Non-modifiable risk factors Modifiable Risk Factors

Age (75 years old) Smokingsedentary lifestyle

Gender: male Alcoholdiet
Hereditary: HF, DM, HPN Obesityhypercholesterolemia

Injury to the endothelial cells that line the artery walls

Inflammation to the injured endothelial tissue

Adhesion of molecules that bind macrophages and other inflammatory cytokines and enzymes that further injure the wall

Macrophages engulf oxidized LDL

Penetrate into the intima of the blood vessel

Increase foam cell formation

Fatty streak

Produce more toxic oxygen radicals Release growth factors

Immunologic and inflammatory changes causing progressive damage to the vessel wall Smooth muscle cells proliferation in the injured endothelia
 Formation of fibrous plaque

Calcification and protrusion into the vessel lumen (coronary artery)

Obstruction of blood flow to distal tissue of heart

Decrease blood flow to heart muscle

Increase contractility of myocardium

↑HR

Increase preload and afterload

Increase workload of the left ventricle

Increase force contraction of the LV

Increase stress on the left ventricular wall

 Left ventricular hypertrophy and dilation

↑blood volume and pressure in left ventricle

Can’t pump sufficient blood

Decrease Cardiac Output Left ventricle cannot accommodate all blood

Stimulates baroreceptor in aortic and carotid bodies Decrease blood flow in aorta

Damming back of blood from LV to LA

Decrease blood flow in system
SNS stimulation
Inadequate tissue perfusion

Release of epinephrine and norepinephrine

↓ blood flow to kidneys ↓blood flow to GI ↓blood flow to brain ↓blood flow to extremities↓blood flow to heart

Vasoconstriction ↑HR and contractility

↓oxygen in brain ischemia
↓Urine Output Altered digestion Pale, cold, clammy skin, weak thready pulse and slow capillary refill

RAAS activation
Anaerobic respiration
oliguria Dizziness, lightheadedness, confusion restlessness

Sodium and Water Retention

↑lactic acid production
Hematuria and proteinuria

↑ BP ↓blood flow to liver ↑transferases, hyperbilirubinemia Chest pain

 Backflow of blood to pulmonary vessels

↑pulmonary venous blood and pressure

Backflow of blood from lungs to pulmonary artery

Fluid shifting from capillaries into pulmonary tissues and alve

Backflow of blood pulmonary artery to right ventricle then to right atrium

Decrease Oxygen saturation

Impaired oxygen and carbon dioxide exc
Pulmonary Edema

Superior Vena Cava Inferior Vena Cava Pulmonary Congestion

Increase venous pressure

Pulmonary HPN Dyspnea, cough and crackles
Shortness of breath

↑pulmonary artery pressure

Jugular vein distention Increase capillary hydrostatic pressure Liver capillaries Lower extremities

Portal HPN hepatomegaly Rupture of microvascular aneurysm

Peritoneal cavity
Bipedal edema

ascites
Internal hemorrhoids
hemoptysis
Venous stasis in the abdominal organs
Increase pressure in stomach

Anorexia, abdominal pain and nausea