Diseases of the Heart
Arteriosclerosis
This is a progressive degeneration of arterial walls, associated with ageing and
accompanied by hypertension.
Large and medium arteries
Loss of elasticity
increases systolic
The tunica media is blood pressure,
This causes the The lumen dilates
infiltrated with and the pulse
vessels to lose their and they become
fibrous tissue and pressure (the
elasticity. tortuous.
calcium. difference between
systolic and
diastolic pressure).
Small arteries and arterioles
Hyaline thickening
of the tunica
This increases Ischaemia of
media and tunica
peripheral tissues supplied by
intima causes
resistance and affected arteries
narrowing of the
blood pressure. may occur
lumen and they
become tortuous.
Senile arteriosclerosis: A condition affecting elderly people in which the
progressive loss of elasticity and reduced arterial lumen leads to cerebral
ischaemia and loss of mental function.
Venous Thrombosis
Superficial thrombophlebitis
In this acute inflammatory condition a thrombus forms in a superficial vein and the
tissue around the affected vein becomes red and painful. The most common causes
are:
Intravenous infusion
Varicosities in the saphenous vein.
Deep vein thrombosis (DVT)
A thrombus forms in a deep vein commonly in the lower limb, pelvic or iliac
veins, but occasionally in an upper limb.
The thrombus may affect a long section of the vein and, after some days,
fibrinolysis may enable recanalisation through the blockage.
Deep vein thrombosis may be accompanied by pain and swelling, but is often
asymptomatic.
There are several predisposing factors:
Reduced rate of Changes in the Damage to the
blood flow blood blood vessel wall
Immobility Increased blood Accidental injury
associated with viscosity in, e.g., Surgery
prolonged bedrest dehydration,
Pressure on veins in polycythaemia
the popliteal region Increased
Pressure on a vein adhesiveness of
by an adjacent platelets
tumour
Prolonged low blood
pressure, as in shock
Varicose Veins
A varicosed vein is one which is so dilated that the valves do not close to prevent
backward flow of blood. Such veins lose their elasticity, become elongated and
tortuous and fibrous tissue replaces the tunica media. Predisposing factors are:
There appears to be a familial tendency but no abnormal
Heredity genetic factor has been identified.
Females are affected more than males, especially following
Gender pregnancy.
There is progressive loss of elasticity in the vein walls with
Age increasing age so that elastic recoil is less efficient.
Superficial veins in the limbs are supported by
Obesity subcutaneous areolar tissue. Excess adipose tissue may
not provide sufficient support.
Standing for long periods with little muscle contraction
Gravity tends to cause pooling of blood in the lower limbs and
pelvis.
Because of their thin walls, veins are easily compressed by
Pressure surrounding structures, leading to increased venous
pressure distal to the site of compression
Ischemic Heart Disease
Ischaemic heart disease is due to the effects of atheroma, causing narrowing
or occlusion of one or more branches of the coronary arteries.
The narrowing is caused by atheromatous plaques.
Occlusion may be by plaques alone, or plaques complicated by thrombosis.
Narrowing of an artery leads to angina pectoris, and occlusion to myocardial
infarction, i.e. an area of dead tissue.
Angina pectoris
This is sometimes called angina of effort because increased cardiac output required
during extra physical effort causes severe ischaemic pain in the chest. The pain
may also radiate to the arms, neck and jaw. Other factors which may precipitate
angina include:
• Cold weather
• Exercising after a heavy meal
• Strong emotions.
A narrowed coronary artery may supply sufficient blood to the myocardium to meet
its needs during rest or moderate exercise but not when greatly increased cardiac
output is needed, e.g. walking may be tolerated but not running. The thick,
inflexible atheromatous artery wall is unable to dilate to allow for the increased
blood flow needed by the more active myocardium which then becomes ischaemic.
In the early stages of development of the disease the chest pain stops when the
cardiac output returns to its resting level soon after the extra effort stops.
Myocardial infarction
An infarct is an area of tissue that has died because of lack of oxygenated blood.
The myocardium is affected when a branch of a coronary artery is occluded. The
commonest cause is an atheromatous plaque complicated by thrombosis. The
extent of myocardial damage depends on the size of the blood vessel and site of
the infarct. The damage is permanent because cardiac muscle cannot regenerate
and the dead tissue is replaced with non-functional fibrous tissue. The effects and
complications are greatest when the left ventricle is involved. Myocardial infarction
is usually accompanied by very severe crushing chest pain behind the sternum
which, unlike angina pectoris, continues even when the individual is at rest.
Hypertension
The term hypertension is used to describe blood pressure that is sustained at a
higher than the generally accepted 'normal' maximum level for a particular age
group, e.g.:
• at 20years-140/90mmHg
• at 50years-160/95mmHg
• at 75 years -170/105 mmHg.
Arteriosclerosis contributes to increasing blood pressure with age but is not the
only factor involved. Hypertension is described as essential (primary, idiopathic) or
secondary to other diseases.
Essential hypertension
This means hypertension of unknown cause. It accounts for 85 to 90% of all cases.
Benign (chronic) hypertension: The rise in blood pressure is usually slight to
moderate and continues to rise slowly over many years. Sometimes
complications are the first indication of hypertension, e.g. heart failure,
cerebrovascular accident, myocardial infarction. Predisposing factors include:
Inherited tendency
Obesity
Excessive alcohol intake
Cigarette smoking
Lack of exercise.
Malignant (accelerated) hypertension: The blood pressure is already elevated
and continues to rise rapidly over a few months. Diastolic pressure in excess of
120 mmHg is common. The effects are serious and quickly become apparent,
e.g. haemorrhages into the retina, papilloedema (oedema around the optic
disc), encephalopathy (cerebral oedema) and progressive renal disease,
leading to cardiac failure.
Secondary hypertension
Hypertension resulting from other diseases accounts for 10 to 15% of all cases.
Kidney diseases:
Raised blood pressure is a complication of many kidney diseases. The
vasoconstrictor effect of excess renin released by damaged kidneys is
one causative factor.
Adrenal cortex
Secretion of excess aldosterone and cortisol stimulates the retention of
excess sodium and water by the kidneys, raising the blood volume and
pressure.
Adrenal medulla.
Secretion of excess adrenaline and noradrenaline raises blood pressure.
Stricture of the aorta
Hypertension develops in branching arteries proximal to the site of a
stricture.
Compression of the aorta by an adjacent tumour may cause
hypertension proximal to the stricture.
Hypertension may be a complication of some drug treatment, e.g.:
Corticosteroids
Non-steroidal anti-inflammatory drugs
Oral contraceptives
Cardiac Arrhythmias
A cardiac arrhythmia is any disorder of heart rate or rhythm, and is the result of
abnormal generation or conduction of impulses. The normal cardiac cycle gives rise
to normal sinus rhythm which has a rate between 60 and 100 beats per minute.
Sinus bradycardia:
This is sinus rhythm below 60 beats per minute. This may occur during sleep and is
common in athletes. It is an abnormality when it follows myocardial infarction or
accompanies raised intracranial pressure.
Sinus tachycardia:
This is sinus rhythm above 100 beats per minute when the individual is at rest. This
accompanies exercise and anxiety; but is an indicator of some disorders, e.g. fever,
hyperthyroidism, some cardiac conditions.
