CARDIOVASCULAR

SYSTEM
Dr. TAHMINA NAZ
BHS I
CARDIOVASCULAR SYSTEM

 By definition it has been divided into two parts:

 Cardio(heart):

 Pumps the blood throughout the body

 Vascular(blood vessels)

 It forms the network through which the blood

flows
 The heart pumps blood
into two anatomically
separate systems of
blood vessels:

• the pulmonary
circulation
• the systemic circulation.
BLOOD VESSELS
 Arteries & arterioles
 End arteries

 Capillaries

 Veins & venules

ARTERIES
 Transport blood away from the heart
 Wall consist of 3 layers of tissues:
1. Tunica adventitia(fibrous tissues)
2. Tunica media(smooth & elastic tissues)
3. Tunica intima(squamous epithelium)
 Large arteries(aorta) tunica media contains
more elastic tissue and less smooth muscle,
allows the vessel wall to stretch, absorbing the
pressure wave generated by the heart as it
beats.
 Systemic blood pressure is mainly determined
by the resistance(smooth tissue) arterioles
offer to blood flow, and for this reason they are
called Resistance vessels
ARTERIOLES:

 Smallest arteries
 They are formed of smooth muscles

 These are called resistance vessels.

 Anastomoses:
o Arteries that form a link between main arteries
Significance:
o If one artery is occluded anastomotic arteries provides a co lateral
circulation.

 End arteries:
o Arteries with no anastomoses
CAPILLARIES AND SINUSOIDS
Capillaries:
 The smallest arterioles breakup into number of minute
vessels called capillaries.
Sinusoids:
 In some organs liver ,bone marrow the capillaries are
wider then normal, they are termed as sinusoids.
 their walls are incomplete, thus blood flows through
them is slower and can directly come into contact with
the cells outside the walls allow faster exchange.
CAPILLARIES AND SINUSOIDS
VEINS AND VENULES

Veins:
 Blood vessels that return
blood to the heart
 walls are thinner

 composed of three layers

 They possess valves

which prevent backflow of
blood
Venules:
 Smallest veins
 Veins are called capacitance vessels
 because they are distensible, and therefore have
the capacity to hold a large proportion of the
body’s blood.
 At any one time, about two-thirds of the body’s
blood is in the venous system
 the vascular system to absorb (to an
extent)sudden changes in blood volume, such as
in hemorrhage; the veins can constrict, helping to
prevent a sudden fall in blood pressure.
BLOOD SUPPLY
 The outer layer of big arteries and veins receive their
supply from vasa vasorum.
 Inner layer of blood vessels receive oxygen and nutrients
by diffusion from the blood passing through them
 Blood vessel diameter is
regulated by the smooth
muscle of the tunica
media, which is supplied
by sympathetic nerves of
the autonomic nervous
system
 Constant adjustment of
blood vessel diameter
helps to regulate
peripheral resistance and
systemic blood pressure
EXCHANGE OF GASES

 Gas exchange is the delivery of oxygen from the

lungs to the bloodstream, and the elimination of
carbon dioxide from the bloodstream to the lungs
 Carbon dioxide diffuses into the blood by three
mechanism:
1. Dissolved in the water of blood plasma 7%
2. In chemical combination with sodium as sodium
bicarbonate 70%
3. Remainder with hemoglobin 23%
HEART
HEART
 Heart is a cone shaped hollow muscular organ.
 10cm long, 225gm in weight and about the
size of the fist.
 It lies in the thoracic cavity in the
mediastinum(space b/w lungs).
 It lies obliquely
ANATOMICAL RELATION
 Inferiorly: The apex rests on the diaphragm
 Superiorly: The great blood vessel i.e aorta, superior vena
cava, pulmonary artery and veins.
 Posteriorly: Eosophagus, trachea, aorta, inferior vena
cava, thoracic vertebrae
 Laterally: Lungs
 Anteriorly: The sternum, the ribs and intercostal muscles
STRUCTURE OF HEART

 The heart wall is

made up of three
layers of tissue
 Pericardium

 Myocardium

 Endocardium
 PERICARDIUM
 Outermost layer.
 The outer layer membrane
is called parietal
pericardium lines the
fibrous sac. The inner layer
the visceral pericardium is
adherent to the heart
muscle.
 Consists of flat epithelial
cells
 Secretes serous fluid
between visceral and
parietal layers and allowing
smooth muscle movement.
MYOCARDIUM
 Formed of specialized,
striated cardiac muscle
 Each cardiac muscle fibre
has a nucleus and
branches.
 The junction of two muscle
fibre is termed as
intercalated disc.
 When an impulse is initiated
it transmits rapidly causing
muscle contraction.
 The myocardium is thickest
at the apex and thins out
towards the base.
ENDOCARDIUM
 This lines the valves and
chambers of the heart.
 It is thin, smooth
membrane that permits
smooth flow of blood
inside the heart.
 It consists of flat
epithelial cells
LAYERS OF HEART
INTERIOR OF THE HEART
 Heart is broadly divided into right and left side by a
septum
 Each side is divided by atrioventricular valve into
upper atrium and lower ventricle.
 The atrioventricular valves are formed by double
folds of endocardium strengthened by a little
fibrous tissue.
 The right AV valve(tricuspid valve) has three flaps
or cusp
 The left AV valve(mitral valve) has two cusp
INTERIOR OF THE HEART
 The flow of blood is one way from atria to the ventricles.
 Valves open when the atrial pressure exceeds the
ventricular pressure.
 When the pressures exceeds in the ventricles the aortic and
pulmonary valves open
 Chordae tendinea prevent the backward opening of the AV
valve in case of increase in the ventricular pressure.
INTERIOR OF THE HEART
FLOW OF BLOOD VIA HEART
 Superior Vena Cava(SVA) and Inferior Vena
Cava(IVC) opens into the right atrium which
brings all the deoxygenated blood
 Through the right atrioventricular(AV) valve,
this blood goes into the right ventricle.
 From right ventricle blood is pumped into the
pulmonary trunk via Pulmonary artery
FLOW OF BLOOD VIA HEART

 Blood reaches to lungs for purification

 Pulmonary veins carry the oxygenated blood
back to the left atrium
 From here the blood flows into the left ventricle
and finally reaches the aorta through aortic
valves
BLOOD SUPPLY TO THE HEART

 Arterial supply:
 Right and left coronary arteries
 These arteries receive 5% of the blood pumped to
the heart
 Venous supply:
 Most of the venous blood is collected into a many
cardiac veins that join to form the coronary sinus
CONDUCTING SYSTEM OF THE HEART

 Heart has the property of auto rhythmicity i.e it

can generate its own impulses
 It is supplied by both sympathetic and
parasympathetic system.
 Small group of neuromuscular cells in the
myocardium initiate and conduct impulses
 It causes coordination and contraction of the
heart
CONDUCTING SYSTEM OF THE HEART

 SA Node
 Lies in the walls of right atrium near the opening of
SVC
 It is termed as Pace Maker

 AV Node
 Lies near the AV valve.
 It transmits the impulse from the atria to the
ventricles
 delay; the electrical signal takes 0.1 of a second to
pass through into the ventricles. This allows the
atria to finish contracting before the ventricles start
SA Node

AV Node
 CONDUCTING SYSTEM OF THE HEART

 Bundle of His:
 This neuromuscular
bundle originate from AV
node
 It divides into right and
left bundle branches
which breakup into fine
fibers called purkinje
fibers.
 .
NERVE SUPPLY TO THE HEART

 Heart is influenced by the autonomic nerves

 The vagus(parasympathetic) nerve supplies SA
and AV nodes and atrial muscles
 Vagal stimulation reduces heart rate
NERVE SUPPLY TO THE HEART

 The sympathetic nerve supplies SA and AV

nodes and myocardium of atria and ventricles
 It stimulates and increases heart rate
THE CARDIAC CYCLE

 Normal heart rate is 60 – 80beats per minute

Stages of Cardiac Cycle
 Atrial systole: Contraction of atria
 Ventricular systole: Contraction of ventricles

 Complete cardiac diastole: relaxation of atria

and ventricles
HEART SOUNDS

 There are four heart sounds

 First two are easily heard

 They sound like ‘lubdup’

 First sound is lub and it is due to the closure of

atrioventricular vavles
 Second sound is dup, due to the closure of
aortic and pulmonary valves

CARDIAC OUTPUT

 It is the amount of blood ejected from the

ventricle every minute
 The amount expelled by each contraction is the
stroke volume
 Expressed in liters per minute

 It is calculated by
 Cardiac output = Stroke vol x Heart rate
 Venous return is the major determinant of
cardiac output.
 The heart pumps out all blood returned to it.

 Factors affecting venous return:

 Position of body

 Muscular contraction

 Respiratory pump
 Heart rate (speed at which heart beats) is a major
determinant of cardiac output .
 If heart rate rises, cardiac output increases, and if it
falls cardiac output falls.
 Factors affecting heart rate:
 Autonomic nervous system
 Circulating chemicals
 Position
 Exercise
 Emotional state
 Gender
 Age
 Temperature
 BLOOD PRESSURE
 Blood pressure is the force or pressure that the
blood exerts on the walls of blood vessels.
 High BP, blood vessels can be damaged,
causing clots or bleeding from sites of blood
vessel rupture.
 BP too low, then blood flow through tissue
beds may be inadequate. Dangerous for
essential organs such as the heart, brain or
kidneys.
Systolic pressure: is the pressure produced
within the arterial system when the left
ventricle contracts and pushes blood into the
aorta.
 In adults it is about 120 mmHg or 16 kPa.
 Diastolic pressure: when the heart is resting
 following the ejection of blood, the pressure
within the arteries is much lower
 In an adult this is about 80 mmHg or 11 kPa

 Arterial blood pressure (BP) is measured with a

 Sphygmomanometer
 Blood pressure is determined by;

➢ cardiac output
➢ peripheral/arteriolar resistance
➢ Autoregulation (adjustment of blood flow and
regulation by organs)
REGULATION OF BLOOD PRESSURE

 BP controls in two ways:

 Short-term control by brain and hormones

 Lon term control by kidneys
 Short-term control: done by cardiovascular
center CVC in medulla and pons.
 The CVC receives, integrates and coordinates
inputs from:
 baroreceptors (pressure receptors) at wall of
aorta and carotid sinuse.(baroreceptor reflex)
 chemoreceptors at carotid and aortic bodies
sensitive to blood pH and temperature.
 higher centres in the brain
 Long- term control:
 renin–angiotensin–aldosterone system(RAAS)

 antidiuretic hormone (ADH)

 atrial natriuretic peptide(ANP)

 RAAS and ADH regulate blood volume

 ANP hormone release by heart cause loss of

sodium and water.
 CIRCULATION OF BLOOD
 Circulation of blood is
continuous in the body

 Systemic circulation
 Pulmonary circulation
 MAJOR BLOOD VESSELS

 Aorta is largest artery

 Superior and inferior vena cava are largest
veins
AORTA AND ITS BRANCHES

 The aorta will be

described according to
itslocation:

 thoracic aorta

 abdominal aorta
AORTA

 Thoracic aorta:(part of aorta above diaphgram)

1. Ascending aorta gives off right & left coronary
arteries supply mayocardium.
2. Arch of aorta gives off three main branches
a. Brachiocephalic trunk: It divides into right common
carotid & right sub clavian arteries,
b. Left common carotid
c. Left sub clavian
 Abdominal(descending) aorta is continuation of
descending aorta.

Right common iliac artery

 left common iliac artery
VENAE CAVAE:

 Superoir vena cava: formed by the union of the

left and right brachiocephalic veins
 Inferior vena cava: formed by by the union of
the right and left common iliac vein
CIRCULATION OF HEAD & NECK

 Head n neck are supplied by the paired carotid

arteries and the vertebral arteries.
 CAROTID ARTERIES
Internal carotid
1. Right common carotid artery

2. Left common carotid

External carotid
artery
EXTERNAL CAROTID ARTERY
 It supplies the
superficial tissues of
head and neck it gives
of various branches
 superior thyroid artery
 lingual artery
 facial artery
 occipital artery
 temporal artery
 maxillary artery
INTERNAL CAROTID ARTERY

 It gives major contribution to the Circle of Willis

which supplies greater part of the brain.
 It also supply eyes, nose forehead

 It ascends to the base of the skull bone and

forms Circle of Willis.
CIRCLE OF WILLIS: (CIRCULUS ARTERIOSUS)
 It is a part of the cerebral circulation and is
composed of the following arteries:
 Anterior cerebral artery (left and right)
 Anterior communicating artery

 Internal carotid artery (left and right)

 Posterior cerebral artery (left and right)

 Posterior communicating artery (left and right)

 Basilar artery
VENOUS RETURN FROM HEAD & NECK

 External Jugular vein:

 Begin at the level of angle of jaw and enters into
Sub clavian vein
 Internal Jugular Vein
 Both internal jugular veins unite to form Sub clavian
vein
VENOUS RETURN FROM HEAD & NECK
MAIN VENOUS SINUSES

 Superior sagittal
sinus
 Inferior sagittal sinus

 Straight sinus

 Transverse sinus

 Sigmoid sinus
CIRCULATION OF UPPER LIMB
 Supplied by:
 Right subclavian artery
 Left subclavian artery
 Subclavian artery
continued as:
 Axilary artery
 Brachial artery
 Radial artery
 Ulnar artery
 Palmar arches
 Venous return:
 Deep veins follow the course of the arteries and
have the same names.
 superficial veins begin in the hand and consist of
the following:
 cephalic vein
 basilic vein
 median vein
 median cubital vein.
CIRCULATION OF THORAX

 Thoracic aorta begins at 4th thoracic vertebrae

up to 12th thoracic vertebrae where it passes
behind the diaphragm & continue as
abdominal aorta.
 Branches
 Bronchial arteries
 Esophageal arteries
 Intercostal arteries
VENOUS RETURN FROM THORACIC
CAVITY
 Azygous vein
 Hemiazygous vein
 Azygus directly join the
SVC & hemiazygus joins
left brachiocephalic vein
CIRCULATION IN ABDOMEN
 Abdomina aorta begins
from 12th thoracic up to
4th lumbar vertebrae

 It divides into right &

left common iliac
arteries
 Paired arteries:  Unpaired arteries:
• phrenic arteries • Coeliac atery

• renal arteries I. Gastric artry

• suprarenal arteries II. hepatic artery
• gonadal arteries III. Splenic artery

• superior mesenteric
• Inferior mesenteric
INFERIOR VENA CAVA

 IVC is formed by right & left common iliac vein

 At the level of 5th lumbar vertebrae

 its largest vein

 Carries blood from all parts of the body below

diaphragm
PORTAL CIRCULATION
➢ In the portal circulation, venous blood from the
capillary beds of the abdominal part of the
digestive system, travels first to the liver.
➢ In the liver, it passes through a second capillary
bed, the hepatic sinusoids, before entering the
the inferior vena cava
➢ blood with a high concentration of nutrients,
absorbed from the stomach and intestines, goes
to the liver first.
➢ unwanted or potentially toxic materials such as
drugs are eliminated
CIRCULATION IN PELVIS AND LOWER LIMB

 Left and right Common iliac artery divided into:

 Internal iliac artery supply pelvis

 External iliac artery lower limb

 Venous return same name veins

FETAL CIRCULATION
FETAL CIRCULATION
 The fetus obtain its oxygen & nutrients & excretes its
waste material through maternal circulation.
 Lungs, GIT & kidneys do not begin to function till birth
 Placenta allows exchange of substances btw fetal &
maternal circulation
FETAL CIRCULATION
 Placenta is firmly attached to the uterine wall and
consists of an extensive network of fetal capillaries
bathed in maternal blood
 It attached to the fetus by umbilical cord which
consists of 2umblical arteries & 1umblical vein.
 Functions:
 Exchange of substances
 Protection of fetus
 Maintenance of pregnancy
FETAL CIRCULATION
 SHOCK
 Shock (circulatory failure) occurs when the
metabolic needs of cells are not being met
because of inadequate blood flow.
 Hypovolaemic shock

 Cardiogenic shock

 Septic shock

 Neurogenic shock

 Anaphylactic shock
 Hypovolaemic shock:
 Cardiac output may fall because of low blood
volume and hence low venous return
 severe haemorrhage – whole blood is lost

 extensive burns – serum is lost

 severe vomiting and diarrhoea – water and

electrolytes are lost
 Cardiogenic shock
 damaged heart muscle cannot maintain an
adequate cardiac output, e.g.in myocardial
infarction
 Neurogenic shock

 spinal anaesthesia and spinal cord damage,

interfere with normal nervous control of blood
vessel diameter, leading to hypotension.
 Septic shock
 Bacterial toxins release in sever infections
cause inflammatory and immune responses.
 Mediators release causes sever vasodilation.

 Anaphylactic shock

 Allergic reactions cause systemic release of

inflammatory mediators e.g. histamine and
bradykinin causes venous pooling and
hypotension due to vasodilation.
THROMBUS

 Thrombosis:
 Formation of a blood clot inside a blood vessel
 Factors increasing the risk of Thrombus:
 Slow blood flow.. Bedrest,tumor or tight cloting
compressing vessel,sock.
 Damage to blood vessel (atherosclerosis)
 Increased blood coagulability
EMBOLISM
 Blocking of a vessel by any mass travelling in the
blood.
 This can be a thrombus or part of a thrombus
 Emboli in artery travel away from heart until they
reach a narrow artery & lodge there thus blocking
the blood supply
 Emboli originating in vein travel towards the heart
& then to the lungs, thus causing pulmonary
embolism
 It is a common cause of stroke , myocardial
infarction and gangrenous limbs
 VASCULAR
PATHOLOGIES
ATHEROMA
 Plaques are patchy changes that develop in the large or
medium size arteries
 It consists of cholesterol, lipids and monocytes
 Initial changes show a fatty streak in the artery wall.
 Mature plaques consist of accumulations of cholesterol
and other lipids, excess smooth muscle and fat-filled
monocytes (foam cells).
 The plaque is covered with a rough fibrous cap
 Arteries most commonly involved are those in the heart
,brain, kidney, small intestine & lower limb.
CAUSES OF ATHEROMA:
 Origin is unclear.
 Fatty streaks in artery wall may be the origin.
Effects:
 May cause partial or complete obstruction of
the artery
Complications:
 Hemorrhage
 Aneurysm
 Effects of atheroma:
 Narrowing of an artery cause ischaemic pain in
the heart is called angina pectoris and in the
lower limbs intermittent claudication.
 Occlusion of an artery like coronary artery is
occluded cause myocardial infarction. Brain
causes cerebral ischaemia and this leads to
cerebral infarction(stroke)
 Complications:

 Thrombosis
 Infarction

 Hemorrhage

 Aneurysem (local vessel dilation)

ARTERIOSCLEROSIS:

 progressive degeneration of arterial walls,

associated with ageing and accompanied by
hypertension. It results from calcium deposits
that accumulate in the tunica media of arterial
walls and is usually associated with
atherosclerosis.
.
ATHEROSCLEROSIS:
Atherosclerosis is the formation of fatty
deposits (cholesterol and triglycerides) along
the tunica intima of arterial walls.
 The atherosclerotic plaques reduce the lumen
of the arteries and increase the probability of
blood clots being formed.
 Such deposits in the coronary, carotid, or
cerebral arteries may lead to serious circulatory
problems.
ANEURYSMS:

 Aneurysms are abnormal local dilations of

arteries, which vary considerably in size.
 An aneurysm damages theblood vessel
endothelium, making it rougher than usual,
which increases the risk of clot formation.
 Saccular aneurysms bulge out on one side of the
artery. Brain(circle of willis)
 Fusiform or spindle-shaped distensions occur
mainly in the abdominal aorta. They are usually
associated with atheroma.
 Dissecting aneurysms occur mainly in the arch of
the aorta. They are caused by infiltration of blood
between the endothelium and tunica media,
beginning at a site of endothelial damage.
VENOUS THROMBOSIS

 They are of two types:

1. Superficial Thrombophlebitis:
 Usually formed in superficial veins
2. Deep vein Thrombosis:
 Usually
affects the lower limb, pelvic or iliac veins &
sometimes the upper limb vein.
VARICOSED VEINS
 Blood pooling in a vein stretches & damage
its soft wall & the vein becomes in elastic,
dilated & coiled
 Risk factors may include
 Obesity

 Pregnancy

 Increasing age
 Prolong standing

 Females & family history.

SITES AND EFFECTS:

 Varicose veins of the legs

 Haemorrhoids

 Oesophageal varices

 Scrotal varicocele
TUMORS

 Angiomas:
 Benign tumor of the blood vessel or lymph vessel
 Haemangiomas:
 They consist of an excessive growth of blood vessel
 Capillary Haemangiomas:
 Capillary growth, they are usually present at
birth,after 5 years 80% may disappear
EDEMA(OEDEMA)

 excess fluid accumulates in tissues

(extravascular), causing swelling.
 It may occur either in superficial tissues or
deeper organs
SITES
 superficial tissues causes pitting. edema
 An indentation remains after firm finger pressure
has been applied
 Paralyzed person have edema at sacral area
,called dependent edema
 pulmonary edema venous congestion in the lungs
or increased pulmonary vessel permeability results
in accumulation of fluid in the tissue spaces and in
the alveoli.
 Pleural effusion.
 excess serous fluid in the pleural cavity. This is
usually due to infection or inflammation of the
pleura, or to left ventricular failure.
 Ascites.
 is accumulation of excess fluid in the peritoneal
cavity.
 causes include liver failure (when plasma protein
synthesis is reduced),obstruction of abdominal
lymph nodes draining the peritoneal cavity, or
inflammatory conditions.
HEART FAILURE
HEART FAILURE

 When heart is unable to maintain circulation

which meets the need of the body organ.
 Symptoms depend upon which side of the heart
function is compromised.
 Left heart failure is more common because it is
mainly responsible to circulate blood
COMPANSATORY MECHANISM

 Acute failure can not be compensated

 Chronic failure can be compensated by:

1. Enlarged cardiac muscle fiber

2. Enlarged Cardiac chamber

3. Decreased renal flow activates the renin

angiotensin aldosterone system leads to salt &
water retention
ACUTE HEART FAILURE

 If heart failure occurs abruptly, blood to body

tissues reduced, no time for significant
compensation.
 Death may follow if the brain’s vital centres are
starved of oxygen.
 if the acute phase is survived , myocardial
damage may lead to chronic heart failure
ACUTE HEART FAILURE

Commonest Causes:
1. Myocardial Infarction (MI)

2. Pulmonary embolism

3. Cardiac arrhythmia

4. Malignant hypertension

5. Rupture of heart chamber

CHRONIC HEART FAILURE

 develops gradually and in the early

stages there maybe no symptoms because
compensatory changes occur
CHRONIC HEART FAILURE

Causes:
1. Anemia

2. Lung disease

3. Hypertension

4. Cardiac disease
RIGHT SIDE HEART FAILURE

 Also called Congestive heart failure

 When compensation has reached its limit,
and the ventricle can no longer empty
completely.
 the right atrium and venae cavae become
congested with blood, followed by
congestion throughout the venous system.
 The organs affected first are liver, spleen &
kidneys.
CAUSES:
 Resistance to blood flow through the lungs.
 When this is increased the right ventricle has more
work to do. The two commonest causes are
pulmonary embolism and left ventricular failure,
when the pulmonary circulation is congested
because the left ventricle is not clearing all the
blood flowing into it
 Weakness of the myocardium.
 This is caused by myocardial damage following
ischaemia or infarction
LEFT SIDE HEART FAILURE
 Contraction of myocardium is not enough to force
blood into aorta
 leads to dilation of the atrium and an increase in
pulmonary blood pressure
 followed by a rise in the blood pressure in the
right side of the heart and eventually systemic
venous congestion
 Congestion in the lungs leads to pulmonary edema
and dyspnoea(shortness of breath), often most
severe at night. (paroxysmal nocturnal dyspnoea)
Causes:
1. Ischemic heart disease ( reduces the
efficiency of the myocardium)
2. Hypertension ( heart’s work-load is increased
because of raised systemic resistance)
3. Mitral & aortic valve disease(reduce efficient
emptying of the heart chambers, myocardial
workload is increased)
DISORDERS OF HEART VALVE

mitraland aortic valves are subject to greater

pressures than those on the right side and are
more susceptible to damage
A severe valve disorder causes heart failure.

Damaged valves generate abnormal heart

sound called murmurs
Causes:
 Rheumatic fever

 Congenital abnormalities

 Fibrosis of lungs
  Stenosis: the narrowing of a valve opening,
impeding blood flow through the valve.

 Incompetence: also called regurgitation, a

functional defect caused by failure of a valve to
close completely, allowing blood to flow
backwards
ISCHEMIC HEART DISEASES:
 The reduction of blood flow to the heart
muscle due to build up of plaque in the arteries
of the heart
 It is the most common of the cardiovascular
diseases
 A common symptom is chest pain or
discomfort which may travel into the shoulder,
arm, back, neck, or jaw.
 Occasionally it may feel like heartburn
ANGINA PECTORIS
 Angina, also known as angina pectoris, is chest
pain or pressure, usually due to not enough blood
flow to the heart muscle.
 Angina results when there is an imbalance
between the heart's oxygen demand and supply.
 This imbalance can result from an increase in
demand (e.g., during exercise) without a
proportional increase in supply (e.g., due to
obstruction or atherosclerosis of the coronary
arteries).
MYOCARDIAL INFARCTION:

 Myocardial infarction (MI), commonly known as

a heart attack, occurs when blood
flow decreases or stops to a part of the heart
 complete blockage of a coronary artery caused
by a rupture of an atherosclerotic plaque is
usually the underlying mechanism of an
MI.causing damage to the heart muscle
RHEUMATIC HEART DISEASE

 It is an autoimmune disorder; the antibodies

produced to combat the original infection
damage connective tissues in
the heart, joints, skin, and brain.
 It is of two type

 Acute

 Chronic
Acute:all layers of the heart wall are inflamed
( pancarditis)
 Fibrotic nodules develop on mitral valve cusps,
which shrink as they age, distorting the cusp
and causing stenosis and incompetence of the
valve.
 Chronic rheumatic heart disease.
 Inflamed tissue becomes fibrous as it heals,
and this fibrous tissue interferes with the
action of the myocardium and the heart valves.

 Chronic fibrotic changesin the pericardium and

myocardium cause heart failure.
INFECTIVE ENDOCARDITIS

 Pathogenic organisms (usually bacteria or

fungi) in the blood may colonies any part of the
endocardium, but the most common sites are
on or near the heart valves and round the
margins of congenital heart defects.
 The main predisposing factors are
bacteraemia, depressed immune response and
heart abnormalities
CARDIAC ARRHYTHMIAS

 A cardiac arrhythmia is any disorder of heart

rate or rhythm, and is the result of abnormal
generation or conduction of impulses.
 A heart rate that is too fast – above 100 beats
per minute in adults – is called tachycardia and
a heart rate that is too slow – below 60 beats
per minute – is called bradycardia.
 Ventricular fibrillation and asystole cause
sudden and complete loss of cardiac output,
i.e. cardiac arrest and death
 atrial fibrillation(AF), contraction of the atria is
uncoordinated and rapid, pumping is
ineffective and stimulation of the AV node is
disorderly.
CONGENITAL ABNORMALITIES

 Abnormalities in the heart and great vessels at

birth maybe due to intrauterine developmental
errors or to the failure of the heart and blood
vessels to adapt to extra uterine life
 Patent ductus arteriosus:
 the ductus arteriosis bypasses the non-functional lungs
in fetous.
 At birth, when the pulmonary circulation is established,
the ductus arteriosus should close completely
 If it remains patent, blood regurgitates from the aorta to
the pulmonary artery where the pressure is lower,
reducing the volume entering the systemic circulation
and increasing the volume of blood in the pulmonary
circulation. This leads to pulmonary congestion and
eventually cardiac failure
 Atrial septal defect
 This is commonly known as ‘hole in the heart’.
Afterbirth, when the pulmonary circulation is
established and the pressure in the left atrium
exceeds that in the right atrium, the atrioseptal
valve closes. Later the closure becomes
permanent due to fibrosis .
 When the membranes do not overlap, an opening
between the atria remains patent after birth.
 Coarctation of the aorta :common site of
coarctation (narrowing) of the aorta is between
the left subclavian artery and ductus
arteriosus. This leads to hypertension in the
upper body
 Fallot’s tetralogy
 combination of four congenital cardiac abnormalities, which
causes cyanosis, growth retardation and exercise intolerance
in babies and young children. The four abnormalities are:
 stenosis of the pulmonary artery at its point of origin,which
increases right ventricular workload
 ventricular septal defect, i.e. an abnormalcommunicating
hole between the two ventricles, justbelow the
atrioventricular valves
 aortic misplacement, i.e. the origin of the aorta is displaced
to the right so that it is immediately above the septal defect
 right ventricular hypertrophy to counteract the pulmonary
stenosis.
HYPERTENSION

also known as high blood pressure (HBP), is

a long-term medical condition in which
the blood pressure in the arteries is
persistently elevated.
 Long-term high blood pressure, is a major risk
factor for coronary artery disease, stroke, heart
failure, atrial fibrillation, peripheral vascular
disease, vision loss, chronic kidney disease
 High blood pressure is classified as either primary
(essential) high blood pressure or secondary high
blood pressure

 Essential hypertension unknown cause

 the condition is symptomless and is only
discovered during a routine examination
 Risk factors for hypertension include obesity,
diabetes mellitus, family history, cigarette
smoking, a sedentary lifestyle and high intakes of
salt or alcohol.
 Malignant (accelerated) hypertension;
 rapid and aggressive acceleration of hypertensive
disease.
 Diastolic pressure in excess of 120 mmHg is
common.
 The effects are serious and quickly become
apparent, e.g. haemorrhages into the retina,
papilloedema (oedema around the optic disc),
encephalopathy (cerebraloedema) and progressive
renal disease, leading to cardiac failure
 Pulmonary hypertension
 Normally, the pulmonary circulation is a low-
pressure system, to prevent fluid being forced
out of the pulmonary capillaries into the alveoli.
 When blood pressure rises, alveoli begin to fill
with fluid, which blocks gas exchange.
 Rising pulmonary blood pressure may
resultfrom left-sided heart failur