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MINIATLAS CARDIOVASCULAR SYSTEM updated edition

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					MINIATLAS: CARDIOVASCULAR
           SYSTEM (updated edition)




                                  1
Summary:


     The first anatomical examinations, nowadays
part of the history of medicine, highlighted the
importance of the heart and the blood vessels. As
far as physiology is concerned, the cardiovascular
system plays a more crucial role than all the other
body systems, since it is not only responsible for
its own nutrition but also for that of the rest of the
tissues.In unicellular organisms, simple diffusion
of substances is sufficient to maintain the dynamic
balance that enables life. However, more complex
structures such as multicellular organisms would
be unthinkable without a system of oxygen and
nutrient distribution.


     Given the critical role of the cardiovascular
system, it is easy to understand that anything that
interferes with its good health will have an impact
o n o t h e r o rg a n s a n d s y s t e m s . I n We s t e r n
countries, the leading cause of death is
associated with different conditions that adversely
affect the normal functioning of the cardiovascular
system; for example, the high prevalence of
atherosclerosis interferes with blood flow and
often affects the performance of the heart muscle.
Due to its unquestionable relevance and
considering the great need to count on updated
material on cardiovascular anatomy, physiology,
disease and treatment, we want to offer you what
we consider a very interesting scientific product.
We hope to have created a work that is not only
readable but also of high scientific rigor.




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Chapter 1:
Anatomy and physiology of the
cardiovascular system

    In chapter 1, there is a complete summary of
all the elements that contribute to guarantee the
correct performance of the cardiovascular system.
The general organization of the cardiovascular
system is described before detailing the anatomy
of the heart with illustrations of its anterior and
posterior view as well as a coronal section of this
organ.


    The physiology of the cardiac pump is then
explained, so the mechanisms behind intracardiac
flow and particularly the generation of the electric
impulses and cardiac conduction are outlined. To
understand this process, the essentials of the
contractility of the myocardial fibers are also
commented.


    It is then reviewed how oxygen supply to the
heart is performed by the coronary arteries and
their branches. Furthermore, systemic circulation
is defined and compared with pulmonary
circulation. Similarly, the differences between
arteries and veins are also highlighted in this part,
and there are portraits of both arterial and venous
systems. The chapter also includes annotations
on how venous return is made possible through
the participation of various extravenous strategies.


    Also in this chapter, normal blood flow is
reported so one can see how the circulatory
system allows for continuous flow in this virtually
closed system. The last part of this section deals




                                                        3
with blood pressure and the cardiovascular
reflexes that act to compensate for or buffer any
changes in blood pressure (baroreceptors) or
chemical blood variations (chemoreceptors).


Chapter 2:
Hypertension

    Hypertension is defined as a chronic increase
in systolic or diastolic blood pressure. This second
chapter establishes the diagnostic and
classification criteria for the disorder. This way , it
characterizes essential and secondary
hypertension before detailing all the factors
involved in renovascular hypertension, a particular
case of hypertension that typically originates in
the kidney arterial system .


    The hypertensive heart disease can have
many and serious consequences: morphological
changes in the heart, and secondary pathologies
such as hypertensive encephalopathy ,
hypertensive nephropathy, and hypertensive
retinopathy. All of these disorders are reviewed in
these pages, too.


  Hypertension also affects blood vessels. This
chapter describes the main types of endothelial
damage that might occur in the hypertensive
patients, as well as the association between the
disease and atherosclerosis.




                                                  4
Chapter 3:
Atherosclerotic disease

    Chapter 3 focuses on atherosclerosis. First, it
helps us understand how atherosclerosis can
develop by analyzing all the risk factors
associated to the disorder. As it is discussed,
here, all of the following can play a role in its
ethiopathogenesis: age, family history, genetic
defects, diet, dyslipidemia, hypertension,
smoking, stress, personality, diabetes and obesity.


    Then the chapter provides all the relevant
facts about atherogenesis. This way, it explains
how certain lipoproteins are involved in the
atherogenic process. As it is discussed in these
pages, the “response -to-injury” hypothesis
proposes that the first step in development of
atherosclerosis is the increased endothelial
permeability to lipoproteins and other blood
components as a result of endothelial dysfunction.
Endothelial damage is caused by the
cardiovascular risk factors and plays a significant
role in the formation of atheromatous plaques and
development of atherosclerosis. All the
subsequent stages of the atheroma formation are
also portrayed:proliferation and migration of
smooth muscle cells, fatty streaks, fibrous plaque
and plaque expansion. The histological
classification of atherosclerotic lesions by the
American Heart Association is also provided.


    Atherosclerosis and its consequences are
contemplated in the last part of the chapter.
Since the atheroma plaques are prone to rupture,
thrombosis and thromboembolism derived from
atherosclerosis are common. This part examines




                                                      5
the main vessels affected by thromboembolism.
Ischemic heart disease, stable and unstable
angina pectoris as well as prinzmetal angina are
pathologies associated to atherosclerosis and
they are all portrayed along these pages. The
concept of chronic ischemic heart disease is also
defined.


     As a result of ischemia, a group of cardiac
smooth muscle cells may undergo necrosis, this is
known as myocardial infarction, and a large part of
chapter 3 is devoted to the expressions and
characteristics of this disorder. Since it can
appear in different regions of the heart, subcardial
infarction is compared to transmural infarction.
T h i s s e c t i o n a l s o f e a t u re s t h e m o r p h o l o g i c
p ro g re s s i o n o f m y o c a rd i a l d a m a g e a n d t h e
electrocardiogram patter ns associated to
myocardial ischemia and infarction.


     The complications of infarction are varied.
Here the author reviews cardiogenic shock,
arrhytmias, heart rupture, ventricular aneurysm
cardiac thrombosis, and ischemic stroke and its
consequences. Right ventricular infarction is also
described, and one can find here the diagnostic
criteria of acute myocardial infarction, too.


     Later on, carotid atherosclerosis is
characterized, with the most frequent location
sites. The author also reviews iliac artery
a t h e r o s c l e r o s i s a n d i t s t y p i c a l i n d i c a t o r,
intermittent claudication which consists of pain in
the lower limbs upon walking only. Finally, renal
atherosclerosis, a significant cause of renal failure,
and renovascular hypertension are pictured in
the last pages of the chapter.




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Chapter 4:
Heart failure

    Heart failure is the protagonist of the fourth
chapter of this miniatlas. It starts with an
overview of the difference between normal and
hypertrophic myocardial fibers, since these are
increased but also stretched in the failing heart,
resulting in decreased contractility and thus
efficiency.


    A discussion on the different types of heart
failure and its manifestations follow. As it is
commented here, left and right heart failure are
different in many ways, and for this reason, the
etiology and clinical manifestation of each are
analyzed separately.


    For the left heart failure, there are notes on
the predisposing factors, the coarctation of the
aorta and valvular disorders: aortic stenosis,
aortic regurgitation and mitral regurgitation. The
main signs and symptoms of left heart failure are
detailed too, particularly acute pulmonary edema.


     For right heart failure, pulmonary
hypertension is pointed out as the most common
predisposing factor. It can be caused by chronic
pulmonary disease that is described here, along
with the valvular heart diseases linked to pulmonic
and tricuspid regurgitation. There is a list of the
clinical manifestations of the disorder.


    Other causes of heart failure are summarized
at the end of the chapter. Cardiomyopathies ,
myocarditis, cardiac tamponade, constrictive
pericarditis and rheumatic fever are all reported.




                                               7
Chapter 5:
Diseases of the venous system

     The veins can be the location of different
pathologies. Deep venous thrombosis originate
when thrombi form in the venous vessels, the
disease is linked to death by pulmonary embolism
and it can also result in symptomatic chronic
v e n o u s i n s u ff i c i e n c y , a l s o k n o w n a s p o s t -
thrombotic syndrome. All relevant information
about these conditions is contained in this
c h a p t e r, w h i c h a l s o c o n t a i n s c o m m e n t s o n
varicose veins of the lower limbs.


Chapter 6:
Other cardiovascular diseases

    Two cardiovascular disorders are considered in
the last part of this book: aneurysms and
diabetic angiopathies. Aneurysms are abnormal
local dilations of the blood vessels that appear as
a result of vascular disease. Diabetic angiopathies
are long-term vascular complications seen in the
diabetic patient with a potentially fatal outcome ,
since it promotes atherosclerosis and is
associated to        myocardial and cerebral infarction.



!

     This second edition is accompanied by two
valuable annexes: one of reference tables with
the average values of laboratory tests and
other data of interest, and one of addresses of
websites associated with the speciality.




                                                                         8
Table of contents

               Chapter 1: Anatomy and physiology of the
                     cardiovascular system
                     • The cardiovascular system
                     • Anatomy of the heart
                     • Intracardiac flow
                     • Blood supply to the heart, the coronary arteries
                     • Myocardial fiber. Ultrastructure and contractility
                     • Major blood vessels. Structure
                     • The arterial system
                     • The venous system
                     • Normal blood flow
                     • Venous return
                     • Cardiovascular reflexes (baroreceptors)
                     • Cardiovascular reflexes (chemoreceptors)
                     • Normal blood pressure


               Chapter 2: Hypertension
                     Causes

                     • Hypertension
                     • Essential hypertension
                     • Secondary hypertension
                     • Renovascular hypertension


                     Consequences
                     • Hypertensive heart disease
                     • Hypertensive encephalopathy
                     • Hypertensive nephropathy .
                     • Hypertensive retinopathy
                     • Hypertension, endothelial damage and atherosclerosis.
                     • The distribution of lymphoid tissue in the body




                                                                               9
Chapter 3: Atherosclerotic disease
      Risk factors for atherosclerosis

      • Age as an atherogenic risk factor
      • Family history and genetic defects
      • Diet
      • Dyslipidemia
      • Hypertension
      • Stress and personality
      • Tobacco use
      • Diabetes and the metabolic syndrome
      • Obesity
      • Hyperhomocysteinemia


      Atherogenesis
      • Atherogenic lipoproteins
      • Atherogenesis, response-to-injury hypothesis
      • Chronic endothelial damage
      • Endothelial dysfunction .
      • Proliferation and migration of smooth muscle cells
      • Fatty streaks
      • Fibrous plaque formation
      • Phases in the development and expansion of a coronary atheromatous
      plaque
      • Classification of atherosclerotic lesions


      Atherosclerosis and its consequences
      • Atherosclerosis, thrombosis and thromboembolism
      • Main vessels affected by atherosclerosis
      • Ischemic heart disease
      • Stable angina pectoris
      • Unstable angina pectoris
      • Angina pectoris, Prinzmetal angina
      • Chronic ischemic heart disease
      • Myocardial infarction
      • Subendocardial vs. transmural infarction
      • Morphologic progression of myocardial damage
      • Electrocardiogram and myocardial infarction




                                                                      10
      • Complications of infarction, cardiogenic shock
      • Infarction complications, arrhythmias
      • Infarction complications, heart rupture
      • Complications of infarction, ventricular aneurysm and cardiac
      thrombosis
      • Right ventricular infarction
      • Diagnostic triad of AMI
      • Carotid atherosclerosis
      • Clinical consequences of ischemic stroke
      • Iliac artery atherosclerosis
      • Intermittent claudication
      • Renal atherosclerosis
      • Renovascular hypertension


Chapter 4: Heart failure
      • Normal and hypertrophic myocardial fibers
      • Types of heart failure


      Left heart failure. Predisposing factors
      • Hypertension
      • Valvular heart diseases: aortic stenosis
      • Valvular heart diseases: aortic regurgitation
      • Valvular heart diseases: mitral regurgitation
      • Coarctation of the aorta


      Left heart failure. Clinical manifestations
      • Left heart failure
      • Acute pulmonary edema


      Right heart failure. Predisposing factors
      • Pulmonary hypertension
      • Chronic pulmonary disease
      • Valvular heart diseases: pulmonic regurgitation
      • Valvular heart diseases: tricuspid regurgitation




                                                                        11
       Right heart failure. Clinical manifestations
       • Right heart failure


       Other causes of heart failure
       • Ischemic heart disease and heart failure
       • Cardiomyopathies as a cause of heart failure
       • Myocarditis and heart failure
       • Cardiac tamponade, constrictive pericarditis and heart failure
       • Rheumatic fever and heart failure


Chapter 5: Diseases of the venous system
       • Deep venous thrombosis
       • Varicose veins of the lower limbs
       • Post-thrombotic syndrome
       • Pulmonary thromboembolism



Chapter 6: Other cardiovascular diseases
       • Aneurysms. Macroscopic aspect and localization
       • Diabetic angiopathy


    References


    Tables of interest and normal values of laboratory tests


    Web addresses of the specialty




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