CARDIOVASCULAR DISEASE (Overview) Toni Mustahsani Aprami, dr., Sp.PD, Sp.JP Department of Cardiology...
Preview:
Citation preview
- Slide 1
- Slide 2
- CARDIOVASCULAR DISEASE (Overview) Toni Mustahsani Aprami, dr.,
Sp.PD, Sp.JP Department of Cardiology and Vascular Medicine
Cardiovascular Subdivision, Department of Internal Medicine Hasan
Sadikin Hospital/Medical School, Padjadjaran University
- Slide 3
- Understanding the Cardiovascular System The Heart: A Mighty
Machine Four chambers Two upper chambers are called atria Two lower
chambers are called ventricles Valves regulate the flow of
blood.
- Slide 4
- Slide 5
- Slide 6
- Conduction System of the Heart 5
- Slide 7
- The Heartbeat Is Controlled Each heartbeat is referred to as a
cardiac cycle. Takes a total of 0.85 seconds / cycle on the average
when at rest..... Thats ~70 X/minute, range 60-80 beats/ minute.
Systole - Contraction of heart muscle. Diastole - Relaxation of
heart muscle.
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Blood Flow within the Heart
- Slide 12
- Blood Vessels 11
- Slide 13
- Capillary Bed Anatomy 12
- Slide 14
- Capillary Exchange
- Slide 15
- Functions of the Cardiovascular System 1.Contractions of the
heart generates blood pressure, which moves blood through blood
vessels. 2.Blood vessels transport blood, which moves from the
heart into arteries, capillaries, and veins, before returning to
the heart. 3.Exchanges at the capillaries (smallest vessels)
refreshes blood and then tissue fluid (interstitial fluid). 4.The
heart and blood vessels regulate blood flow, according to the needs
of the body.
- Slide 16
- CARDIOVASCULAR DISEASE Congenital Heart Disease (ASD, VSD, PDA,
TOF) Rheumatic Heart Disease (MS/MR, AS/AR) Hypertensive Heart
Disease Coronary Artery Disease Cardiomyopathies Pericarditis
Peripheral Artery Disease Aneurysm and Disectie Aortae Deep Vein
Thrombosis Cardiac Tumor
- Slide 17
- Coronary Artery Disease 90% Atherosclerosis Process
- Slide 18
- Atherosclerosis can, and does, occur in almost any artery in
the body. But in the heart its effects can be crucial. The body
depends on a strong pumping heart to circulate life-giving blood,
and this includes to the heart muscle itself. If the coronary
arteries become blocked, the cardiac muscle begins to fail, and so
the blood circulation decreases, which includes the circulation to
the heart muscle itself. (Thibodeau, 494)
- Slide 19
- Atherosclerosis is a disease of large (elastic) and medium
sized (muscular) arteries characterized pathologically by smooth
muscle proliferation, lipid accumulation, cell necrosis, fibrosis,
and calcification. Most commonly involved : Aorta
CoronaryCarotidIliacMesentric CoronaryCarotidIliacMesentric
- Slide 20
- Slide 21
- Uncontrollable Sex Hereditary Race Age Controllable High blood
pressure High blood cholesterol Smoking Physical activity Obesity
Diabetes Stress and anger Predict Risk Diagnostic/Screening test :
EST, CRP, Echocardiography, CACS
- Slide 22
- Atherogenesis
- Slide 23
- Normal Artery Endothelium Internal elastic lamina External
elastic lamina Media Intima Adventitia
- Slide 24
- Response to Injury
- Slide 25
- Endothelial Dysfunction
- Slide 26
- Initiation of Fatty Streak
- Slide 27
- Fatty Streak
- Slide 28
- Fibro-fatty Atheroma
- Slide 29
- FIBROUS CAP NECROTIC CENTER MEDIA (smooth muscle cells,
macrophages, foam cells, lymphocytes, collagen, elastin,
proteoglycans, revascularization) (cells debris, cholesterol
crystals, foam cells, calcium)
- Slide 30
- Endothelial Dysfunction Foam Cells Fatty Streak Intermediate
LesionAtheroma Fibrous Plaque Complicated Lesion/Rupture
Endothelial injury nitric oxide endothelin-1 vasodilation Lipid
accumulation adhesion molecules (ICAM, VCAM) monocyte adhesion
macrophage LDL uptake Inflammation continued macrophage/lipid
accumulation leukocyte accumulation cytokines (IL-6,TNFa, IFNg)
MMP's CRP (hepatic) oxidized LDL homocysteine smoking aging
hyperglycemia hypertension 35-45 yrs45-55 yrs 55-65 yrs >65 yrs
The Evolution of Atherosclerosis
- Slide 31
- Common Consequences of Atherosclerosis in Vessels
- Slide 32
- Altered Vessel Function Vessel change Plaque narrows lumen Wall
weakened Thrombosis Breaking loose of plaque Loss of elasticity
Consequence Ischemia, turbulence Aneurysms, vessel rupture
Narrowing, ischemia, embolization Athero-embolization Increase
systolic blood pressure
- Slide 33
- Burden and causes of cardiovascular diseases: with an emphasis
on Asia
- Slide 34
- Chronic diseases and injuries Infectious, maternal, perinatal
and nutritional conditions Changing patterns of death Worldwide:
1990-2020 Global Burden of Disease Project, 1996 Millions of
deaths
- Slide 35
- Leading causes of death Worldwide: 1990-2020 RankCause %
RankCause % 1Coronary Artery disease 12.41Coronary Rtery disease
16.3 2Cerebrovascular disease 8.72Cerebrovascular disease 11.2
3Lower respiratory infections 8.53COPD 6.9 4Diarrhoeal diseases
5.84Lower respiratory infections 3.7 5Perinatal conditions
4.45Respiratory tract cancers 3.5 6COPD 3.9 6Road traffic accidents
3.4 7Tuberculosis 2.17Tuberculosis 3.4 8Measles 2.18Stomach cancer
2.3 9Road traffic accidents 1.99HIV 1.8 10Respiratory tract cancers
1.910 Self inflicted injuries 1.8 19902020 Global Burden of Disease
Study, 1996
- Slide 36
- Reported in 1990 14 million deaths worldwide 5 million in
developed countries 9 million in developing countries Predicted for
2020 25 million deaths worldwide 6 million in developed countries
19 million in developing countries Deaths from cardiovascular
disease Worldwide: 1990-2020 Global Burden of Disease Study,
1996
- Slide 37
- World population change 0 2 4 6 8 10 17001800190020002100 World
population (billions) United Nations 1999
- Slide 38
- Regional population change Population (billions) 2000 2050
Change Developing world 4.9 7.9 3.0 Developed world 1.0 1.0 0.0
Total 5.9 8.9 3.0 United Nations 1999
- Slide 39
- 0 500 1000 1500 2000 2500 3000 3500 Trends in per capita
cigarette consumption: 1971-1991 1971 1981 1991 Per capita
cigarette consumption High income countries Low & middle income
countries China The World Health Report, 1999: Making a
Difference
- Slide 40
- Tobacco-related death and disability 19902020 Deaths (millions)
3.0 8.4 India 0.1 1.5 China 0.8 2.2 DALYS (%) 2.6 9.0 Global Burden
of Disease Project, Lancet 1997
- Slide 41
- Trends in overweight/obesity (BMI 25+ kg/m 2)
- Slide 42
- 0 50 100 150 200 250 300 350 DevelopedDevelopingWorld Millions
1995 2025 Projected King et al. Diabetes Care 1998; 21:1414-31 0 50
100 150 200 250 300 350 Asia-Pacific Global distribution of
diabetes
- Slide 43
- Prevalence of smoking in the Asia Pacific APCSC, 2006
Indonesia
- Slide 44
- Prevalence of hypertension 140/90mmHg + Indonesia 27 11
- Slide 45
- Prevalence of obesity and overweight
- Slide 46
- Prevalence of, and predictions for, diabetes
- Slide 47
- Summary I Global epidemic of CVD; the leading cause of death
and disability About 11 million new cardiovascular deaths each year
by 2020 By 2020, 80% of cardiovascular deaths will occur in low and
middle income countries About half of these deaths will occur in
the Asia-Pacific region
- Slide 48
- Summary II Classic CVD risk factors act similarly in different
populations These risk factors are already common in many
low/middle-income countries, and are often increasing (e.g.
Asia)
- Slide 49