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Chapter 8
Cardiovascular System Diseases
and Disorders
Copyright © 2015 Cengage Learning®.
Anatomy and Physiology
• Cardiovascular system
– Heart, arteries, and veins with blood
• Heart
– Size of man’s fist
– Located slightly left of the middle of the chest
– Composed of cardiac muscle, 4 chambers, 4 valves
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The Heart
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Anatomy and Physiology
• Heart:
– Wall of heart has three layers
• Epicardium
• Myocardium
• Endocardium
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Common Signs and Symptoms
– Chest pain
– Shortness of breath
– Tachycardia
– Cardiac palpitations
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Diagnostic Tests
• Noninvasive procedures:
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Auscultation
Doppler
Arterial blood pressure
Electrocardiogram
Echocardiography
PET scan
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Diagnostic Tests
• Cardiac catheterization
– Invasive procedure to determine oxygen content and
blood pressure
• X-rays
– To determine normal function of heart and vessels
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Diagnostic Tests
• Common X-rays:
– Angiocardiography
– Angiography
– Venogram
• Blood tests
– Enzymes
• Creatine phosphokinase (CPK)
• Lactate dehydrogenase (LDH)
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Diseases of the Cardiovascular
System
• Cardiovascular disease
– CVD
– Leading cause of death in the United States
– High blood pressure is common cause
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Diseases of Arteries
• Hypertension
– Indicator of development of cerebrovascular,
cardiovascular, and kidney disease
– Chronic disease
– Leading cause of stroke and heart failure
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Diseases of Arteries
• Hypertension
– Normal blood pressure
• 120/80
– Top number (systolic)
• Measures highest pressure in artery when ventricles contract
– Bottom number (diastolic)
• Measures pressure in artery when ventricles relax
– High blood pressure
• Greater than 140/90
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Diseases of Arteries
• Hypertension
– Primary
• Idiopathic with gradual onset
• Also known as essential hypertension
– Risk factors:
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Heredity
Diet
Age
Obesity
Smoking
Stress
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Diseases of Arteries
• Hypertension
– Treatment:
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Antihypertensive medications
Lifestyle changes
Low-salt diet
Stress-reducing exercise
Smoking cessation
Diuretics
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Diseases of Arteries
• Arteriosclerosis and atherosclerosis
– Loss of elasticity and thickening of artery wall
– Also known as hardening of arteries
– Plaque
• Deposits of fatty or lipid material in wall of artery
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Diseases of Arteries
• Atherosclerosis
– Major areas affected:
• Coronary arteries
• Cerebral arteries
• Aorta
• Peripheral arteries
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Diseases of Arteries
• Atherosclerosis
– Risk factors:
• Noncontrollable factors
– Heredity
– Age
– Sex
– Diabetes
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Diseases of Arteries
• Atherosclerosis
– Risk factors:
• Controllable factors
– Diet
– Sedentary lifestyle
– Cigarette smoking
– Stress
– Hypertension
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Diseases of Arteries
• Atherosclerosis
– Diagnosis by blood pressure, arteriograms, X-rays,
and Doppler
– Symptomatic treatment:
• Bypass surgery of occluded arteries and plaque removal
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Diseases of Arteries
• Peripheral vascular disease (PVD)
– Caused by atherosclerotic plaque in arteries
supplying blood to legs
– Intermittent claudication
• Muscle cramps relieved with rest and increased with activity
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Diseases of Arteries
• Peripheral vascular disease (PVD)
– Treatment:
• Endarterectomy
– If necrosis occurs, amputation or resection may be
necessary
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Diseases of Arteries
• Aneurysm
– Weakening in wall of artery leading to bulge or
rupture
– Usually asymptomatic and discovered accidentally
– Aorta
• Most common location
– Treatment:
• Repairing aneurysm before rupture through resection and
grafting
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Types of Aneurysms
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Diseases of Arteries
• Coronary artery disease
– Narrowing of arteries that supply blood to
myocardium
– Single leading cause of death in United States
– Commonly due to atherosclerosis
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Diseases of Arteries
• Coronary artery disease
– Progressive narrowing of vessels may lead to
ischemia of heart muscle and symptoms
– Scar tissue replaces muscle
– Occlusion may progress slowly or suddenly as result
of thrombus or embolus
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Diseases of Arteries
• Coronary artery disease
– Myocardial infarction
• Death of heart muscle
– Diagnosis by history, electrocardiogram (ECG), and
angiograms
– Treatment:
• Aimed at increasing blood flow or decreasing oxygen needs
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Diseases of Arteries
• Coronary artery disease
– Treatment:
• Angina treated with vasodilators
• Angioplasty
• Coronary artery bypass graft (CABG)
• Reduction of atherosclerotic risk factors
– Diet
– Exercise
– Smoking
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CABG
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Diseases of the Heart
• Angina pectoris
– Chest pain
– Lack of oxygen to heart
– Sign of impending myocardial infarction
– Treatment:
• Decrease workload of heart
• Use nitroglycerin
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Diseases of the Heart
• Myocardial infarction
– Heart attack
– Occurs when heart does not get enough oxygen
– Symptoms:
• Severe chest pain with diaphoresis and nausea
• Referred pain to neck, arm, and jaw with discomfort similar to
bad or unrelieved indigestion
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Diseases of the Heart
• Myocardial infarction
– Treatment:
• Give immediate attention to prevent shock
• Relieve respiratory distress
• Decrease workload
• If cardiac arrest, cardiopulmonary resuscitation (CPR) must
be performed
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Diseases of the Heart
• Myocardial infarction
– Treatment:
• Oxygen and pain medication
• Medications to treat arrhythmias
• Clot-busting medications
• Education on prevention by lifestyle changes
– Smoking cessation
– Diet
– Exercise
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Diseases of the Heart
• Hypertensive heart disease
– Result of long-term hypertension
– Causes:
• Disease or disorder causing chronic elevation in blood
pressure
– Treatment:
• Treat cause of hypertension
• Can only be controlled
– No cure
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Diseases of the Heart
• Rheumatic heart disease
– Autoimmune disorder caused by streptococcal throat
infection
– All layers of heart and valves can be affected
– Treatment:
• Prevention/treatment of streptococcal infections
• Rest during acute stage
• Valve replacement to correct deformity
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Diseases of the Heart
• Congestive heart failure (CHF)
– Heart fails to pump adequate blood supply
– Develops slowly and increases workload of heart
– Symptoms:
• Gradual increase in dyspnea
• Tachycardia
• Tachypnea
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Diseases of the Heart
• CHF
– Symptoms:
• Neck vein distention
• Edema in ankles and lower legs
• Right-sided leads to congestion of liver and spleen
• Left-sided leads to congestion of lungs
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Diseases of the Heart
• CHF
– Diagnosis by history and physical, chest X-ray, and
ECG
– Treatment:
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Decrease workload
Diuretics
Salt and fluid restrictions
Medications to strengthen and slow heart
– E.g., digitalis
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Diseases of the Heart
• Cardiomyopathy
– Disease of heart muscle
– Characterized by dilated, enlarged, thin, flabby heart
muscle
– No cure
– Leads to CHF, myocardial infarction, and death
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Diseases of the Heart
• Carditis
– Inflammation of heart
• E.g., pericarditis, myocarditis, endocarditis
– Often secondary to respiratory, urinary tract, or skin
infection
– Treatment:
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Rest
Antibiotics
Analgesics
Antipyretics
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Diseases of the Heart
• Valvular heart disease
– Malfunction of heart valves
– Murmurs or abnormal heart sound
– Causes:
• Congenital abnormalities or malformations
• Rheumatic fever
• Endocarditis
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Diseases of the Heart
• Arrhythmias
– Abnormal heart rhythm
– Sinus rhythm is normal heart rhythm
• 60 to 100 beats per minute
– Flutter
• Unusually fast heart rate
– Fibrillation
• Wild and uncoordinated
– Heart block
• Interruption in conduction system
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Diseases of the Heart
• Arrhythmias
– Divided into first-, second-, or third-degree
– Premature or early contractions (PVCs) may affect
atria or ventricles
– Treatment:
• Unnecessary if asymptomatic
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Diseases of the Veins
• Phlebitis
– Inflammation of superficial veins
– Symptoms:
• Pain
• Swelling
• Red, cord-like hardening along vein toward heart
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Diseases of the Veins
• Phlebitis
– Treatment:
• Analgesics
• Warm compresses
• Elevation of area above heart level
• Elastic stockings
• Exercise
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Diseases of the Veins
• Thrombophlebitis
– Clotting in vessels of legs, thighs, and pelvis
– Asymptomatic until embolization occurs
– Risk factors:
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Immobility
Dehydration
Varicose veins
Leg/pelvic surgery, obesity, pregnancy
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Phlebitis and Thrombus
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Diseases of the Veins
• Deep vein thrombosis (DVT)
– Treatment:
• Reduce clot
• Prevent embolization
• Use anticoagulants
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Diseases of the Veins
• Varicose veins
– Dilated, tortuous, and elongated veins in legs
– Causes:
• Prolonged sitting or standing
• Pregnancy
• Obesity
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Diseases of the Veins
• Varicose veins
– Symptoms:
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Leg fatigue and cramps
Thickening veins
Edema
Fluid
– Treatment:
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Elevate legs
Walk
Use support or elastic hose
Strip vein
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Trauma
• Hemorrhage
– Abnormal loss of blood
– May be acute or chronic
– Exsanguination
• Loss of circulating blood
– Internal bleeding can lead to anemia or shock due to
blood loss
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Trauma
• Hemorrhage
– Low-pressure vessels lead to petechiae or
ecchymosis of purpura
– High-pressure vessels lead to squirting of bright red
blood
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Trauma
• Shock
– Extremely low blood pressure that leads to decreased
tissue perfusion
– Types:
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Cardiogenic
Septic
Hypovolemic
Neurogenic
Anaphylactic
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Trauma
• Shock
– Symptoms:
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Facial pallor
Cool and clammy skin
Cyanosis
Tachycardia
Tachypnea
Altered mental status
Syncope
Unconsciousness
Oliguria or anuria
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Trauma
• Shock
– Treatment:
• Rest in supine position
• Move to warm, quiet environment
• Elevate feet and legs above heart
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Rare Diseases
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Malignant hypertension
Cor pulmonale
Raynaud’s disease
Buerger’s disease
Polyarteritis nodosa
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Effects of Aging
• Decreased contractility of heart muscle
• Decreased elasticity of vessels
• Thickening of valves
– Becoming sclerotic
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