Slide 1What is cardiovascular disease?Cardiovascular diseasesWhy should we care?...3 D’sSlide 5Slide 6Slide 7Disability and CVDSlide 9Slide 10PathophysiologyOxygen Delivery to MuscleSlide 13Peripheral Artery Disease (PAD)Slide 15AtherosclerosisBlood VesselsRole of endotheliumSlide 19Stages of Atherosclerosis Stage 1: Fatty StreakStages of Atherosclerosis Stage 1: Fatty StreakStages of Atherosclerosis Stage 1: Fatty StreakStage 2: Fibrous PlaqueSlide 24SummaryCardiovascular Disease (CVD) Unit 2 Lecture 2Fall 2017What is cardiovascular disease?•Heart and/or blood vessel disease•Why is this a problem?•Types1) Coronary heart disease•Blood vessels delivering oxygen to heart–Blockage•Angina and MI2) Cerebrovascular Disease•Blood vessels delivering oxygen to brain–Blockage (ischemic) –Aneurysm (hemorrhagic) 3) Hypertension•Elevation in pressure in arteries–Increase work required by heart to pump blood into systemic circulation–Increase stress on walls of arteries leading to aneurysms–Kidney failureCardiovascular diseases4) Heart failure•Failure of heart in pumping blood appropriately 5) Peripheral vascular disease•Narrowing of peripheral arteries–Pain walking, decreased flow6) Rheumatic Heart Disease- develops in 60% of people with rheumatic fever- involves heart valves7) Cardiomyopathies - abnormalitiles of heart muscle- dialated, ischemic, hypertorphicWhy should we care?...3 D’sDeathsGo A S et al. Circulation. 2014;129:e28-e292Cardiovascular disease (CVD) and other major causes of death: total, <85 years of age, and ≥85 years of age.Percentage breakdown of deaths attributable to cardiovascular disease (United States: 2010). Go A S et al. Circulation. 2014;129:e28-e292Copyright © 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 S et al. Circulation. 2014;129:e28-e292Copyright © American Heart Association, Inc. All rights reserved.Prevalence of low coronary heart disease risk, overall and by sex (National Health and Nutrition Examination Survey: 1971–2006). Go A S et al. Circulation. 2014;129:e28-e292Copyright © American Heart Association, Inc. All rights reserved.Disability and CVD•8 million Americans disabled due to CV disease•19% of all disabilities due to CV disease•Stroke is leading cause of long-term disability (1.1 million stroke survivors report difficulties performing basic activities of living, CDC)•Two-thirds of heart attack patients don’t make a full recoveryDisability: the consequence of an impairmentProjected total costs of cardiovascular disease (CVD), 2015 to 2030 (2012 $ in billions) in the United States. Go A S et al. Circulation. 2014;129:e28-e292Copyright © American Heart Association, Inc. All rights reserved.Diabetes: $174 billionLung Disease: $154 billionAlzheimer’s Disease:$148 billionDollarsThe 22 leading diagnoses for direct health expenditures, United States, 2010 (in billions of dollars). Go A S et al. Circulation. 2014;129:e28-e292Copyright © American Heart Association, Inc. All rights reserved.PathophysiologyHow do Coronary Heart Disease Peripheral Artery DiseaseCerebrovascular Disease develop?Oxygen Delivery to Muscle •Narrowing of blood vessels that supply blood •If blood flow is compromised, then oxygen supply to muscle is less than demand•Symptoms if oxygen supply < demand–Chest pain (angina)–Shortness of breath– pain down arm or in back or jaw – sweating –Indigestion –Low back painPeripheral Artery Disease (PAD) Symptoms•numbness/weakness•sores that will not heal•slow hair/nail growth on extremity•weak peripheral pulse•Erectile dysfunction• intermittent claudicationCerebrovascular DiseaseThrombus – solid mass of platelets and/or fibrin that forms locally in a vesselEmbolus – a piece of a thrombus that is carried in the bloodstreamAtherosclerosis •“Response to injury” hypothesis•Stages: –Endothelial Dysfunction1) Fatty streak2) Fibrous plaque3) Complicated Lesion•Calcified (decrease vessel elasticity)•Clot: Thrombus --- Embolus•Reduce radiusBlood VesselsRole of endothelium•Endothelium Dysfunction – “sticky”–Expresses adhesion molecules (VCAM-1, ICAM)•LDL-C becomes trapped and modified (oxidized)•Monocytes/Lymphocytes enter•Foam cells are created• smooth muscle begins to migrate Stages of AtherosclerosisStage 1: Fatty Streak•Endothelium Dysfunction –“sticky”–Expresses adhesion molecules (VCAM-1, ICAM)•LDL-C becomes trapped and modified (oxidized)•Monocytes/Lymphocytes enter•Foam cells are created•Smooth muscle begins to migrateStages of AtherosclerosisStage 1: Fatty StreakReversibility is easiest at this stage•Endothelium Dysfunction – “sticky”–Expresses adhesion molecules (VCAM-1, ICAM)•LDL-C becomes trapped and modified (oxidized)•Monocytes/Lymphocytes enter•Foam cells are created•Smooth muscle begins to migrateStages of AtherosclerosisStage 1: Fatty StreakReversibility is easiest at this stageStage 2: Fibrous Plaque•Characterized by fibrous cap–smooth muscle–connective tissue–dead cells, Ca2+, foam cells–some LDL•Endothelial damage continues•Cap thickness, population with SMCs and collagen are more stableStage 3: Complicated Lesion/RuptureSummary•Heart disease is the #1 cause of death in the US•CAD, PAD, Cerebrovascular disease are all cardiovascular diseases•Atherosclerosis contributes to all 3•The process of atherosclerosis is progressive and involves many stages, however it is