Toni Mustahsani Aprami dr SpPD SpJP Department of Cardiology and Vascular Medicine Cardiovascular Subdivision Department of Internal Medicine Hasan Sadikin HospitalMedical School ID: 737978
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Slide1
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
UniversitySlide2
Understanding the Cardiovascular System
The Heart:
A Mighty Machine
Four chambersTwo upper chambers are called atriaTwo lower chambers are called ventriclesValves regulate the flow of blood.Slide3Slide4Slide5
Conduction System of the Heart
5Slide6
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. . . . .That’s ~70 X/minute, range 60-80 beats/ minute.Systole - Contraction of heart muscle.
Diastole
- Relaxation of heart muscle.Slide7Slide8Slide9Slide10
Blood Flow within the HeartSlide11
Blood Vessels
11Slide12
Capillary Bed Anatomy
12Slide13
Capillary ExchangeSlide14
Functions of the Cardiovascular System
Contractions of the heart generates blood pressure, which moves blood through blood vessels.
Blood vessels transport blood, which moves from the heart into
arteries, capillaries, and veins, before returning to the heart.Exchanges at the capillaries (smallest vessels) refreshes blood and then tissue fluid (interstitial fluid).
The heart and blood vessels regulate blood flow, according to the needs of the body.Slide15
CARDIOVASCULAR DISEASE
Congenital Heart Disease (ASD, VSD, PDA, TOF)
Rheumatic Heart Disease (MS/MR, AS/AR)
Hypertensive Heart DiseaseCoronary Artery DiseaseCardiomyopathiesPericarditisPeripheral Artery DiseaseAneurysm and Disectie
Aortae
Deep Vein Thrombosis
Cardiac TumorSlide16
Coronary Artery Disease
90% Atherosclerosis ProcessSlide17
Atherosclerosis
can, and does, occur in almost any artery in the body. But in the heart it’s 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)Slide18
Atherosclerosis
is a disease of large (elastic) and
medium sized (muscular) arteries characterized
pathologically by smooth muscle proliferation, lipidaccumulation, cell necrosis, fibrosis, and calcification. Most commonly involved
:
Aorta
Coronary
Carotid
Iliac
MesentricSlide19Slide20
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 , CACSSlide21
AtherogenesisSlide22
Normal Artery
Endothelium
Internal elastic lamina
External elastic lamina
Media
Intima
AdventitiaSlide23
Response to InjurySlide24
Endothelial DysfunctionSlide25
Initiation of Fatty StreakSlide26
Fatty StreakSlide27
Fibro-fatty
AtheromaSlide28
FIBROUS CAP
NECROTIC CENTER
MEDIA
(smooth muscle cells,
macrophages, foam cells,
lymphocytes, collagen,
elastin
,
proteoglycans
, revascularization)
(cells debris, cholesterol crystals,
foam cells, calcium)Slide29
Endothelial Dysfunction
Foam
Cells
Fatty
Streak
Intermediate
Lesion
Atheroma
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 yrs 45-55 yrs 55-65 yrs >65 yrs
The Evolution of AtherosclerosisSlide30
Common Consequences of Atherosclerosis in VesselsSlide31
Altered Vessel Function
Vessel change
Plaque narrows lumen
Wall weakenedThrombosisBreaking loose of plaqueLoss of elasticity
Consequence
Ischemia, turbulence
Aneurysms, vessel rupture
Narrowing, ischemia,
embolization
Athero-embolization
Increase systolic blood pressureSlide32
Burden and causes of cardiovascular diseases:
with an emphasis on AsiaSlide33
Chronic diseases and injuries
Infectious, maternal, perinatal and nutritional conditions
Changing
p
atterns
of
d
eath
Worldwide: 1990-2020
Global Burden of Disease Project, 1996
Millions of deathsSlide34
Leading causes of death
Worldwide: 1990-2020
Rank
Cause % Rank Cause %
1
Coronary Artery disease
12.4
1
Coronary
Rtery
disease
16.3
2
Cerebrovascular
disease
8.7
2
Cerebrovascular
disease
11.2
3 Lower respiratory infections
8.5
3
COPD
6.9
4 Diarrhoeal diseases
5.8
4
Lower respiratory infections
3.7
5
Perinatal
conditions
4.4
5
Respiratory tract cancers
3.5
6 COPD
3.9 6
Road traffic accidents
3.4
7 Tuberculosis
2.1
7
Tuberculosis
3.4
8 Measles
2.1
8
Stomach cancer
2.3
9 Road traffic accidents
1.9
9
HIV
1.8
10 Respiratory tract cancers
1.9
10
Self inflicted injuries
1.8
1990
2020
Global Burden of Disease Study, 1996Slide35
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
c
ardiovascular
d
isease
Worldwide
: 1990-2020
Global Burden of Disease Study, 1996Slide36
World population change
0
2
4
6
8
10
1700
1800
1900
2000
2100
World population (billions)
United Nations 1999Slide37
Regional population change
Population (billions)
2000 2050
ChangeDeveloping world 4.9 7.9 3.0Developed world 1.0 1.0 0.0Total 5.9 8.9 3.0
United Nations 1999Slide38
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 DifferenceSlide39
Tobacco-related death and disability
1990 2020
Deaths (millions) 3.0 8.4
India 0.1 1.5 China 0.8 2.2DALYS (%) 2.6 9.0
Global Burden of Disease Project, Lancet 1997Slide40
Trends in overweight/obesity
(BMI 25+ kg/m
2)Slide41
0
50
100
150
200
250
300
350
Developed
Developing
World
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 diabetesSlide42
Prevalence of smoking
in the Asia
Pacific
APCSC, 2006
IndonesiaSlide43
Prevalence of hypertension
140/90mmHg +
Indonesia
27
11Slide44
Prevalence of obesity and overweightSlide45
Prevalence of, and predictions for, diabetesSlide46
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 regionSlide47
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)Slide48
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