Coronary heart disease: disease of the blood vessels supplying the heart muscle
Cerebrovascular disease: disease of the blood vessels supplying the brain
Peripheral arterial disease: disease of blood vessels supplying the arms and legs
Rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
Congenital heart disease: malformations of heart structure existing at birth
Deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs
Cardiovascular diseases account for ~36% of yearly deaths in Ireland
Atherosclerosis
Damage occurs to the inner lining of an artery and deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances can build up
Cholesterol build up is caused by too much ('bad') LDL-Cholesterol in the plasma
Once in the subendothelium it becomes oxidised by free radicals released by the endothelium
Plaque
The build-up of fatty substances, cholesterol, cellular waste products, calcium and other substances in the artery
Thrombosis
Inappropriate activation of the normal haemostatic process within the non-interrupted vascular system, resulting in thrombus (blood clot) formation that blocks blood flow to vital areas
Blood vessel structure
The cavity of a vessel is called the central lumen
The epithelial layer that lines blood vessels is called the endothelium
The endothelium is smooth and minimises resistance
Endothelial dysfunction
A change in the surface structure of endothelial cells, with presentation of surface adhesion receptors (sticky) which allow rolling and transmigration of white blood cells (monocytes) and adhesion and activation of platelets
Causes of endothelial dysfunction and atherosclerosis
Hypertension
Diabetes
Elevated cholesterol (Raised LDL, low HDL)
Age
Smoking
Obesity
Family history
Response to endothelial injury
1. Monocyte transmigration through the endothelium
2. Monocytes differentiate into macrophages
3. Macrophages ingest lipoproteins and become foam cells
4. Foam cell/Fatty streak formation
Stages in atherosclerotic plaque development
Lipoprotein trapping in the subendothelial space
Lipoprotein aggregation (LDL cholesterol)
Monocyte transmigration from the bloodstream to the injured site
Foam cell formation/fatty streaks – monocytes become macrophages and engulf the lipoprotein
Slow plaque build-up over years
Plaque rupture
Smoking increases the risk of heart attack by making platelets more active, decreasing HDL cholesterol, and causing endothelial dysfunction
Hyperglycaemia in diabetes
Leads to endothelial damage and plaque build-up
People with diabetes are two to four times more likely to have a heart attack than someone without the disease
Cardiovascular diseases account for 65% of diabetic-related illnesses that lead to death
Angina pectoris
Chest pains caused by partial blockage of the coronary arteries
Myocardial infarction (heart attack)
Death of the muscle tissue in the heart resulting from blockage of the blood flow in one or more coronary arteries
Types of stroke
Ischaemic stroke: caused by a blood clot, air bubble or fat globule blocking an artery that carries blood to the brain
Haemorrhagic stroke: caused by a blood vessel bursting and bleeding into the brain
Treatments for blocked coronary arteries
1. Stents: restore blood flow
2. Coronary artery bypass surgery: use a healthy blood vessel to bypass the blocked or diseased area
The nicotine in cigarettes enhances the influence of adrenaline on the body, which increases blood pressure by constricting your blood vessels
Silent Heart Attack (Silent Ischemia)
• Neuropathy and nerve damage leads to a ‘numbness’, the diabetic does not sense touch, heat, cold or pain.• Because of this, the diabetic may be unaware of symptoms, leading to a silent heart attack
Coronary arteries supply oxygen- rich blood to the heart muscle
Haemorrhagic strokes, This haemorrhage may be due to: a vessel bursting within the brain itself a blood vessel on the surface of the brain bleeding into the area between the brain and the skull