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OBJECTIVES

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The student understands the primary disturbances, compensatory responses, decompensatory processes, and possible therapeutic interventions that pertain to various abnormal cardiovascular situations:

  • Defines circulatory shock.

  • Identifies the primary disturbances that can account for cardiogenic, hypovolemic, anaphylactic, septic, and neurogenic shock states.

  • Lists the compensatory processes that may arise during various types of circulatory shock.

  • Identifies the decompensatory processes that may arise during shock and describes how these lead to irreversible shock states.

  • Indicates how coronary artery disease may lead to abnormal cardiac function.

  • Defines the term angina pectoris and describes the mechanisms that promote its development.

  • Indicates the mechanisms by which various therapeutic interventions may alleviate angina and myocardial ischemia in association with coronary artery disease.

  • Defines the term cardiomyopathy and differentiates between dilated and hypertrophied cardiomyopathies.

  • Defines the term heart failure and differentiates between acute and chronic heart failure and between systolic and diastolic failure.

  • Identifies the short-term and long-term compensatory processes that accompany chronic systolic heart failure.

  • Describes the advantages and disadvantages of the fluid accumulation that accompanies systolic heart failure.

  • Defines pulmonary and systemic arterial hypertension.

  • Identifies the various factors that may contribute to the development of systemic hypertension.

  • Describes the role of the kidney in establishing and/or maintaining systemic hypertension.

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INTRODUCTION

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Cardiovascular disease represents the number one cause of deaths in most industrialized countries. How and when a person’s cardiovascular system breaks down depends upon an increasing number of known risk factors. These include family history and genetic predisposition to various CV system malfunctions, poor diet and/or obesity, inactivity, environmental pollutants, and the acute or chronic effects of various infective agents. In this last chapter, a variety of specific pathologies that may be evoked by these risk factors are introduced. We have already described specific pathologies associated with abnormal cardiac electrical activities and valve function in Chapter 5, so will now focus on the pathologies associated with system-wide abnormalities. It is not intended as an in-depth coverage of cardiovascular diseases but rather as an introductory presentation of how the physiological processes described previously are evoked and/or altered during various abnormal cardiovascular states. In each case, there is generally a primary disturbance associated with malfunction of some component of the cardiovascular system that threatens the maintenance of normal arterial pressure. These primary disturbances evoke appropriate compensatory reflex responses to restore arterial pressure. Often, however, pathological situations also lead to inappropriate “decompensatory processes,” which tend to accelerate the deterioration of cardiovascular function. Therapeutic interventions may be required and are often designed to limit or reverse these decompensatory processes. Students are again encouraged to review the summary of cardiovascular variables and their determinants in Appendix C because a thorough knowledge of this material will greatly help understand the physiological consequences of these abnormalities.

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CIRCULATORY SHOCK

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Image not available.A state of circulatory “shock” exists whenever there is a generalized, severe reduction in blood supply to the body tissues and the metabolic ...

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