1. Forms of cardiovascular disease Coronary heart disease Strokes Gangrene Aneurisms

2. Forms of coronary heart disease Angina Chest pain after exertion Spreads to neck, jaws, arms, back Shortage of blood to heart (no muscle death) Cramp Heart attack (myocardial infarction) moderately large coronary artery blocked sudden severe chest pain can be treated Heart failure Blockage of main coronary artery gradual damage heart becomes steadily weaker NEXT

3. Embolism A clot breaks off It may lodge elsewhere Coronary artery – Heart attack Brain - Stroke Gangrene A thrombus has broken off (embolised) and travelled via the left ventricle to the left leg, where it has blocked an artery, cutting off the blood supply to the foot.

4. An occlusive stroke An artery is blocked

5. Aneurysm Atherosclerosis narrows lumen of an artery Increases blood pressure This weakens the wall Balloons out and may burst NEXT

6. Strokes due to aneurysm Aneurysm in brain artery Haemorrhage within brain Stroke NEXT

7. Platelets An electron micrograph of a platelet. It looks like a chocolate chip cookie. The chocolate chips are granules that contain a variety of mediators. When activated, platelets release the granules to promote... coagulation, change of shape stickiness They plug small vascular holes. NEXT

8. Cholesterol Useful in small amounts Stabilises membranes Used in synthesis of Vitamin D Used in synthesis of hormones (testes, ovaries, adrenal glands) NEXT

9. Lipoproteins Very low density lipoproteins (VLDLs) Bad (cholesterol from liver to tissues for storage) Low density lipoproteins (LDLs) Bad (made from VLDLs in tissues, cholesterol from liver to tissues) High density lipoproteins (HDLs) Good (cholesterol from tissues to liver) NEXT

10. Coronary heart disease An undamaged artery NEXT Endothelial cells Elastic lamella Smooth muscle

11. Coronary heart disease Damage to artery Due to hypertension? Phagocytes invade wall NEXT Endothelial cells Elastic lamella Smooth muscle Phagocytes invade

12. Coronary heart disease LDLs in blood plasma enter artery wall LDLs carry cholesterol from the liver They deposit cholesterol The cholesterol and LDLs are attacked by the phagocytes The damage prevents LDLs returning to the plasma so they deposit more cholesterol NEXT

13. Coronary heart disease The phagocytes release growth factors These stimulate the growth of smooth muscle NEXT

14. Coronary heart disease Plaque of fibrous fatty tissue builds up Platelets stick to it They release clotting factors (thromboxanes) The endothelium normally releases prostaglandins to prevent clotting At the site of an atheromatous plaque the balance is wrong The blood clots NEXT

15. Progress of a thrombosis

16. A thrombosis Mild  Severe

17. Arteriosclerosis Calcification of the deposit Often in aorta or coronary arteries This causes hardening of arteries NEXT Calcification

18. Risk factors Diet – avoid saturated fat Exercise – see exercise unit Gender – oestrogen increases HDL, testosterone increases LDL Heredity – choose parents carefully Stress – avoid it! Age – arteriosclerosis inevitable as you get older Hypertension –stress, obesity, smoking, excessive drinking, lack of exercise, salt intake Smoking - carbon monoxide, nicotine, clotting NEXT

19. CHD and Cholesterol/Blood pressure/Smoking Relative risk (death rates per 10,000 people years) Factors increase each other’s effects NEXT 59.7 29.6 23.3 10.7 30.3 11.2

20. Nicotine Nicotine binds to some acetylcholine receptors reduces arteriole diameter increases adrenaline release increases blood pressure increases heart rate decreases blood supply to extremities increases stickiness of platelets Increases fat levels NEXT ACh Nicotine

21. Carbon monoxide Carbon monoxide (and nicotine) damage the endothelium Binds to haemoglobin and reduces oxygen transport by 15% in smokers Other effects of smoking decreases antioxidant concentration (eg Vitamin C and E) this increases the damage done by free radicals released by phagocytes Raises number of platelets Increases ratio of VLDLs and LDLs to HDLs in the blood

22. Saturated fat Decreases number of LDL receptors on liver cells so they stay in circulation Increases blood cholesterol concentrations Increases ratio of LDLs to HDLs NEXT

23. CHD and age

24. Prevention Screening Encouraging lifestyle changes Problem: long term nature of cardiovascular diseases – no symptoms until damage is already done Treatment Pacemaker helps maintain rhythm Bypass Surgery using leg blood vessel 21000 in UK in 1992 Transplant Surgery since 1967 140 in UK in 1992