Module 7 - CARDIOVASCULAR PATHOLOGY Dr.

Abraham Kassahun
ATHEROSCLEROSIS ▪ Cholesterol accumulation in the ▪ Cholesterol-lowering drugs ➢ No identifiable cause (~90–
vessel wall (e.g., statins) 95%)
• Atherosclerosis is a chronic ▪ Formation of plaques made of ▪ Blood pressure medications ➢ Related to genetics +
condition in which fatty deposits fat, calcium and inflammatory ▪ Blood thinners lifestyle
(called plaques) build up inside the cells ▪ Procedures (if severe): ▪ Secondary Hypertension: Due
walls of arteries. ▪ Narrowing (stenosis) of the ➢ Angioplasty and stenting to an underlying cause, such as:
• Over time, this narrows and stiffens artery ➢ Bypass surgery ➢ Kidney disease
the arteries, reducing blood flow to ▪ Possible plaque rupture, leading ➢ Endocrine disorders
vital organs like the heart and brain. to blood clots HYPERTENSION ➢ Drugs (e.g., NSAIDs, OCPs)
▪ Chronic inflammatory • Risk Factors • Risk Factors
• Hypertension is a chronic condition
disease of arteries → lipid ▪ Non-modifiable: age, male sex ▪ Age
where the force of blood against
plaque formation → ↓ and genetics ▪ Family history
artery walls is persistently elevated,
blood flow ▪ Modifiable: ▪ High salt intake
leading to long-term damage to
➢ Hypertension organs like the heart, brain, kidneys, ▪ Obesity
➢ Diabetes mellitus and eyes. ▪ Sedentary lifestyle
➢ Smoking • American Heart Association ▪ Smoking & alcohol
➢ High LDL / low HDL ▪ Normal: <120/80 mmHg ▪ Diabetes
➢ Obesity, sedentary ▪ Elevated: 120–129 / <80 • Symptoms
lifestyle ▪ Stage 1: 130–139 / 80–89 ▪ Usually called the “silent killer”
• Atherosclerosis can lead to serious ▪ Stage 2: ≥140 / ≥90 because most patients have no
conditions such as: • WHO and Ethiopian STG symptoms.
▪ Coronary artery disease ▪ Normal: 90-120/60-80 mmHg ▪ When severe:
▪ Heart attack ▪ Elevated: 120–139/ 80-89 ▪ Headache
▪ Stroke ▪ Stage 1: 140–159 / 90–99 ▪ Dizziness
▪ Peripheral artery disease ▪ Stage 2: 160–169 / 100–109 ▪ Blurred vision
• Prevention and treatment ▪ Hypertensive Crisis: ≥180 / ▪ Nosebleeds
▪ Lifestyle changes (first-line): ≥120 ▪ Shortness of breath
▪ Healthy diet (more fruits, ➢ Urgency: no end organ • Complications
vegetables, whole grains) injury ▪ Long-standing hypertension
▪ Regular exercise ➢ Emergency: end organ damages blood vessels → leads
• Pathophysiology
▪ Stop smoking injury to:
▪ Damage to artery lining (from
▪ Weight control • Types ➢ Heart failure
smoking, high blood pressure,
• Medical treatment: ▪ Primary (Essential) ➢ Stroke
etc.)
Hypertension ➢ Chronic kidney disease
Module 7 - CARDIOVASCULAR PATHOLOGY Dr. Abraham Kassahun
➢ Hypertensive retinopathy HEART FAILURE • Signs
➢ Atherosclerosis ▪ Crackles in lungs
• Diagnosis • Heart failure is a clinical syndrome ▪ Raised JVP
▪ Repeated BP measurements (≥2 where the heart cannot pump ▪ Pitting edema
readings on different days) enough blood to meet the body’s ▪ S3 heart sound
needs or can only do so at high
• Management • Complications
filling pressures.
1. Lifestyle (for ALL patients) ▪ Pulmonary edema
▪ Reduce salt intake • Types of Heart Failure ▪ Cardiogenic shock
(<2g/day) 1. Based on function ▪ Arrhythmia
▪ Exercise regularly (≥150 ▪ Systolic HF (HFrEF) → ▪ Kidney failure
reduced ejection fraction
min/week) • Diagnosis
▪ Weight loss (<40%)
▪ Echocardiography
▪ Stop smoking ▪ Diastolic HF (HFpEF) →
▪ BNP/NT-proBNP
▪ Limit alcohol normal EF but poor filling
▪ Chest X-ray
(stiff ventricle)
2. Medications ▪ ECG
▪ ACE inhibitors (e.g., 2. Based on side
• Management
enalapril) ▪ Left-sided HF → lung
1. Lifestyle
▪ ARBs (e.g., losartan) symptoms
▪ Salt restriction
▪ Calcium channel blockers ▪ Right-sided HF → systemic
▪ Fluid restriction (in severe
(e.g., amlodipine) congestion
• Symptoms cases)
▪ Thiazide diuretics • Causes
▪ Left-sided HF ▪ Weight monitoring
▪ Coronary artery disease
➢ Shortness of breath ▪ Treat underlying cause
RAAS system (Renin angiotensin ▪ Hypertension
(dyspnea) 2. Medications (core therapy)
aldosterone system) ▪ Valvular heart disease
➢ Orthopnea (worse when ▪ ACE inhibitors / ARBs
▪ Cardiomyopathy
• Low BP → Angiotensinogen (by lying flat) ▪ Beta-blockers
▪ Arrhythmias
Renin ↑) → Angiotensin I (ACE – ➢ Paroxysmal nocturnal ▪ Diuretics (e.g., furosemide)
• Pathophysiology ▪ Aldosterone antagonists
Angiotensin converting enzyme) → dyspnea
▪ When cardiac output drops: (spironolactone)
Angiotensin II → causes ↑ BP ➢ Fatigue
Activation of Renin–angiotensin
▪ Vasoconstriction ▪ Right-sided HF 3. Advanced treatment
system → fluid retention ▪ Devices (ICD, CRT)
▪ ↑ Aldosterone (Na+ and ➢ Leg swelling (edema)
▪ Sympathetic activation → ↑ ▪ Surgery (valve repair,
water retention) ➢ Abdominal swelling
heart rate
▪ ADH ↑ (Water Retention) (ascites) transplant)
▪ Fluid builds up → congestion in
➢ Enlarged liver
lungs/body
Module 7 - CARDIOVASCULAR PATHOLOGY Dr. Abraham Kassahun
CORONARY ARTERY DISEASE (CAD) • Clinical Presentation ▪ Healthy diet
1. Stable Angina ▪ Exercise
• Coronary artery disease is a ▪ Chest pain on exertion ▪ Weight control
condition where the coronary ▪ Relieved by rest or nitrates 2. Medications (core)
arteries (supplying the heart ▪ Predictable pattern ▪ Antiplatelets (aspirin)
muscle) become narrowed or 2. Unstable Angina ▪ Statins (lower cholesterol)
blocked, usually due to ▪ Chest pain at rest ▪ Beta-blockers
Atherosclerosis. ▪ Increasing ▪ Nitrates (relieve chest pain)
• This reduces oxygen supply to the severity/frequency ▪ ACE inhibitors (especially if
heart → ischemia. ▪ Medical emergency HF/DM)
• Pathophysiology 3. Myocardial infarction 3. Revascularization
▪ Cholesterol plaques build up in ▪ Severe, prolonged chest ▪ PCI (angioplasty + stent)
coronary arteries pain (>20 min) ▪ CABG (bypass surgery)
▪ Gradual narrowing → ↓ blood ▪ Not relieved by rest • Complications
flow ▪ May radiate to left arm, jaw ▪ Heart failure
▪ Increased demand ▪ Associated with sweating, ▪ Arrhythmia
(exercise/stress) → chest pain nausea ▪ Sudden cardiac death
▪ Plaque rupture → clot → • Risk Factors
complete blockage ▪ Smoking
▪ Hypertension
▪ Diabetes mellitus
▪ High LDL cholesterol READING ASSIGNMENT
▪ Obesity and sedentary lifestyle • Infective endocarditis
▪ Family history • Valvular Heart disease
• Diagnosis • Cardiomyopathies
▪ ECG (ST changes, T inversion) • Rheumatic Heart Disease
▪ Cardiac enzymes (troponin ↑ in
MI)
▪ Echocardiography
▪ Coronary angiography (gold
standard)
• Management
1. Lifestyle
▪ Stop smoking