Cardiovascular system

Dr Zachariah
zachariahm@ub.bw
Block 246/A217
UB
 Learning Objectives
• Outline the structure and function of the heart and circulatory system
• List the major types of heart diseases and their cause
• Explain the process of major peripheral vascular disease
• Discuss the role of cholesterol and apolipoproteins in atherosclerosis
• Review some of the methods for detecting and investigating heart
disease
Cardiovascular System (CVS)
CVS; heart, blood vessels,
pericardium, arteries, veins
arterioles, capillaries, venoule
Encloses an distribute the blood
to tissues
Heart
Weighs 500g
Covered by a fibrous layer and
pericardium, insulated by fat
Pumps blood across the body; 70
beats/min
Unidirectional flow ensured by
valves
Introduction
 Functions of the cardiovascular system
(CVS)
 Pumps blood
• Deliver O2around the body
• Removal of CO2 from the organs
• Carries hormones
• Delivers nutrients to liver by hepatic portal vein
• Deliver specialised cells around the body in fighting diseases. e.g. B-cells from
thymus to point of infection
• Removal of waste material from metabolism e.g urea
• Transports gonadotropic hormones to reproductive organs
 Controls the body temperature
Produces CSF through choroid plexuses; contribute to blood-brain
barrier
Keeps pH and blood ions stable
 Functions of the cardiovascular system
• Heart
• Electric impulses generating from the sinoatrial (SA node)
• SA node ensures heart beats regularly
• Systolic (ventricular contraction) and diastolic (ventricular relaxation); Blood pressure
“test” e.g 110/80
• Electrocardiogram (ECG); heart rhythm an underlying cardiac morphology
• P wave; atrial depolarization
• QRS wave; ventricular depolarization
• T wave; ventricular repolarization
 Functions of the cardiovascular system
Blood pressure;
• Hydrostatic force that propels blood around the body
• Depends on the cardiac output and peripheral resitance
• Highest in arteries than in veins; systolic pressure
• Bulging of arteries as heart contracts defined as pulse
• Arteries pulls back as heart contracts; diastolic pressure
• 120mmHg/70mmHg
Changes in the normal blood pressure causes;
Low blood pressure
High blood pressure
Shock
Cardiogenic
hypovalaemic
Blood lipids Diagnosis of CVD
Cholesterol HDL; RR >1.2 mmol/L
LDL; <3.0 mmol/L
Reading assign’t; using the Friedewald
formulae
Total cholesterol; <5.0 mmol/L
Triacylglycerols; <1.7 mmol/L
Drawn after overnight fast
Apolipoproteins not routinely tested
ApoA-ApoE
Can ApoB be a CVD biomarker?
Diagnosis of hyperlipidaemia
Primary
Secondary
Familial hypercholesterolaemia; autosomal dominate, mutant LDL receptor ,ApoB100
 Diagnosis of CVD
Biomarker Isoenzym Brain GIT Cardiac Skelet Liver Kidney Erythroc
e muscle al ytes
 biological molecule whose concentration in muscl
the blood changes in response to a specific e
disease CKBB 100 96 1 0 - - -
 Cell signalling molecules (CK1)
 Proteins CKMB 0 1 22 3 - - -
 Enzymes (CK2)

Enzymes CKMM
(CK3)
0 3 77 97 - - -
 A a biological protein that speeds up
chemical reactions in living organisms LD1 - - 60 3 0.2 28 40
 Biological catalyst LD2 - - 30 4 0.8 34 30
 Endpoint testing/ Kinetic fixed time LD3 - - 5 8 1 21 15
 Kinetic continuous monitoring LD4 - - 3 9 4 11 10
 Immunoassays LD5 - - 2 76 94 6 5
Isoenzymes
 Different molecular forms of one particular
enzyme. E.g creatinine kinase
 Tissue specific e,g brain vs cardiac muscle
Enzymes; biomarker Diagnosis of CVD
 Lactate Dehydrogenase
 Non specific tissue damage
 R=240-480 IU/L
 LDH1-5;
 MI; LDH1 and LDH5
 Creatinine Kinase
 By product from ATP production
 Abundant in cardiac, skeletal muscle and brain
 Isoenzymes M and B
 MM; cardiac and skeletal
 MB; 22% cardiac muscle. Higher after MI
 BB; brain and smooth muscle
 Triple marker; Troponin I & T, myoglobin and CKMB
 Myoglobin peaks @ 6hrs increase before CKMB
 Troponin I peaks @ 12-16hrs -4 weeks
 CKMB peaks @12hours
 Aspartate transaminase (glutamate oxaloacetate)
 Isoenzymes; cardiac muscles & skeletal muscle, liver, kidney and RBC
 RR= 10-50 IU/L
 MI; 10-100-fold increase of the upper reference range, peaks@36hrs
 Maybe increase after cardiac surgery
 Diagnosis of CVD
Hormones; biomarker
 Natriuretic peptides
 Promote loss of Na+2 and H2O by the kidneys
 Atrial natriuretic peptides
 B type natriuretic peptides
 C type natriuretic peptides
 D natriuretic peptides

 B type natriuretic peptides

 RR= 100-400pg/mL
 Produced by both atria and ventricles
 Produced consistently by the cardiac muscle cells & secreted
 proBNP more stale in plasma and longer half life
 Useful to detect the strain of the ventricle walls
 Increased BNP or proBNP due to volume overload
 Heart failure
 Heart failure
 Occurs after MI
 Heart pumps at rate insufficient to meet the body needs
 Heart not pumping
 Pro BNP/ BNP useful in accident and emergency dept’ patient to confirm heart failure
 Diagnosis of CVD
ECG; electrocardiogram
Physical examination
 Diagnosis of CVD; Future
Future marker of cardiac disease
One that would predict rupture of a vulnerable
plaque
Test that detect Ischaemia before it results in
infarction
Future tests in Botswana?
Myoglobin, Troponin I, T, BNP,
Histology tests?
 Cardiovascular disease (CVD)
Group of disorders of the heart
and blood vessels
Number killer in developed
countries
31% of global deaths are due
to CVDs
Prevalence in Africa is
estimated to be 20 million
people

World Health Organization - Noncommunicable Diseases (NCD) Country Profiles , 2014.

 Cardiovascular disease
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 disease; Risk factors
Risk factors
Tobacco
Alcohol
Poor diet; high cholesterol
Genetics
Some drugs e.g steroids
Gender males more than females
Ethnicity; African Americans (Other black or Africans?)
Ageing/>65 increased risk
Predisposing factors
Obesity
Diabetes
Blood pressure
 Vascular disease; cholesterol and
Lipoproteins
High fat diet increases risks of CVD
Increase homocysteine>cholesterol
Cholesterol essential; cell membrane
Atherosclerosis due to high cholesterol
Insoluble in plasma transport as a lipoprotein particle
ApoA,ApoB, ApoC,ApoD and ApoE
From the gut
Chylomicrons>TAG>VLDL>LDL>HDL
Concentration of LDL correlates positively with incidence of coronary
heart disease
HDL removes fats and cholesterol from the arteries and cells to the
liver for excretion/re-utilization
 Vascular disease
 Endothelium controls
vascular homeostasis,
vascular tone regulation,
vascular smooth muscle
cell proliferation, vascular
permeability and
thrombosis
 Functions; mediated by
Nitric oxide the most
potent vasodilator
 Endothelial dysfunction is
the partial or complete
loss of balance of these
functions.
 Endothelial dysfunction
predisposing factor/
marker of atherosclerosis
 Vascular disease: Atherosclerosis

 A.k.a arteriosclerosis
 Simultaneous development of atheroma in an artery and sclerosis of artery wall
 Atheroma encourage adhesion of platelets; thrombus (clot)
 Hallmark for CVD
 Heart attack
 Stroke
• LDL’s - less than 120 dl/mg
• HDL’s - greater than 60 dl/mg
Xanthoma on
• Total cholesterol should be below 200 dl/mg tendons/skins
• Levels over 240 indicates high risk of CVD hypercholestromia
Major peripheral vascular disease; Stroke
Partial blocakge of coronary artery; Angina
pectoris
Myocardiaal Ischemia, atherom, tumour,
embolism
Ischemic stroke- restricted blood flow
 Thrombotic stroke- stationary clot forms in a cerebral
artery
 Embolic Stroke - wandering blood clot
Hemorrhagic stroke- blood vessel ruptures in the
brain
Aneurysm- a weakening
 or “ballooning” in an artery
Myocardial Infarction
±34 million globally
Botswana??
Major peripheral vascular disease; Deep Vein Thrombosis
Like varicose veins
Blood clots in deep veins
Dislodges goes to heart an lungs
Obesity and hypertension may increase DVT
Maybe inherited disorder; weakness in vein
walls
Oral contraceptives, cancers
Difficult to diagnose until thrombus moves
Anticoagulant therapy
Major peripheral vascular disease;
aneurysm
 Aortic aneurysm
 A round tube like bulge in weak areas of arterial wall
 High blood pressure
 Smoking
 Blood clot
 70% occur in abdomen segment
 Pulsing abdominal pain
 Back pain
 Rupture results in sevre shock and fatal
 Treatment; Synthetic graft
 Blood pressure disorders; Hypotension & Shock
Heart
Pumps blood
Deliver O2around the body e.t.c
Blood pressure below 100/60 mmHg; hypotension
 Dizziness/fainting (syncope)
 Common in;
 Abnormal heart rhythms
 Anaemia
 Hypoglycaemia
 Hyperventilation
 Low CO2 (hypocapnia)

Lower 90 mmHg/60 mm; Shock myocarditis

 Low blood volume (hypovolaemic); excess bleeding-trauma
 Cardiogenic shock; heart attack, pulmonary embolism, drug toxicity, endocarditis &
myocarditis
 Excessive vasodilation e.g extreme allergic reaction
 Fatal if not treated
 Blood pressure disorders; Hypertension
Heart
 Pumps blood
 Deliver O2around the body e.t.c
Blood pressure higher 140/90 mmHg; hypertension
 Detected at random check ups
 Silent killer
 Retinopathy
 Enlarged heart; echocardiography; ECG
 Nephropathy
Common in;
 Kidney disease
 Oral contraceptives/abnormal hormones
 Essential hypertension
 Ageing; loose flexibility and become stiffer
 Unhealthy lifestyle
 Diabetes
Untreated; heart failure, kidney failure, myocardial infarction
Questions?
Reference
• Burtis C. A, Ashwood E. R and Bruns D. E, Tietz Fundamentals of
Clinical Chemistry, latest edition
•Questions?