascular Disease – diagnosis and treatment

Blood Vessels and Pressure Structure of blood vessels Blood pressure and regulation Pulmonary arterial hypertension

Figure 8.14

ECG Tracings

Figure 8.11

Ischemic Heart Disease Coronary artery disease Myocardial ischemia Myocardial hypoxia Myocardial infarct Myocardial necrosis

From wikipedia

Risk Factors for Cardiovascular Disease

Age

Male sex

Heredity

Smoking

Diabetes mellitus

Hypertension

High cholesterol

Obesity

Lack of exercise

Diagnosis and Treatment of Ischemic Heart Disease

Diagnosis BP monitoring Symptoms ECG Angiogram Stress Test Nuclear myocardial

perfusion tests

Coronary Angiogram

Lexiscan (regadenoson)

For myocardial perfusion imaging (MPI) A2A adenosine receptor agonist Vasodilates coronary arteries as if

exercising Injected into blood stream prior to gamma

camera scan Can give a good indication of myocardial

perfusion

Treatment of Ischemic Heart Disease

• Treatment– Coronary bypass surgery– Angioplasty– Stents– Cholesterol lowering

agents– Anticoagulents– Antianginal medications

Ranexa

For angina Thought to inhibit a sodium ion channel in

the cardiac muscle cells Contraction of those cells might normally

cause compression of cardiac blood vessels during diastole.

Can be taken with other anti-anginal meds Very effective

Congestive Heart Failure

Congestive Heart Failure

Heart becomes weak

Blood backs up in veins and capillaries

Fluid excess in tissues

Symptoms include shortness of breath, edema, difficulty breathing (especially when lying down,) difficulty exercising

Congestive Heart Failure

Causes: cardiomyopathy hypertension lung disease coronary artery disease previous MI valve disease

Blood Vessels and Pressure Artery structure and function

Control over smooth muscle

Vascular Disease Atherosclerosis Pulmonary arterial hypertension

Figure 8.10

Vessel Wall Structure

Tunica intima – epithelium and connective tissue

Tunica media – smooth muscle

Tunica externa– connective tissue and epithelium

Figure 8.1

Arterial blood pressure and flow

Systolic and diastolic pressure

Regulatory factors Cardiac Sympathetic nervous system from vasomotor center

of brain stimulates smooth muscle Chemical messengers – hormones, paracrines

Components of Orthe Nervous System

Figure 11.1

Organization of the Nervous System

Figure 11.12 (1 of 2)

Sympathetic and Parasympathetic Divisions of the Autonomic Nervous System

Figure 11.12 (2 of 2)

Sympathetic and Parasympathetic Divisions of the Autonomic Nervous System

Table 19.2

Hormonal Control of Blood Pressure

Pulmonary Arterial Hypertension

Pulmonary Arterial Hypertension (PAH)

Pulmonary arteries become narrowed causing decreased gas exchange and difficulty breathing

Causes R ventricular hypertrophy

Blood will back up in veins

Common causes of PAH

• Genetic defect

• Autoimmune diseases, such as scleroderma

• Congestive heart failure

• History of blood clot in the lung

• HIV infection

• Lung or heart valve disease

• Obstructive sleep apnea

• In many cases the cause is unknown- Idiopathic pulmonary arterial hypertension

Symptoms of PAH

Chest pain, usually in the front of the chest

Dizziness

Fainting

Fatigue

Leg edema

Light-headedness during exercise

Shortness of breath during activity

Weakness

Treatment for PAH Letairis (ambrisentan) Flolan or other prostacyclins Bosentan (Tracleer) Calcium channel blockers Diuretics Sildenafil (Viagra) Supplemental oxygen Surgical correction of defects Lung transplant