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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 University. Understanding the Cardiovascular System. - PowerPoint PPT Presentation
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CARDIOVASCULAR DISEASE
(Overview)
Toni Mustahsani Aprami, dr., Sp.PD, Sp.JP
Department of Cardiology and Vascular MedicineCardiovascular Subdivision, Department of Internal Medicine
Hasan Sadikin Hospital/Medical School, Padjadjaran University
Understanding the Cardiovascular System
• The Heart: A Mighty Machine
–Four chambers• Two upper chambers are
called atria• Two lower chambers are
called ventricles–Valves regulate the flow
of blood.
Conduction System of the Heart
5
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.
Blood Flow within the Heart
Blood Vessels
11
Capillary Bed Anatomy
12
Capillary Exchange
Functions of the Cardiovascular System
1. Contractions of the heart generates blood pressure, which moves blood through blood vessels.
2. Blood vessels transport blood, which moves from the heart into arteries, capillaries, and veins, before returning to the heart.
3. Exchanges at the capillaries (smallest vessels) refreshes blood and then tissue fluid (interstitial fluid).
4. The heart and blood vessels regulate blood flow, according to the needs of the body.
CARDIOVASCULAR DISEASECongenital Heart Disease (ASD, VSD, PDA, TOF)
Rheumatic Heart Disease (MS/MR, AS/AR)
Hypertensive Heart Disease
Coronary Artery Disease
Cardiomyopathies
Pericarditis
Peripheral Artery Disease
Aneurysm and Disectie Aortae
Deep Vein Thrombosis
Cardiac Tumor
Coronary Artery Disease
90% Atherosclerosis Process
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)
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 : AortaCoronaryCarotidIliacMesentric
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 , CACS
Atherogenesis
Normal Artery
Endothelium
Internal elastic lamina
External elastic lamina
Media
Intima
Adventitia
Response to Injury
Endothelial Dysfunction
Initiation of Fatty Streak
Fatty Streak
Fibro-fatty Atheroma
FIBROUS CAP
NECROTIC CENTER
MEDIA
(smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, revascularization)
(cells debris, cholesterol crystals,foam cells, calcium)
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 Atherosclerosis
Common Consequences of Atherosclerosis in Vessels
Altered Vessel Function
• Vessel change– Plaque narrows
lumen– Wall weakened
– Thrombosis
– Breaking loose of plaque
– Loss of elasticity
• Consequence– Ischemia, turbulence– Aneurysms, vessel
rupture– Narrowing, ischemia,
embolization– Athero-embolization
– Increase systolic blood pressure
Burden and causes of cardiovascular diseases:with an emphasis on Asia
Chronic diseases and
injuries
Infectious, maternal, perinatal and
nutritional conditions
0
20
40
60
1990 2020 1990 2020
Changing patterns of deathWorldwide: 1990-2020
Global Burden of Disease Project, 1996
Millions of deaths
Leading causes of deathWorldwide: 1990-2020
Rank Cause % Rank Cause %1 Coronary Artery disease 12.4 1 Coronary Rtery disease 16.32 Cerebrovascular disease 8.7 2 Cerebrovascular disease 11.23 Lower respiratory infections 8.5 3 COPD 6.94 Diarrhoeal diseases 5.8 4 Lower respiratory infections 3.75 Perinatal conditions 4.4 5 Respiratory tract cancers 3.56 COPD 3.9 6 Road traffic accidents 3.47 Tuberculosis 2.1 7 Tuberculosis 3.48 Measles 2.1 8 Stomach cancer 2.39 Road traffic accidents 1.9 9 HIV 1.810 Respiratory tract cancers 1.9 10 Self inflicted injuries 1.8
1990 2020
Global Burden of Disease Study, 1996
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 countries19 million in developing countries
Deaths from cardiovascular disease
Worldwide: 1990-2020
Global Burden of Disease Study, 1996
World population change
0
2
4
6
8
10
1700 1800 1900 2000 2100
Wor
ld p
opul
atio
n (b
illio
ns)
United Nations 1999
Regional population change
Population (billions)2000 2050 Change
Developing world 4.9 7.9 3.0Developed world 1.0 1.0 0.0Total 5.9 8.9 3.0
United Nations 1999
0
500
1000
1500
2000
2500
3000
3500
Trends in per capita cigarette consumption: 1971-1991
1971 1981 1991
Per c
apita
cig
aret
te c
onsu
mpt
ion
High income countries
Low & middle income countries
China
The World Health Report, 1999: Making a Difference
Tobacco-related death and disability
19902020
Deaths (millions) 3.0 8.4 India 0.1 1.5 China 0.8 2.2
DALYS (%) 2.6 9.0
Global Burden of Disease Project, Lancet 1997
Trends in overweight/obesity (BMI 25+ kg/m2)
0
50
100
150
200
250
300
350
Developed Developing World
Mill
ions
19952025 Projected
King et al. Diabetes Care 1998; 21:1414-31
0
50
100
150
200
250
300
350
Asia-Pacific
Global distribution of diabetes
Prevalence of smokingin the Asia
Pacific
APCSC, 2006
Indonesia
Prevalence of hypertension140/90mmHg +
Indonesia 27 11
Prevalence of obesity and overweight
Prevalence of, and predictions for, diabetes
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 region
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)
Terima KasihAtas
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