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.
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)
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
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)
