1. The pathology of cardiovascular disease (CVD)

2. What do you know?
Discuss with a partner anything you might know about cardiovascular disease.
Make a note of 5 things if you can on a white board

3. What you are learning Atherosclerosis and its link to CVD
Thrombosis – how they form and their possible damage including heart attack (MI) and strokes
Peripheral vascular disorders including Deep vein thrombosis (DVT) and pulmonary embolism
Cholesterol levels and its control
Familial hypercholesterolaemia (FH) and it’s treatment

7. Cardiovascular diseases (CVD)
Diseases which have an effect on the cardiovascular system and the vascular system.
This can effect all organs and tissues including heart, brain, etc..
They come from the development of atherosclerosis

8. Atherosclerosis Part of the artery develop plaques called atheromas
Endothelium (inner lining) develops a fatty deposit (mainly cholesterol)
Over time fibrous material is added and calcium is deposited
Atheroma (if big enough) reduce the lumen diameter
Blood flow is restricted and pressure increases
Atherosclerosis leads to cardiovascular disease (CVD) such as coronary heart diseases (including angina), strokes and heart attacks (MI)
Atherosclerosis is the root cause of peripheral vascular disease (PVD)

9. Blood clotting Blood clotting prevents loss of blood at a wound
Damaged cells cause clotting factors to be released
Inactive enzyme prothrombin is changed to active thrombin
Thrombin causes plasma protein fibrinogen to form threads of fibrin
Fibrin forms a mesh catching platelets and cells
Wound is sealed and scar tissue can grow around the threads
Formation of a clot (thrombus) is called a thrombosis
Clots can break free inside damage blood vessels and travel until they block a blood vessel (an embolus)

11. Damage from clots
A coronary artery thrombosis can lead to a heart attack (myocardial infarction or MI)
If a coronary artery is blocked blood supply to part of the heart will fail
A thrombosis in a brain artery can cause a stroke
A blocked artery in the brain means part of the brain will fail
Both these are caused by lack of oxygen to tissues which then die

12. Peripheral vascular disorders
Disorders that occur due to reduced blood flow in blood vessels other than in the brain or heart
Reduced blood flow is due to atherosclerosis
Deep vein thrombosis (DVT)
Pulmonary embolism

13. Deep vein thrombosis (DVT)
Blood clots in the veins
Most common in legs
Tissues are deprived of oxygenated blood
Pain in leg
Clots can break off and be transported around body

14. Pulmonary embolism
A clot formed in a blood vessel e.g. leg vein breaks off
It is transported to the heart
It passes to the lungs
It gets stuck in a lung blood vessel (artery)
Tissues not supplied with blood can die.
This is a pulmonary embolism
Can be fatal

15. Cholesterol Is a type of fat (lipid) that all cells can make
The liver produces 25% of all the cholesterol the body makes from saturated fats in the diet
It is an essential component of cell membranes
It is essential to produce certain steroids e.g. sex hormones
It is needed for normal health

16. Cholesterol and LDLs
Cholesterol is transported to cells in the body by low density lipoproteins (LDLs)
LDL receptors are synthesised by most cells and inserted into the cell membrane
LDL cholesterol molecules attach to the LDL receptors and are engulfed by the cell
The cholesterol is released for use in the cell
If a cell has enough cholesterol negative feedback stops production of the LDL receptors
LDL cholesterol circulates in the blood
This cholesterol can be deposited in the walls of arteries as an atheroma
Atheromas cause a reduction in the blood flow

17. Cholesterol and HDLs
Some excess cholesterol is transported by HDL to the liver
It will be broken down by the liver
This helps prevent excess build up of cholesterol in the blood stream
Cholesterol carried by HDL does not end up in the artery walls
More HDLs will help remove cholesterol

18. Cholesterol and a healthy lifestyle
A lifestyle including a diet avoiding too much saturated fat and taking regular exercise helps maintain a higher HDL level in the blood
Evidence suggests replacing some saturated fat with unsaturated fat helps as does a reduction in overall fat
Medication called STATINs help reduce cholesterol levels
Statins inhibit an enzyme in the liver essential for the synthesis of cholesterol
Statins do have risks as well as benefits

19. Cholesterol and Familial hypercholesterolaemia (FH)
FH is an inherited disorder
It is autosomal dominant
It causes a decrease in LDL receptors or changes in their structure
Less LDL cholesterol is taken into cells
A very high level of LDL cholesterol is found in blood
The cholesterol is deposited in the artery walls from a young age
A much higher risk of coronary artery disease
A genetic test can show if the FH allele has been inherited
Treated with modified lifestyle and medication including statins

20. What you should know
Explain what atherosclerosis is and its link to CVD
Explain what thrombosis is, how they form and their possible damage including heart attack (MI) and strokes
Explain what peripheral vascular disorders are including Deep vein thrombosis (DVT) and pulmonary embolism
Explain what cholesterol is, its usefulness and how its levels are controlled
Explain what Familial hypercholesterolaemia (FH) is, its negative effects and it’s treatment
Consolidation
Read textbook and do questions, make notes,
complete summary, read scholar
multiple choice, mix and match