Degenerative Disorders: by Dr. Madiha Ehsan Ulhaq

DEGENERATIVE DISORDERS
BY DR. MADIHA EHSAN ULHAQ

CARDIOVASCULAR DISORDERS
• Coronary circulation
• Heart action –conduction system, myocardial
contraction,relaxation
• Atheroscleosis mechanism
• Factors affecting cardiac performance in frank
starling and lapcalce law-
preload,afterload,contractibility
• Pathophysiology in ischemic heart diseases-
myocardial ischemia (angina and types)annd
myocardial infarction
• Nervous system disorders:
• Meningitis
• Abscess
• Head trauma
• Respiratory system disorders

CORONARY CIRCULATION
FRANK STARLING LAW
• The law states that the stroke volume of the

heart increases in response to an increase in
the volume of blood in the ventricles, before
contraction (the end diastolic volume), when
all other factors remain constant
LAPLACE LAW
• Following Laplace's law, the tension upon the
muscle fibers in the heart wall is the pressure
within the ventricle multiplied by the volume
within the ventricle divided by the wall
thickness (this ratio is the other factor in
setting the afterload). ... As afterload
increases, cardiac output decreases.
Preload
• All of the factors that contribute to passive
ventricular wall stress
(or tension) at the end of diastole
• end-diastolic volume (EDV) at the beginning of
systole
Afterload
• All of the factors that contribute to total
myocardial wall stress (or tension) during
systolic ejection
• ventricular pressure at the end of systole (ESP)
ANGINA
• Angina is chest pain
caused by an imbalance
between oxygen
supply (decreased
coronary blood flow)
and oxygen
demand(increased
myocardial oxygen
consumption), which
leads to a decrease in
the oxygen
supply/demand ratio and
myocardial hypoxia
• It is the result of
myocardial ischaemia
• Angina is generally presented as discomfort, tightness,
heaviness sensation rather than total pain
• Angina occurring at rest and worsening is suggestive of
an MI (heart attack) and necessitates instant medical
attention and if left untreated causes death
• Angina generally occurs with exertion, extreme stress,
after heavy meal, in cold temperatures when heart
muscles require more oxygen and the obstructed
coronary arteries are not able to do it. Anginal pain
generally ends in 15 minutes and is eased up by resting
or by placing a Nitro tablet under tongue, which helps
in relaxing blood vessels and reduces blood pressure
with resultant less demand for oxygen by heart
muscles.
Risk factors
• Age (above 55 years for men, above 65 for
women).
• Cigarette smoking.
• Diabetes mellitus (DM).
• Dyslipidemia.
• Family History of premature heart disease.
• Hypertension.
• Kidney disease (microalbuminuria or GFR)
• Obesity.
• Sedentary lifestyle.
Cause
• The main cause of angina by far is coronary artery disease , arteriosclerosis.
• One of the less common causes of angina is coronary artery spasms.
• The decreased flow can result from coronary artery vasospasm, fixed stenotic
lesions (chronic vessel narrowing), or from a blood clot (thrombus) that
incompletely (non-occlusive thrombus) or completely occludes a coronary artery
(occlusive thrombus).
• Oxygen consumption can be elevated by increased heart rate, contractibility
(ionotropy), preload and afterload
PATHOPHYSIOLOGY
• Angina develops due to myocardial ischemia and
this happens when the coronary blood flow
becomes inadequate to meet the oxygen demand
of the heart muscle. In other words, angina
occurs as a result of imbalance between the
heart's demand and supply of oxygen. This
imbalance results from an increase in demand
(e.g. during physical exertion, exercise etc)
without a proportional increase in supply of
oxygen due to obstruction or atherosclerosis of
the coronary arteries.
• Stable Angina Pectoris:
This is also known as effort angina and is one of
the more common forms of angina. This type
of angina is present when the patient is
exerting himself e.g. running, brisk walking,
climbing stairs, exercising etc. hence the name
"effort angina." Symptoms abate following the
cessation of activity or after taking
medications such as Nitro. Stable angina is
usually predictable.
• Unstable Angina Pectoris:
This type of angina is not that common, but is quite
a serious condition when compared to stable
angina. Symptoms are unpredictable, more
intense, and are unrelieved with rest or
medications. Unstable angina is a pain that starts
even at rest, is of severe intensity, and not
relieved by Nitro. It is an indication of heart
attack and immediate medical attention is
required. Unstable angina is also known as
"crescendo angina."
• Variant (Printzmetal's) angina
results from coronary vasospasm, which temporarily reduces
coronary blood flow (i.e., produces ischemia by reducing
oxygen supply; "supply ischemia"), thereby decreasing the
oxygen supply/demand ratio. Enhanced sympathetic
activity (e.g., during emotional stress), especially when
coupled with a dysfunctional coronary vascular
endothelium (i.e., reduced endothelial production of the
vasodilators nitric oxide andprostacyclin) can precipitate
vasospastic angina. This form of angina is treated with
drugs that reverse or inhibit coronary vasospasm. These
drugs include calcium-channel blockers and nitrodilators.

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DEGENERATIVE DISORDERS

BY DR. MADIHA EHSAN ULHAQ

• Respiratory system disorders

• The law states that the stroke volume of the

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