Cardiovascular Disease (CVD) Objectives: Describe the movement of blood through the cardiovascular system Discuss the prevalence of CVD Define the types of CVD Define ischemia, infarction, angina, thrombus, embolus, aneurysm, stenosis, claudication, and cardiac arrest Describe symptoms of a MI Describe the development of atherosclerosis

Describe blood flow through the Cardiovascular System

Blood flow through the heart

Describe blood flow through the Cardiovascular System

Cardiovascular Disease (CVD) Prevalence of CVD – American adults (>1 in 3) have 1 or more types of CVD 2150 die each day one death every 40 sec. –Lifetime risk of CVD in women is 1 in 2 –Coronary Heart Disease causes 1 of every 5 deaths –Stroke causes 1 of every 17 deaths –33% of US adults have hypertension

Circulation, February 7, 2007

Deaths attributable to cardiovascular disease (United States: 1900–2010). Go A et al. Circulation 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

Percentage breakdown of deaths attributable to cardiovascular disease (United States: 2010). Go A et al. Circulation 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

Prevalence of cardiovascular disease in adults ≥20 years of age by age and sex (National Health and Nutrition Examination Survey: 2007–2010). Go A et al. Circulation 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

Incidence of heart attack or fatal coronary heart disease by age, sex, and race (Atherosclerosis Risk in Communities Surveillance: 2005–2010). Go A et al. Circulation 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

What are the Types of CVD? 1.Hypertension (Hypertensive Disease) - Essential hypertension 2.Ischemic Heart Disease (IHD) - Coronary Heart Disease (CHD/CAD) Ischemia (Greek, isch- restriction) – insufficient blood flow –Causes hypoxia (reduced oxygen) and or anoxia (no oxygen) which leads to infarction (cell death) –Caused by thrombosis (blood clot formation) or stenosis (vessel narrowing) often due to atherosclerosis Acute Myocardial Infarction (MI) Angina pectoris Cardiac arrest Sudden death

Types of CVD 3. Cerebrovascular Disease (Stroke) Cerebral thrombosis (ischemic stroke: most common) Cerebral hemorrhage (hemorrhagic stroke) –Aneurysm Transient Ischemic Attack (TIA) – symptoms < 1hr

CVD Types (cont.) 4. Diseases of Arteries - Atherosclerosis: a subtype of arteriosclerosis - “sclerosis of an atheroma” - Peripheral Vascular Disease Peripheral artery disease (PAD) –intermittent claudication »Pain in one or both legs on exertion –Dx: ankle-brachial index Varicose Veins

Venous Conditions - Venous thrombosis (clot in veins) -Deep Vein Thrombus (DVT) -Often occurs in legs (pain, warmth, swelling) -Portion of thrombus breaks off and embolizes becoming: -Pulmonary Embolism (PE) -Sx: Shortness of breath, chest pain -Venous Thromboembolism (VTE) -DVT with resulting PE

CVD Types (cont.) 5. Heart Failure (HF) 5.8 million prevalence; 550,000 incidence Sx: dyspnea, cough, fatigue, edema Ventricle contraction is weak Blood backs up in veins causing fluid build up in lungs, legs, feet 6. Other Cardiovascular Diseases Arrhythmias – many types –Most threatening: ventricular fibrillation Valvular heart disease

Cause of CVD Most (90%) due to atherosclerosis* –A form of arteriosclerosis Plaque (atheroma) development –Lipid, inflammatory cells, smooth muscle, calcium, and connective tissue –More often in branch points –May grow and cause stenosis –May rupture and bring thrombus *

Pathophysiology of atherosclerosis Injury and inflammation at the artery intima –Includes oxidation of LDL cholesterol (LDL-C) Platelets respond and adhere to intima Platelets release growth factors Monocytes are recruited to the injury site –Monocytes  Macrophage consume oxidized LDL  morph into foam cells  swelling  plaque (raised area) Smooth muscle cells also move into the area Continued development of plaque Hanson, G. O. (2005). “Inflamation, Atherosclerosis, and Coronary Artery Disease.” N Engl J Med 352(6):