8VM80
Pathophysiology of the
Cardiovascular System
Lecture notes
Milou van Mil
February 2021– April 2021
,Table of contents
PERIPHERAL CIRCULATION
Lecture 1 – Introduction ......................................................................................................................................... 3
Lecture 2 - Peripheral Circulation ........................................................................................................................... 3
Lecture 3 – Organization Health Care ..................................................................................................................... 7
Lecture 4 – Health Care Cost ................................................................................................................................ 10
Lecture 5 – Imaging for Peripheral Vascular Disease ........................................................................................... 13
Lecture 6 – Vascular Imaging: Ultrasound ............................................................................................................ 17
Lecture 7 – Peripheral Arterial Obstructive Disease ............................................................................................. 22
Lecture 8 – Peripheral Arterial Obstructive Disease II .......................................................................................... 27
Lecture 9 – Aortic Aneurysm (AAA) ...................................................................................................................... 32
Lecture 10 – Thoracic Aortic Pathology (TAP) ...................................................................................................... 37
Lecture 11 – Cerebrovascular Disease I ................................................................................................................ 45
Lecture 12 – Cerebrovascular Disease II ............................................................................................................... 50
Lecture 13 – Evidence Based Medicine in Peripheral Vascular Disease ............................................................... 56
Lecture 14 – Patient Specific Decision Support in Peripheral Vascular Disease ................................................... 60
CENTRAL CIRCULATION
Lecture 1 – Introduction ....................................................................................................................................... 67
Lecture 2 – Introduction to central circulation and heart valves ......................................................................... 67
Lecture 3 – Physiology and regulation processes of central circulation ............................................................... 76
Lecture 4 – Non-invasive diagnostic modalities of the heart ............................................................................... 83
Lecture 5 – Invasive diagnostic modalities of the heart ....................................................................................... 96
Lecture 6 – Electrical conduction and ischemic heart disease ........................................................................... 102
Lecture 7 & 8 - Invasive diagnostics – coronary arteries & Treatment of coronary artery disease ................... 110
Lecture 9 – Transcatheter treatment of aortic valve stenosis ............................................................................ 120
1
,2
, PERIPHERAL CIRCULATION
Lecture 1 – Introduction
Introductory lecture, see slides.
Lecture 2 - Peripheral Circulation
The circulatory system: exists of an arterial system and a venous system. The heart is the motor of the circulatory
system. With pressure, oxygenated and nutritional blood is pumped to the rest of the body. It will make sure
that every living cell will receive oxygen and metabolic substrates that are needed.
The venous system and arterial system are located closely to each other. Also the nerves follow the same track.
The venous system is a low
pressure system, but the blood
that comes from the heart is
expelled with high pressures.
For that reason, the arteries
and veins have other
structures. For example,
arteries have thicker vessel
wall to withstand the pressure.
The need for a circulatory system: all living cells require metabolic substrates (oxygen, amino acids, glucose)
and a mechanism to remove byproducts of metabolism (carbon dioxide, lactic acid). To accomplish the
necessary exchange, organisms have a sophisticated system of blood vessels that facilitates the exchange of
substances between cells and blood, and between blood and environment.
• If the system fails, the person will die. Or there can also be a part of the system that fails, which can
result for example in a kidney to die.
On the picture on the right, the different sizes of the arteries can be
seen. The largest artery is the aorta, comes from the heart. Here the
aorta has a diameter of 2-3 cm. If you go further down, the diameter
will reduce to 2-2.5 cm. In the pelvic arteries, it will be 10-15 mm. in
the upper leg, it is 4-5 mm. If we go further in the side branches, it will
be approximately 4 mm. The thickness of the wall here is 1 mm. The
further we go to the periphery, the arteries will become smaller. After
the arteries, there will be arterioles. These will have a diameter of 13
μm but the wall thickness is only 6 μm. If you go even further, in the
capillaries, the diameter will be about 8 μm whereas the wall is 0.5 μm.
• The smaller the arterial vessels are, the thinner the walls. The
same counts for the veins. The further back to the heart, the
veins will become larger and the wallthickness will increase.
3
Pathophysiology of the
Cardiovascular System
Lecture notes
Milou van Mil
February 2021– April 2021
,Table of contents
PERIPHERAL CIRCULATION
Lecture 1 – Introduction ......................................................................................................................................... 3
Lecture 2 - Peripheral Circulation ........................................................................................................................... 3
Lecture 3 – Organization Health Care ..................................................................................................................... 7
Lecture 4 – Health Care Cost ................................................................................................................................ 10
Lecture 5 – Imaging for Peripheral Vascular Disease ........................................................................................... 13
Lecture 6 – Vascular Imaging: Ultrasound ............................................................................................................ 17
Lecture 7 – Peripheral Arterial Obstructive Disease ............................................................................................. 22
Lecture 8 – Peripheral Arterial Obstructive Disease II .......................................................................................... 27
Lecture 9 – Aortic Aneurysm (AAA) ...................................................................................................................... 32
Lecture 10 – Thoracic Aortic Pathology (TAP) ...................................................................................................... 37
Lecture 11 – Cerebrovascular Disease I ................................................................................................................ 45
Lecture 12 – Cerebrovascular Disease II ............................................................................................................... 50
Lecture 13 – Evidence Based Medicine in Peripheral Vascular Disease ............................................................... 56
Lecture 14 – Patient Specific Decision Support in Peripheral Vascular Disease ................................................... 60
CENTRAL CIRCULATION
Lecture 1 – Introduction ....................................................................................................................................... 67
Lecture 2 – Introduction to central circulation and heart valves ......................................................................... 67
Lecture 3 – Physiology and regulation processes of central circulation ............................................................... 76
Lecture 4 – Non-invasive diagnostic modalities of the heart ............................................................................... 83
Lecture 5 – Invasive diagnostic modalities of the heart ....................................................................................... 96
Lecture 6 – Electrical conduction and ischemic heart disease ........................................................................... 102
Lecture 7 & 8 - Invasive diagnostics – coronary arteries & Treatment of coronary artery disease ................... 110
Lecture 9 – Transcatheter treatment of aortic valve stenosis ............................................................................ 120
1
,2
, PERIPHERAL CIRCULATION
Lecture 1 – Introduction
Introductory lecture, see slides.
Lecture 2 - Peripheral Circulation
The circulatory system: exists of an arterial system and a venous system. The heart is the motor of the circulatory
system. With pressure, oxygenated and nutritional blood is pumped to the rest of the body. It will make sure
that every living cell will receive oxygen and metabolic substrates that are needed.
The venous system and arterial system are located closely to each other. Also the nerves follow the same track.
The venous system is a low
pressure system, but the blood
that comes from the heart is
expelled with high pressures.
For that reason, the arteries
and veins have other
structures. For example,
arteries have thicker vessel
wall to withstand the pressure.
The need for a circulatory system: all living cells require metabolic substrates (oxygen, amino acids, glucose)
and a mechanism to remove byproducts of metabolism (carbon dioxide, lactic acid). To accomplish the
necessary exchange, organisms have a sophisticated system of blood vessels that facilitates the exchange of
substances between cells and blood, and between blood and environment.
• If the system fails, the person will die. Or there can also be a part of the system that fails, which can
result for example in a kidney to die.
On the picture on the right, the different sizes of the arteries can be
seen. The largest artery is the aorta, comes from the heart. Here the
aorta has a diameter of 2-3 cm. If you go further down, the diameter
will reduce to 2-2.5 cm. In the pelvic arteries, it will be 10-15 mm. in
the upper leg, it is 4-5 mm. If we go further in the side branches, it will
be approximately 4 mm. The thickness of the wall here is 1 mm. The
further we go to the periphery, the arteries will become smaller. After
the arteries, there will be arterioles. These will have a diameter of 13
μm but the wall thickness is only 6 μm. If you go even further, in the
capillaries, the diameter will be about 8 μm whereas the wall is 0.5 μm.
• The smaller the arterial vessels are, the thinner the walls. The
same counts for the veins. The further back to the heart, the
veins will become larger and the wallthickness will increase.
3
