Cardiovascular Disease

failure of the heart to pump adequate amount of blood supply metabolic requirements of the organs.

• 1. myocardial hypertrophy
• 2. ventricular dilation
• 3. physiologic mechanisms: inc. HR, intravascular volume, catecholamines, redistribution of blood flow

• 1. ischemic heart disease
• 2. hypertension
• 3. myocarditis
• 4. cardiomyopathy
• 5. valvular disease

• 1. right ventricular failure
• 2. left ventricular failure
• 3. left and/or right ventricular failure
• 4. CHF due to left vent failure eventually leads to right vent. failure

cyanotic and noncyanotic. cyanotic have shunting of poorly-oxygenated systemic venous return to systemic arterial circulation, bypassing the lungs.

• 1. atrial septal defect
• 2. ventricular septal defect
• 3. patent ductus arteriosus to connect the aorta and pulmonary arteries
• 4. tetralogy of fallot
• 5. transposition of the great arteries (right vent empties into aorta, left to pulmonary)

ventricular septal defect where there is a narrowing of the right ventricular outflow, overriding of the aorta over the right ventricular outflow and right ventricular hypertrophy

• 1. narrowing of the coronary arteries by 75% by atherosclerosis which leads to gradual opening of collateral arteries
• 2. coronary artery thrombosis initiated by fissure in the fibrous cap of an atherosclerotic plaque
• 3. other factors including increased myocardial oxygen consumption, reduced ability to deliver oxygen, coronary artery spasm.

• 1. angina pectoris
• 2. acute myocardial infarction
• 3. chronic ischemic heart disease
• 4. sudden cardiac death

chest pain for several minutes associated with exercise or emotional stress relieved by rest. no myocardial necrosis occurs.

gradual onset of CHF with at least one large left ventricular scar. biventricular hypertrophy and dilation of all cardiac chambers

sudden onset of ischemia-induced cardiac arrhythmia with or without myocardial necrosis. can occur in patients with history of IHD

• few hours: coagulation necrosis
• few days: neutrophil infiltration
• 1 week: granulation tissue
• weeks to months: scar formation

• 1. arrhythmia and sudden death
• 2. CHF/shock
• 3. mural thrombus/emboli
• 4. myocardial rupture
• 5. mitral valve regurgitation
• 6. ventricular aneurysm
• 7. chronic ischemic heart disease

cardiomyopathy and myocarditis

primary is confined to the heart muscle while secondary involves the heart as a multi-system disorder.

dilated, hypertrophic, restrictive

familial in 25-35% of cases, dilation of all 4 heart chambers, variable fibrosis and myocyte hypertrophy

autosomal dominant point mutation with variable expression. causes spontaneous myocardial hypertrophy, interventricular hypertrophy that obstructs left ventricular outflow tract

stiffening of ventricular wall resulting in impaired ventricular filling during diastole. it is idiopathic or associated with other conditions relating to the myocardium

most common cause is viral infection (enterovirus). can also be caused by bacterial, fungal and parasitic organisms. non-infections cases include toxins, hypersensitivity reactions and auto-immune diseases.