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Objec;ves
Topic 4
Cardiovascular Disease II
Kate Smith
K.F.Smith@curtin.edu.au
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
HEARTFAILURE
Heartfailureriskfactors
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
Heartfailurecauses
HFtermstounderstand
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
SystolicHeartFailure
Le#sidedHeartFailure
Inabilityofthehearttogenerateoutput sucienttoperfuse;ssues
Renalperfusiondecreases Ac;va;onofRAAS
Strokevolumedependenton:
Contrac;lity Preload AZerload
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
SystolicHeartFailure
SystolicHeartFailure
Contrac;lityreduced,egMI:
Ventricularremodellingresultsindisrup;on ofstructure Consequentdila;onofmyocardium SVdecreases,LVEDVincreases
IncreasedaZerload,egHTN,aor;cvalve disease
Resistancetoventricularemptying Increasedwork Hypertrophy MediatedbyangiotensinII
Preloadincreases
Toomuchstretch
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
ViciousCycle
LeZsidedHeartFailureconsequences
Signs&symptoms
Shortnessofbreath Cough Decreasedurineoutput Fa;gue
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
HeartFailure
Management
DRUGS!
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
DiastolicHeartFailure
RightsidedHeartFailure
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
RightsidedHeartFailure
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
FacultyofHealthSciences
9/09/13
RightsidedHeartFailureconsequences
RightvsLeZHeartFailure
Signs&symptoms:
Swollenankles Liverfailure Weightloss
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
NewYorkHeartAssocFunc;onalClassica;onScale
ClassI: Nosymptomswithordinaryac;vity ClassII:Slightlimita;onofphysicalac;vity. Comfortableatrest,butordinaryphysicalac;vity resultsinfa;gue,palpita;on,dyspnoea,orangina ClassIII:Markedlimita;onofphysicalac;vity. Comfortableatrest,butlessthanordinaryphysical ac;vityresultsinfa;gue,palpita;on,dyspnoea,or anginapain ClassIV:Unabletocarryoutanyphysicalac;vity withoutdiscomfort.Symptomsofcardiacinsuciency maybepresentevenatrest
IP100Introduc;ontoPathophysiology
ANEURYSM Deni;on:localiseddila;onoroutpouching ofavesselwallorcardiacchamber Areaofweakness&vulnerability Forma;onisduetodisrup;onofthevessel wall Atherosclerosisisthemostcommoncauseof arterialaneurysms HTNincreasesstressonthewall Aortasuscep;ble
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
FacultyofHealthSciences
Aneurysm
Aneurysms
Trueaneurysms
Fusiformcircumferen;al Saccular Morelikelytoburst
Falseaneurysms
Extravascularhaematoma Morelikelytodissect
IP100Introduc;ontoPathophysiology
vascularweb.org
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
Aneurysm
Aneurysm
drstandley.com
www.aneurysmsymptoms.net
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
Cerebralaneurysm
ARTERIOSCLEROSIS Arteriosclerosisis...
Chronicdiseaseofthearterialsystem characterisedbyabnormalthickening&hardening ofthevesselwalls
drugster.info
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
Vesselsandinjury
VesselsandInjury
Vesselsmadeupof3layers:
Tunicain;ma(endothelialcells) Tunicamedia Adven;;a
Arteriosclerosis=hardeningofarteries Atherosclerosisisthepathologicalprocess
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
Atherosclerosis
Injuriousenvironment:
Smoking,hypertension,diabetes,increasedLDL& decreasedHDLcholesterol Also:elevatedCreac;veprotein,increasedserum brinogen,insulinresistance,oxida;vestress, infec;on,periodontaldisease
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
ATHEROSCLEROSIS
ANTITHROMBOTICS INJURY INFLAMMATION VASODILATION
CORONARYARTERYDISEASE
COMPLICATEDPLAQUE
EMBOLIS
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
CADRiskFactors
Atherosclerosisintherestofthebody
Anyvessel Supplyofbloodtoimportantareassuchas
Heart Brain Kidney Lungs Liver Limbs
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
Thrombus
rejuvenal.info
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
Thrombosis
Embolism
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
EmbolismandEmbolus
ConsequencesofEmbolism
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
Haemostasis
PlateletFunc;ons
Arrestofbleeding Threecomponents:
1. Platelets 2. Bloodproteins(cloJngfactors) 3. Vasculature(endothelialcells&subendothelial matrix)
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
FacultyofHealthSciences
FacultyofHealthSciences
FacultyofHealthSciences
CloJng
CloJng
Complexsystemwiththreebasicsteps:
1. ReleaseofcloJngfactorsfrominjured;ssue cells&s;ckyplatelets 2. Seriesofchemicalreac;onsresul;nginthe forma;onofthrombin 3. Forma;onofbrin&trappingofbloodcellsto formaclot
Processusuallypresentedastwopathwaysof ini;a;on
1. Intrinsic(;ssuefactor) 2. Extrinsic(contactac;va;on)
thatjoininacommonpathway
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
9/09/13
CloJng
1.IntrinsicPathway
Pathwaysac;vatedbymanysubstances releasedduring;ssueinjury&infec;on,eg
Collagen Proteinases Kallikrein Plasmin Bacterialproducts,egendotoxins
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
2.ExtrinsicPathway
CommonPathway
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
Tutorial&Lab
CommonwealthofAustralia
Copyright Regulations 1969
Tutorial:
Ques;onsthatleadyoutoexploretherole ofinamma;oninthepathophysiologyof atherosclerosis Usep.594onwardsfromyourtext
Lab:
ECGs&BP
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences
IP100Introduc;ontoPathophysiology
FacultyofHealthSciences