I II Hyperlipidemia a Elevated serum lipid concentration b Major serum lipids i Total cholesterol triglycerides c Usually associated with hyperlipoproteinemia d Optimal Fasting Levels 200mg dL e Excess alcohol Intake Atherosclerosis a Pathogenesis i Accumulation of fatty deposits leads to formation of fibrous tissue ii Results in narrowing of the arterial lumen leading to tissue in vessel walls ischemia iii Tissue ischemia 1 Oxygen and nutrient supply is insufficient to meet metabolic demands 2 Factors affecting tissue oxygen demands a Rate of tissue perfusion tissue workload iv Coronary arteries commonly affected 1 Cardiac ischemia via thrombus formation coronary vasospasm endothelial cell dysfunction v Lipids transported via apoproteins as lipoproteins 1 HDL transports cholesterol from peripheral tissue to liver clearing atheromatous plaque 2 Other lipoproteins associated with greater risk of atherosclerosis vi Coronary atherosclerosis 1 Coronary artery endothelium is injured leading to increased permeability and leukocyte recruitment 2 LDL migrates and accumulates at the site of endothelial injury due to oxidation by cells and macrophages 3 Oxidized lipids damage the endothelium and smooth muscle further stimulating more macrophage recruitment 4 Macrophages engulf lipids forming foam cells 5 Foam cells release inflammatory mediators and GF to attract more leukocyte and smooth muscle proliferation 6 Excess lipids and debris accumulate within vessel wall and coalesce into lipid core which becomes an atheromatous plaque vii Vulnerable plaques 1 Large lipid core thin cap shear stress 2 Can rupture erode to stimulate clot formation on the plaque III Cardiac Disease a Markers i If muscle dies or is damaged it releases all proteins like myoglobin 1 Heart attack will show increased myoglobin in blood 2 Also renal disorders 1 Muscle contraction ii Troponin iii I Inhibitors iv Myoglobin 1 Myosin actin from overlapping cardiac spectrum In cardiac and skeletal muscle 1 2 Elevated in renal failure trauma and skeletal muscle 1 Cytosolic enzyme used to transfer energy in muscle 2 Dimer composed of 2 subunits B brain form and M muscle disease v Creatine Kinase CK metabolism form 3 3 isoenzymes a CK BB i Brain origin b CK MB i Much longer to rise takes hours ii Most specific for cardiac muscle c CK MM i Most CK in skeletal muscle 4 Total CK 40 sensitivity 5 CK MB a 85 specificity for cardiac injurt AMI possible false positive because present in skeletal muscle b Elevated 4 6 hours after onset of chest pain peaks at 12 24 hours returns to baseline within 2 3 days vi Troponin 1 Rises slightly more than CK but still take hours IV Coronary Heart Disease CHD a CHD coronary artery disease b Insufficient delivery of oxygenated blood to the myocardium most commonly due to atherosclerotic coronary arteries c Most common type of heart disease Leading cause of death in the U S d 75 coronary related deaths are due to atherosclerosis e Risk Factors f Etiology i Atherosclerosis causes narrowing of the arterial lumen causing cardiac ischemia via ii Thrombus formation iii Coronary vasospasm iv Endothelial cell dysfunction g Sequelae i Angina pectoris ii MI iii Dysrhythmia iv Heart failure v Sudden cardiac death h Acute Coronary Syndromes i Acute changes in plaque morphology plaque rupture and ii Chest pain more severe and longer lasting than in chronic coronary thrombosis syndromes iii Unstable angina partial occlusion iv MI complete occlusion v Diagnosis ECG biomarkers vi Myocardial Infarction 1 Reduced cardiac output triggers compensatory responses 2 Compensatory sympathetic nervous system activation increases myocardial workload via Increased heart rate contractility and blood pressure 3 i Chronic Coronary Syndromes i Slow progression due to chronic obstruction from stable atherosclerotic plaques ii Angina pectoris iii Chest pain due to intermittent myocardial ischemia iv Results in inefficient cardiac pumping leading to pulmonary congestion and shortness of breath v Chronic ischemic cardiomyopathy vi vii History of angina and MI results in heart failure viii More common in older adults Insidious progressive ischemic myocardial damage j Sudden Cardiac Death i Unexpected death due to cardiac injury within 1 hour of symptom onset Increased survival rate due to external defibrillators and CPR ii Inflammation and scarring Endocardial and Valvular Disease a Endocardial and valvular structures damaged by b c Calcification d Congenital malformations e Results in altered heart hemodynamics and increased myocardial workload f Valvular Diseases i Stenosis failure of valve to completely open results in pressure accumulation and increased cardiac workload ii Regurgitation failure of valve to completely close results in volume accumulation and increased cardiac workload g Endocardial Diseases i Rheumatic heart disease ii Acute inflammatory disease due to group A hemolytic streptococcal infection V iii Antibodies against streptococcal antigens damage connective tissue in joints heart and skin iv Mainly in children v vi Endocardial invasion and colonization by microorganisms results Infective endocarditis in inflammation vii Most common bacteria streptococcus staphylococcus viii Predisposing risk factors present VI Myocardial Disease a Inflammatory cardiac muscle disorder i characterized by myocyte necrosis and degeneration ii Left ventricular dysfunction dilation of all four chambers b Etiological factors i Viruses most common ii Other microbial agents iii iv Physical agents Immune mediated diseases c Cardiomyopathy i Non inflammatory cardiac muscle disorder ii Etiological Factors 1 Genetic Acquired iii Dilated Cardiomyopathy 1 Dilation of one both ventricular chambers 2 Etiological Factors a Alcohol toxicity b Pregnancy c Post Viral myocarditis d Genetic abnormality 3 Slow Progression 4 Results in biventricular heart failure with low ejection fraction iv Hypertophic Cardiomyopathy 1 Thickened hyperkinetic ventricular muscle mass 2 Etiological Factors a Genetic b Aquired 3 Septum commonly affected resulting in idiopathic hypertrophic subaortic stenosis 4 Variable progression usually slow v Restrictive Cardiomyopathy 1 Rarest form 2 Stiff fibrotic ventricle with impaired diastolic filling 3 Etiological Factors a Fibrotic disorders b Amyloidosis most common 4 Results in decreased cardiac output and left sided heart VII Pericardial Disease VIII Congenital Heart Disease failure a Cardiac abnormality present at birth b