Pharm

PharmDDProgram
Program
(2024/2025)
(2023/2024)

(MD 305)

Lecture No. (5, 6)

Cardiovascular system
By

Ghada A.Badawi
ASSOCIATE PROFESSOR OF PHARMACOLOGY AND TOXICOLOGY

9 March 2025 www.su.edu.eg

1
 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Physiology and Pathophysiology of cardiovascular system

(Cardiac disorders) (Vascular disorders).

9 March 2025 www.su.edu.eg

2
 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s Competencies

3.C1.1 Outline the basic physiology of major organ systems and connect
between causes, clinical presentation, diagnosis and management of
diseases.
3.C1.2 Illustrate the pathophysiology of common diseases and relate
between body function and the functional changes that occur in different
diseases.

9 March 2025 www.su.edu.eg

3
Cardiovascular Disorders
 I. Heart failure

Heart failure (HF) = Congestive heart failure (CHF):

Def: is a condition in which the heart is no longer pumping
blood effectively, involve the left or right ventricle or both
leading to decrease in cardiac output (CO) which is
inadequate to provide the oxygen needed by the body.

heart pumping activity of blood CO O2 in tissues.

Signs of congestive heart failure:-
1. Tachycardia

2. Decreased exercise tolerance

3. Shortness of breath

4. peripheral, pulmonary edema

5. Cardiomegaly.

 Drugs in treatment of congestive heart failure:

The principal therapeutic objective in the treatment of
congestive heart failure is to increase the cardiac
contractility (positive inotropic action) e.g. Digitalis.
 II. Myocardial ischemia
(Angina pectoris)

Def: Imbalance between the supply of oxygen and myocardial demand.

• Angina pectoris is the most frequent disorder of ischemic heart
disease (IHD).
Risk factors of IHD:
1. Hypertension
2. Hyperlipidemia
3. Hyperglycemia
4. Smoking

Figur: Myocardial oxygen balance.

Cause of myocardial ischemia:
1. Decrease of coronary blood supply due to coronary spasm.
2. Narrowing of coronary artery by atherosclerosis due to the
accumulation of lipid plaques and/or thrombus.
3. Decrease of the flow of oxygenated blood due to:
a. Anaemia
b. Increase of carboxyhaemoglobin (smoking).
c. Hypotension as it decrease coronary perfusion pressure.
4. Increase of demand for oxygen due to:
a. Exercise
b. Disease e.g. Thyrotoxicosis:
Thyroid gland (T3,T4) secretion basal metabolic rate (BMR)
O2 consumption.
c. Hypertension increase myocardial muscle tension O2
demand.
Manifestation of Angina:
Mild Ache sever chest pain then to neck arm
epigastrium.
 Types of angina pectoris

1. Classic or chronic stable angina:

• Pain is precipitated by increased workload on the
heart e.g. exercise, emotions, stress and cold exposure
and fad quickly.
• The diagnosed exercise testing by ergometer.
2.Variant angina (vasospastic angina, Prinzmetal’s
angina):
• Pain occur due to vasospasm of the coronary arteries, which
can progress to cardiac infarction or even death.
• This kind of angina resist drugs (very dangerous type).
• Frequently occurs at night, at rest or during minimal exercise.
 Types of angina pectoris

3.Unstable angina: (also very dangerous)

• Angina that occurs at rest.
• Angina of very recent (sudden) onset
• Also referred to as “pre-infarct” angina since it is usually associated with
extensive blockage of coronary arteries. Coronary blood flow does not meet
the needs of the heart even at rest
•persist for long duration, Requires intensive treatment and evaluation.
.
4. Decubitus Angina
• Patient lie down
• Occur in association with heart failure and consequent myocardial tension.
 Myocardial infarction or “heart attack”
• It is an irreversible injury and eventual death of
myocardial tissue that results from ischemia and
hypoxia.
• Myocardial infarction is the leading killer of both
men and women in the United States.
• Most heart attacks are the direct result of
occlusion of a coronary blood vessel by a lipid
deposit.
• Prolonged vasospasm might also precipitate a
myocardial infarction in certain individuals.
III. Abnormalities of cardiac conduction
(Arrhythmia, dysrhythmia)
Def: any disturbance that occurs to regularity of normal heart rhythm.
The disturbance resulted from either
a. Disturbance of impulse formation
b. or disturbance of impulse conduction
Causes
1. Myocardial infarction
2. Ischemia, hypoxia
3. Electrolyte imbalance
4. Altered cellular pH e.g. alkalosis or acidosis
5. Drug toxicity e.g. digitalis & excessive catecholamines
6. Congenital defects in the heart
 Types of arrhythmia
1. Sinus node arrhythmia
a. Sinus bradycardia: slow heart rate (<60 beats
/minute)
b. Sinus tachycardia: fast heart rate (>100 beats
/minute)
2. Atrial arrhythmia
Contraction of the heart before the normal contraction
due to Premature atrial contractions (most occur from
ectopic impulses), it divided into:
a. Atrial fibrillation: heart rate (>350 beats /minute) with
variable ventricular conduction.
b. Atrial flutter: heart rate (>300 beats /minute) with fixed
ventricular conduction.
 Ventricular arrhythmia
1- Ventricular premature beats
One of the most common types of arrhythmia, can
progress into ventricular tachycardia or fibrillation.
2- Ventricular tachycardia
Excessive ventricular contraction rates, can have
marked effects on cardiac output.
3- Ventricular fibrillation
The most serious cardiac arrhythmia, characterized by a
complete loss of ventricular coordination, cardiac output
falls to zero, lead to rapid death if not treated.
 Vascular Disorders
I. Arterial disease
1. Hypertension.
2. Hypotension.
3. Atherosclerosis.
4. Aneurysm.
I. Venous disease
1. Varicose veins.
2. Venous thrombus.
 1. Hypertension
Def: elevation of systolic and/ or diastolic arterial blood pressure
above 140/90 mmHg.
Hypertension is the most common cardiovascular disease.
Diagnosis: The diagnosis of hypertension is based on repeated,
reproducible measurements of elevated blood pressure.
 Regulation of Blood Pressure in normal and hypertensive
individuals:
According to the hydraulic equation, the arterial blood pressure
(BP): It is directly proportionate to the product of the blood flow
(cardiac output, CO) and the resistance to passage of blood
through precapillary arterioles (peripheral vascular resistance,
PVR): BP = CO × PVR
Physiologically, in both normal and hypertensive individuals,
blood pressure is maintained by moment-to-moment regulation of
cardiac output and peripheral vascular resistance.
 Etiology of hypertension:
1. Primarily hypertension (essential or idiopathic hypertension):
when the etiology of hypertension is unknown (about 80% of
cases).
2. Secondary hypertension: less commonly (about 20% of cases).
Hypertension may be due to other diseases and once the diseases
treated, the hypertension disappears.
Examples of secondary hypertension:

a. Renal diseases: glomerulonephritis.

b. Endocrinal diseases: Cushing's syndrome & phaeochromocytoma.
c. Toxaemia of pregnancy
d. Use of certain drugs e.g. oral contraceptive & steroids.
 Risk factors for development of essential hypertension:
1. Familial history of hypertension.
2. Increasing age.
3. Race & gender: higher in black men.
4. Obesity.
5. Cigarette smoking.
6. Alcohol consumption.
7. High salt intake.
Classification of hypertension
Table 1: Classification of hypertension on the basis of blood pressure.

Systolic/Diastolic Pressure (mm Hg) Category

< 120/80 Normal
120–135/80–89 Prehypertension
≥ 140/90 Hypertension
140–159/90–99 Stage 1
≥ 160/100 Stage 2
 Sever (Malignant) hypertension: with a diastolic pressure
above 125 mm Hg,
Malignant hypertension is dangerous because dramatic
increases in pressure may damage the retina or kidneys and
lead to cerebral edema and stroke.
It requires immediate medical treatment with powerful
intravenous vasodilators such as diazoxide or sodium
nitroprusside.
 1. Hypotension
Def: it is an abnormally low blood pressure.
Orthostatic hypotension (also called postural hypotension):
occurs upon standing.
 Causes of orthostatic hypotension:

1. Aging: Associated with baroreceptor responses

cardiac output vascular responsiveness.
2. Decreased blood or fluid volume: Caused by dehydration,
diarrhea, diuretic
3. Prolonged bed rest: Associated with reduced plasma volume,
decreased vascular tone.
4. Drug-induced hypotension: e.g. antihypertensive drugs,
calcium channel blockers, vasodilators
5. Idiopathic: Cause un known
 Manifestations of hypotension:
1. Dizziness (syncope)
2. Decreased cardiac output
3. Reduced brain blood flow
4. Pooling of blood in the extremities
5. Falls, particularly in elderly individuals
 Hyperlipidemia
Def: when serum cholesterol and triglyceride levels are
increased, as serum cholesterol levels rise above
(200mg/dL) increase the risk of atherosclerosis.

Causes of hyperlipidemia: is often multifactorial and may

include:
1. Genetic defect.
2. Poor diet.
3. Sedentary lifestyle.
4. The use of certain drugs such as B-blockers and
contraceptives.
 Because dietary lipids and cholesterol are insoluble in the
plasma, they are transported as part of complex called a
lipoprotein
 Lipoprotein is composed of a hydrophobic core of cholesterol
esters and a hydrophilic shell of phospholipids.
 A protein called an apolipoprotein constitutes the protein portion
of the lipoprotein.
Classification of lipoproteins according to their density:
1. Chylomicrons (lowest density)
 Synthesized in the gut wall.
 Mainly transport dietary triglycerides from the intestine into the blood.

2. VLDL (very low-density lipoproteins)

 Synthesized in the liver.
 Contains 50% triglycerides with the remainder equal amounts of
phospholipids and cholesterol.
 May by converted to IDLs in the blood.

3. IDL (intermediate – density liporoteins)

 Composed of equal amounts of triglycerides, phospholipids and
cholesterol.
 Precursor for LDLs.
 4. LDL (low – density lipoprotein)
 Composed of 50% cholesterol.
 Main carrier of cholesterol from liver to tissues.
 Internalized into cells bound to a specific cell-surface LDL
receptor. LDL Atherosclerosis
 "Bad cholesterol" due to its role in atherosclerosis.
5. HDL (high-density lipoprotein)
 Synthesized in the liver
 Carries cholesterol from the blood plasma to the tissues.
"Good cholesterol" because it removes cholesterol from the circulation
HDL Atherosclerosis
 High circulating HDL Levels associated with a reduced potential for
atherosclerosis.
 3. Atherosclerosis

It is one of the most common diseases affecting arteries.

It is caused by deposition of lipid plaques in the walls
of arteries.
Atherosclerotic lesions can affect any artery and the
coronary arteries of the heart are the most commonly
affected.
 Risk factors for Atherosclerosis:

1.Elevated serum levels of LDL.

2.Low levels of HDL.

3.Familial history of hyperlipidemia or atherosclerotic disease.

4.Smoking.

5.Hypertension.

6.Age: a. 45years in males. b. 55years in females.

7. Drugs — β-blockers, oral contraceptives.

 Manifestations of atherosclerosis:
1. Tissue ischemia due to reduced blood flow.
2. Aneurysm or hemorrhage due to weakening of blood vessel
walls.
3. Breaking-off of atherosclerotic plaques to form travelling
emboli.
4. Aneurysm
Def: localized, balloon-like swelling in the wall of an artery
caused by weakening of the arterial wall .

Aneurysm may occur in any artery, but the aorta is most

susceptible to aneurysm due to the constantly high
pressure on the walls of that vessel.
 Causes of Aneurysm:
1. Atherosclerosis: lipid plaques can erode arterial walls
& compromise their integrity.
2. Hypertension.
3. Vascular infection.
4. Normal aging process.
5. Trauma
Aneurysm.
 II. Venous disease
1. Varicose veins
Def: veins become distended over time due to the
pooling of blood in the lower extremities.
This condition occurs most frequently in individuals
who spend long periods of time standing e.g. barbers
or who have impaired return of blood from the lower
extremities.
manifestations of varicose veins: aching and edema.

Their appearance through the skin is also unsightly.

Treatment: often involves the use of support stockings to
prevent venous pooling. Surgical interventions may also
be used to improve appearance and reduce discomfort.
 2. Venous Thrombus
Def: thrombus is a blood clot that forms in the lumen of a
blood vessel.
• Thrombus may form in an artery, but it is more
common in veins due to the lower pressure and reduced
blood flow found in the venous circulation.
Factors that may contribute to the formation of a
thrombus include:
1. Stasis of blood due to poor blood flow: immobility,
heart failure, myocardial infarction and hypotension
2. Damage to blood vessels: from trauma, surgery, IV
drugs, catheters or immune response
3. Hypercoagulability of blood: resulting from
pregnancy, malignancies, coagulation disorders,
dehydration or use of oral contraceptives.
Thrombi may form in superficial vessels of the
skin and extremities or in deep veins (DVT) of
circulation or tissues, which can be much
more dangerous as DVT is associated
significant mortality and morbidity and
require intensive treatment.
 Embolism

Def: An embolism is a thrombus that breaks loose and travels

through circulation.

• Common sites for lodging of emboli are the small

pulmonary blood vessels of the lungs.

• Unfortunately, for many patients with DVT the first

manifestation of the thrombus is a pulmonary embolism.

• Emboli that lodge in cerebral or coronary blood vessels

may be rapidly fatal.
• A bolus of fat released by the breakage of
long bones or an injection of air or foreign
matter into the bloodstream through
intravenous or intra-arterial lines can also
act as an embolism.

• Ischemia and possible death of tissues

may occur when blood flow is blocked by
an embolus.
 Pharm
PharmDDProgram
Program
(2024/2025)
(2023/2024)

Lecture’s References

1-Widmaier E, Raff H, Strang KT. Vander's human physiology. McGraw-

Hill US Higher Ed USE; 2022.
2- McCance KL, Huether SE. Pathophysiology: The biologic basis for
disease in adults and children. Elsevier Health Sciences; 2014 Jan 14..
3- Hall JE, Hall ME. Guyton and Hall textbook of medical physiology e-
Book. Elsevier Health Sciences; 2020 Jun 13.
4- Zdanowicz MM. Essentials of pathophysiology for pharmacy. CRC
Press; 2019 Feb 13.

9 March 2025 www.su.edu.eg

44