,Heart failure and circulatory pathology
Atherosclerosis can lead to:
CAD
Atherosclerotic stroke related to plaque
Abdominal aneurysm due to weakening of the vessel
Nontraumatic amputation of lower extremity
Mesenteric angina
Small bowel infarction
Renovascular atherosclerosis of renal arteries
Hyaline arteriosclerosis
A. Diabetes
- Non-enzymatic glycosylation of small blood vessels, HBA 1C (protein acc. in vessel wall)
- Osmotic damage in tissues containing aldose reductase (converts glucose >> sorbitol, attracts
water until cell bursts), causing:
Lens cataract
Microaneurysms in retina
Peripheral neuropathy
Microalbuminuria (in diabetic nephropathy)
B. Hypertension
- Proteins forced in bm by increased diastolic pressure
- Kidney – shrunken, cobblestone appearance
- Lacunar strokes – tiny infarctions in internal capsule
Aneurysm – outpuching of vessel wall due to weakness
Law of Laplace – increased radius increased stress on wall, therefore all aneurysms will rupture
Possible risk factor:
- Atherosclerosis
Abdominal aortic aneurysm
- Diameter >3cm or >50% larger than normal size
- Most common area of aneurysm
- Lacks blood supply (vasa vasorum) below renal arteries high risk of hypoxia
- Symptoms of rupture:
Severe left flank pain
Hypotension
Pulsatile mass on physical examination
If larger than 5 cm surgery
Visualize with US
, Dissecting aortic aneurysm
Main risk factor:
- Hypertension
Tear in aorta blood runs to pericardial sac cardiac tamponade (proximal dissection,
most common type)
Symptoms:
- Chest pain - TEARING pain radiates to back, retrosternal pain
- Absent/diminished pulse on left side due to subclavian closure
- X-ray – widening of proximal aortic knob
Confirm with transesophageal US or
Angiography
Aneurysm of arch of aorta
- Most common complication – tertiary syphilis (treponema) leads to vasculitis of vasa vasorum
Consequences:
Endarteritis obliterans (obliteration of lumen)
Ischemia
Weakening under systolic pressure depression of arch stretching of aortic
valve ring aortic regurgitation murmur
Heart failure (congestive)
Frank-Starling law works in pathologic conditions– in aortic regurgitation, incomplete aortic closure
blood drips back decreased stroke volume more blood in left ventricle EDV (pathologic)
Concentric hypertrophy – increased afterload (pressure) due to aortic stenosis or chronic HTN
Eccentric hypertrophy – increased preload (vol)
Left heart failure – forward failure
- Left ventricle failure ↑ EDV blood flow back to atrium pulmonary vessels ↑
hydrostatic pressure pulmonary edema
- Chronic LHF hemorrhage phagocytosis of RBC rusty sputum/spit
Cytology – hemosiderin (phagocytosed RBC)
Main symptom
- Dyspnea
- Paroxysmal nocturnal dyspnea – blood returns to lungs during sleep
- Pillow orthopnea – putting pillow under head decreases venous return to heart decreases
dyspnea
Right heart failure – backward failure
- Right side cannot pump blood to left side blood returns to veins ↑ Hydrostatic pressure in
veins
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