INTRODUCTION;
Cardiovascular disease (CVD) is a term referring to the pathological process of atherosclerosis affecting the entire arterial circulation. Coronary artery disease (CAD), also called coronary heart disease (CHD), refers to the pathological process of atherosclerosis, specifically affecting the coronary arteries.
CAD includes the diagnoses of angina pectoris, myocardial infarction (MI), silent myocardial ischemia, and sudden cardiac death. he pathophysiological conditions that underlie CVD are atherosclerosis, altered myocardial muscle mechanics, valvular dysfunction, arrhythmias, and hypertension (HTN). Atherosclerosis is a disease in which lipid-laden plaque (lesions) is formed within the intimal layer of the blood vessel wall of moderate and large size arteries; over time the plaque may extend into the lumen causing a decreased lumenal diameter. Atherosclerosis is also a primary contributor to cerebrovascular disease (cerebrovascular accident [CVA]) and peripheral vascular disease (PVD). Alteration in myocardial muscle mechanics involving the systolic and/or diastolic properties of the myocardium results in an impairment of left ventricular (LV) function. Heart failure is a clinical diagnosis caused by impaired LV functioning and is referred to as congestive heart failure (CHF) when it is accompanied by signs and symptoms of edema (i.e., congestion). here are many causes of heart failure, including myocardial scarring and remodeling as a result of an MI, cardiomyopathy (involving an enlarged, thickened, and/or hardened heart muscle) from various causes, or impaired valvular function, especially within the mitral and aortic valves. Arrhythmias are caused by a disturbance in the electrical activity of the heart, resulting in impaired electrical impulse formation or conduction. Arrhythmias may present as benign or malignant (i.e., life threatening). Examples of malignant arrhythmias are sustained ventricular tachycardia (V-tach) and ventricular fibrillation (V-fib). An example of a common benign arrhythmia in the elderly is atrial fibrillation (A-fib) with a controlled ventricular response involving a ventricular rate between 60 and 100 beats per minute (bpm). HTN is the most prevalent CVD in the United States and one of the most powerful contributors to cardiovascular morbidity and mortality. HTN occurs when the systolic blood pressure is consistently greater than 140 mm Hg or the DBP is equal to or greater than 90 mm Hg. CVD remains the leading cause of death and disability in the United States. According to the American Heart Association’s Heart Disease and Stroke Statistics 2011 Update, an estimated 82,600,000 American adults (more than 1 in 3) have one or more types of CVD.1 Currently, HTN occurs in 76,400,000 individuals, CHD affects 16,300,000, and heart failure is seen in 5,700,000 patients.1 he average annual rates of first cardiovascular events rise from 3 per 1,000 men at age 35 to 44 years to 74 per 1,000 at age 85 to 94. For women, comparable rates occur 10 years later in life with a narrowing gap with advancing age.1 On average, 2,200 Americans die of CVD each day with an average of 1 death every 39 seconds.2 In every year since 1900 except 1918, CVD accounted for more deaths than any other major cause in the United States.3It is also important to note that the United States is in the midst of a demographic shift with a remarkable increase in the diversity of the American population. By 2050, there will be a decrease in the white non- Hispanic population to 52.5% from 75.7% in 1990. Hispanic population will increase to 22.5%, a change in African Americans to 15.7%, and Asian and Pacific Islanders will account for 10.3% of the population.4 hese statistics will have a major impact on the epidemiology, pathophysiology, and treatment of CVD in the forthcoming years. within the United States and worldwide, we are faced with major challenges as CVD dominates as a major cause of death and disease. his chapter provides a review of normal anatomy and physiology of the cardiovascular system and its relevance to physical therapist practice followed by a discussion of various pathologies and pertinent physical therapy implications.
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