PROJECT WORK

A Review on Understanding the Cardiovascular System :Disease , Diagnosis,

and Treatment

Submitted To

I.K.G . Punjab Technical University,Jalandhar

For the partial fullfillment of award of degree

BACHLOR OF PHARMACY

Submitted By

TAMANNA

Roll no:-2117187

Under the guidance of :

Ms. Santosh rani

Assistant Professor of Pharmaceutical Chemistry

 RAYAT BAHRA INSTITUTE OF PHARMACY

Page | 2
 CERTIFICATE

This is to certify that the project entitled “A review on understanding the

cardiovascular system: disease ,diagnosis,treatment” which is submitted in
the partial fulfillment of the requirement for the degree of Bachelor of
Pharmacy, embodies the work carried out by TAMANNA (Reg no.-2117187)
herself under the guidance of Ms Santosh rani at Rayat Bahra Institute of
Pharmacy, Hoshiarpur, Bohan-146001

Signature of supervisor

Ms.Santosh Rani

Assistant professor&supervisor

RBIP,Hoshiarpur

Dr.Maninder Pal

Director-Principal RBIP,

Hoshiarpur
 DECLARATION

I hereby declare that the work contained in this project entitled "A Review on “REVIEW ON
UNDERSTANDING CARDIOVASCULAR SYSTEM:DISEASE, DIAGNOSIS,
TREATMENT ” is my own work and is original. This work has not been submitted in part or
full for award for any other degree in any other Institution / university.

Signature of Candidate

TAMANNA

Bachelor of Pharmacy, 8THsemester

Date:

Place: Rayat Bahra Institute of Pharmacy

ACKNOWLEDGEMENT

Page | 4
I am ever grateful to God, the Creator and the Guardian, and to whom I owe my very existence.
Thanks God, the merciful and the passionate, for providing me the opportunity to step in the
excellent world of science. Today with humility, bowed head, misty eyes, and folded hands
when, I am thanking Almighty in I owe my sincere thanks to the Ms Santosh Rani, Rayat
Bahra Institute of Institute Pharmacy,Hoshiarpur for his valuable advice and help.These
blissful moments, I am incapable of expressing my innermost into words.

The same perplexity haunts inside me in penning down my sagacious sense of gratitude and
admiration towards my venerable guide, Dr. Maninder Pal Singh Prof., Rayat Bahra of
Pharmacy, Hoshiarpur for her illuminating guidance, unflinching support.

I express my in debt to those authors of monographs, articles and books from which I have
gained so much information for completion of this project.

I wish to recall my sincerest gratitude to my colleagues who have spared me much of my time
for compiling this manuscript.

TAMANNA

INRODUCTION

All human movement, whether movement of the body around an athletics track or the
movement of blood around the body, is dependent on energy. The body’s ability to
provide sufficient energy will limit the rate at which movement can occur, e.g. how
fast an athlete can run or cycle. This energy is contained in the food we eat and is
stored throughout the body until it is needed. The energy in these stores can be

Page | 5
released via several metabolic pathways; a specific series of processes which result in
energy that can be used by the body’s cells. Which pathway is used depends on: the substrate
used (carbohydrate, fat or protein), the rate at which energy is needed and the availability of
oxygen. The main role of the cardiovascular system is to provide the oxygen needed in these
metabolic pathways and to remove the by-products of metabolism such as carbon dioxide. In
addition, it plays a vital role in the transport of many substances around the body
includinghormones and substrates. In this we examine the structure and function of the
cardiovascular system including the blood vessels and blood.
Learning Outcomes (LO)
This chapter is designed to help you be able to:
1) Describe the anatomy and structure of the heart and blood vessels;
2) Describe the conduction system of the heart;
3) Identify the main features of an electrocardiogram;
4) Understand the control of cardiac output during physical activity;
5) Understand the terms systolic and diastolic blood pressure;

The Heart

The heart, which is about the size of your fist, is the organ that is responsible for
pushing blood around your body which it does 24 hours a day, seven days a week for
your entire life, potentially resulting in over three billion heart beats. At its most
simple the heart can be considered as a four chambered organ which functions as two
parallel pumps . The four chambers are the left and right atria and left and right ventricles (ven
tri-kel), the atria are receiving chambers while the ventricles expel the blood from the heart. The
right side receives blood from the body .

Page | 6
 FigNo : 1 Anatomy of the HEART

via the vena cava (great vein) which carries blood from the body’s tissues. This blood
is low in oxygen (O2) and high in carbon dioxide (CO2) as it has delivered the O2 to
the working cells and picked up the CO2 which is a by-product of metabolism. Once
the blood has arrived at the right atrium it travels via the tricuspid atrioventricular (a
tre-o-ven-trik yu-lar) valve into the right ventricle where it is ejected into the
pulmonary artery which transports the blood to the lungs. Here, CO2 is removed and
O2 added. Once the blood has travelled through the lungs it is returned to the heart via
the pulmonary veins where it enters the left atrium.

The blood is now high in O2 and low in CO2, having entered the left atrium it flows
through the bicuspid atrioventricular valve into the left ventricle where it is pumped to
the rest of the body the aorta. Since the left side of the heart has to
pump blood to the whole body the muscle here is far larger than that of theright.

The Heart Wall

The heart is surrounded by a layer of connective tissue called the pericardium (peri = around;
cardium = heart) which protects and anchors it in position.
The inner portion of the pericardium comprises two layers separated by the serous
(ser us) fluid which reduces friction to ensure the two layers glide over each other.

Page | 7
This low friction environment is essential to protect the heart wall during the
movement produced as the heart beats; without it the heart would rub against its surrounding
structures with every beat resulting in damage to the heart tissue : Chambers, valves and main
blood vessels of the heart .

Fig No: 2 Heart Walls

To highlight the importance of this low friction environment make a fist with your
right hand, now wrap your left hand around your right tightly. Now pump your right
fist as if it were your heart, you will soon notice the heat generated as the skin of your
hands rub together and if you do this for a couple of minutes you could end up with a
blister. Inside the protective layer of the pericardium is the heart wall which comprises three
layers. The outer layer is the epicardium next is the myocardium ( myo = muscle) which is the
heart, or cardiac, muscle, forming the bulk of the heart, and finally there is the endocardium
endo = within). The myocardium is the part of the heart which produces the beat and, likeskeletal
muscle is striated or striped and has the same mechanism of contraction .There are, however,
several key differences between the two.

The stimulate skeletal muscle you activate the number of motor units you need to

Page | 8
produce the desired force. The heart, however, contracts all its muscle fibres in every
beat. The reason for this is that while skeletal muscle fibres are insulated from each
other so that the electrical stimulation of one fibre does not stimulate the adjacent
fibre, the fibres of the heart are connected by ‘gap junctions’ so that once started, the
electrical signal sweeps across the whole heart resulting in a co-ordinated beat.

The heart beat is said to be an all or nothing event at the organ level, i.e. the whole
heart either beats or it does not beat at all whereas skeletal muscle is an all or nothing
event at the motor unit level, i.e. while all the fibres in a single motor unit will be
stimulated other motor units within the same muscle are not necessarily stimulated.
Another key difference between skeletal and cardiac muscle is the way they re-form
ATP. As discussed the body’s tissues and particularly skeletal muscle,
can derive energy from both anaerobic (without O2) and aerobic (with O2) pathways.
The heart muscle is, however, far more reliant on aerobic metabolism and it is vital
that the blood supply, and therefore the O2 delivery, to the myocardium is maintained.
If the blood supply is interrupted it can result in a myocardial infarction (mi o-kar de
al infark shun) or heart attack. The final layer of the heart wall, the endocardium, is in
direct contact with blood as it passes through the heart chambers and it extends into
the lining of the blood vessels which deliver the blood to, and carry blood away from,
the heart.

Blood flows through both sides of the heart in one direction due to a series of four
valves, two on each side. These valves are situated between the atria and the
ventricles, the atrioventricular valves, and at the point at which blood leaves the
ventricles and enters the main arteries, the semilunar valves (Figure 12.1). On the
right hand side of the heart, the atrioventricular valve has three flaps and is known as
the tricuspid valve while the left hand side equivalent has two flaps and is known as
the bicuspid or mitral valve. As blood flows through the atria and fills the ventricles
the pressure in the ventricles increases, the atria then contract resulting in a final rush
of blood into the ventricles, further increasing the pressure. The atria then relax and

Page | 9
the ventricles contract, the increase in pressure in the ventricles snaps the valves shut
stopping blood flowing back into the atria. This snapping shut of the atrioventricular
valves results in the first of the heart sounds, the ‘lub’ of the ‘lub-dub’ you can hear
when you place your ear against someone’s chest or when you use a stethoscope. The
second sound, the ‘dub’, is caused by the semilunar valves snapping shut after the
ventricles relax following their contraction which pushes blood from the heart. Once
closed, the semilunar valves stop blood flowing back into the ventricles from the main
arteries.

Sometimes the valves of the heart do not seal properly and blood can flow in the
wrong direction, this can be due to a heart abnormality or heart disease. If this occurs
there is a surgical procedure in which the valves can be replaced with synthetic valves
or the valves from a pig’s heart.
Blood Supply to the Heart
One thing to remember about the heart is that while there is always a large volume of
blood travelling through it, it is not this blood that delivers O2 to its own tissue. The
blood supply (and therefore O2 and nutrient supply) to the heart’s tissue is delivered
by a special set of blood vessels which make up the coronary circulation. The arteries
of the coronary circulation leave the aorta as soon as it leaves the left ventricle, they
then wrap around the heart delivering blood to its tissue.
Arteries – blood vessels which take blood away from the heart
After the blood has delivered its O2 to the heart tissue it is taken directly back to the
heart chambers via the cardiac veins which empty directly into the right atrium.
Veins – blood vessels which take blood toward the heart
Key Point 12.3
The term Coronary Heart Disease (CHD) refers to damage and deterioration of the
heart’s blood supply or, if the arteries are damaged this is known as Coronary Artery
Disease (CAD). In the UK 25% of men and 17% of women die from CHD making it
the country’s biggest killer.
Conduction System

Page | 10
For the heart to pump effectively contraction of the myocardium needs to be co
ordinated, this is orchestrated by the heart’s conduction system. While skeletal muscle
needs to be stimulated by a nerve, the heart’s ability to contract is intrinsic, this means 8
that you could disconnect the heart from all nervous connections and it would
continue to beat. Even so it still has a large number of nerves connected to it which
play key roles in regulating its activity.
There are specialist cells within the heart called autorhythmic cells and as the name
suggests these cells have the ability to set a rhythm automatically. They are found in
several clusters throughout the heart and each cluster has its own rhythm. It is this
rhythm that sets the pace of the heart beat. Since the different clusters of these
autorhythmic cells have different rates it is always the cells with the fastest rhythm
that will set the rate at which the heart beats or, the Heart Rate (HR).
In a healthy heart the cells with the fastest rate, or rhythm, are found in the Sinoatrial
(SA) Node at the top of the right atrium. The rhythm of these cells would trigger a
heart beat every 0.6 of a second and result in a heart rate of 100 beats per minute
(bpm). However, the nerves which are connected to the heart slow this rhythm down
so that the heart actually beats at a rate of approximately 75bpm when resting. Resting
heart rate is, of course, very variable and depends on the fitness level and health of the
individual. Resting heart rates of below 30bpm have been recorded in elite endurance
athletes while heart disease patients can have resting values above 100bpm. The SA
node initiates the heart beat by sending an electrical impulse across the left and right
atria which causes them to contract, forcing the blood into the ventricles.

Electrocardiography (ECG)

The electrical impulse which causes the heart to beat can be detected on the surface of
the body by a piece of equipment known as an electrocardiograph . This plots the electrical
changes during the heart beat, producing an
electrocardiogram (ECG) . The normal ECG pattern comprises three
waves: the P wave, QRS Complex and T wave, each of which is associated with

Page | 11
specific events during a single heart beat. The SA node initiates the heart beat by
sending a signal across the atria, this is seen on the ECG as the P wave. There is then
a short pause while the impulse travels down the AV bundle, the bundle branches and
finally the purkinje fibres. The QRS complex results from the contraction signal
sweeping across the ventricles. Finally, the ventricles need to reset before the next
beat, this results in the T wave.

Fig No : 3 The electrocardiogram (ECG)

The ECG can be used in medical screening to identify numerous heart abnormalities.
For example, a missing P wave indicates that the SA node is not functioning and the
second fastest set of autorhythmic cells, the AV node, instead sets the heart rate at 40-
60bpm.

Cardiac Output
We have now examined the basic structure of the heart and how the heart beats to
push blood around the body. We now examine how the amount of blood being

Page | 12
delivered to the body can be manipulated. When you start to exercise the amount of
O2 needed by your muscles will increase very rapidly so you will start to breathe more
deeply and move more air into the lungs so that O2 can be taken by the blood and
delivered to the working tissue around the body. The heart will also have to work
harder to increase the rate at which blood is pumped around the body. The amount of
blood leaving the heart in one minute is called the Cardiac Output (CO) which is a
product of HR and Stroke Volume (SV). At rest if an individual’s heart rate was
60bpm and they pumped out 83ml of blood every beat their CO would be 60bpm 
83ml/beat = 4980ml/min. Cardiac output can therefore be changed by changing either
HR or SV, so for a fixed CO a larger heart with a larger SV would result in a lower
HR. This is why endurance athletes have lower resting heart rates because one of the
changes that occurs with training is an increase in heart size and SV .

Units for Cardiac Output:

CO = 60beats/min83ml/beat
= 4980ml/min = 4.98L/min

Heart Rate
As already stated resting heart rate is dependent on fitness level and athletes have
larger hearts and greater SV than sedentary individuals. Healthy individuals will have
a resting HR of 60-75bpm and a maximal HR (HRmax) which is dependent on age.
As we age our HRmax will decrease by approximately 1 beat each year. A simple
method of calculating your HRmax is to subtract your age from 220, so a 20 year old
would have a HRmax of 200bpm. Care must be taken with this calculation as it is
very approximate and five per cent of all 20 year olds will have a HRmax of less than
180 or greater than 220bpm.
Heart rate increases with exercise intensity in a linear fashion so as
exercise intensity increases so does HR until you reach your HRmax when you will be
working extremely hard.
As you can see the athlete has a much lower HR at all

Page | 13
speeds but both individuals stop exercising at a similar HRmax, 200bpm. The main
difference is that the athlete can run at 24km/h before they fatigue, while the
sedentary individual can only manage 16km/h. 14

Anatomy of the Blood Vessels

There are three main types of blood vessel: the arteries which carry blood away from
the heart at high pressure, the veins which carry blood back to the heart at a much
lower pressure and the capillaries which have very thin walls to allow the exchange of
materials between the blood and the body’s tissues. Arteries and veins have three
layers or tunics; one of the differences between the two types of blood vessel is the
way in which these three layers make up the blood vessel wall. The outer most layer
of a blood vessel is known as the tunica adventitia (; coming from
outside), it surrounds the blood vessel, protects it and anchors it to surrounding tissues.
The second layer, the tunica media is comprised of relatively large
amounts of smooth muscle and plays an important role in the redistribution of blood
flow via vasoconstriction. The final layer, the tunica intima is in
direct contact with the blood and its cells have very smooth surfaces to minimise
Arteries
Arteries carry blood away from the heart, those leaving the right side of the heart
carry blood low in O2 to the lungs and those on the left carry blood high in O2 to the
rest of the body.

Page | 14
 Fig No : 4 Artries

Veins
Veins return blood to the heart so those supplying the left hand side have high levels
of O2 as the blood has just passed through the lungs. The blood in the veins supplying 17
the right side is low in O2 as the blood is returning from the body. The pressure in
veins is much lower than in arteries therefore the walls of the veins are much thinner
with relatively little smooth muscle. The low pressure also means that there is
relatively little driving force to push the blood forward, so the veins have valves.
These are functionally similar to the ones in the heart as they are one-way, meaning
that blood can flow towards the heart but if it tried to flow in the opposite direction
the valve would close to stop the flow until there was enough pressure to drive it
forward again. A mechanism which helps blood return to the heart is known as the
‘muscle pump’. When skeletal muscle contracts concentrically (Chapter 11) it
shortens and widens; this presses against the vein, increasing the pressure, and
pushing the blood forward. This is an important reason why we warm down after
exercise. During physical activity the arteries increase the blood supply to the muscles
and blood is helped back to the heart via the muscle pump, however, if you stop
exercise suddenly without warming down the blood will not be able to return to the
heart as effectively.
Capillaries
Capillaries link the arteries and the veins, and in the capillaries the blood exchanges
the O2 and nutrients it is carrying for CO2 and other waste products produced by the
body’s tissues. For this exchange to occur the walls of the capillaries are very thin and
have no tunica adventitia or tunica media. In the smallest capillaries the tunica intima
can be made up from a single cell wrapped around the lumen which is only wide
enough for blood cells to pass through individually. Even though the cross sectional
area of the lumen of a single capillary is very small there are so many more capillaries 18

Page | 15
than arteries and veins that if you were to combine the cross sectional areas of all the
capillary lumens the total area would be far greater than that of either the arteries or
the veins. This is important as it allows the blood to slow down as it moves through
the capillaries giving time for the exchange of O2 and CO2.
Blood Pressure
As the heart beats there is an increase in pressure which pushes the blood out of the
heart and into the arteries, this pressure is transferred to the artery wall and is known
as Blood Pressure (BP). Blood pressure varies during the heart beat and two measures
are normally taken when we record BP: systolic and diastolic.
Systolic is the pressure exerted on the artery wall when the heart contracts, a period
known as systole). Diastolic pressure is exerted when the heart relaxes to
refill with blood between beats, a period known as diastole . Typical
values for a healthy adult are 120mmHg and 80mmHg for systolic and diastolic,
respectively. It is important to note that these values are resting values and only in the
artery of the upper arm (the brachial artery). If BP was measured in an artery closer to
the heart the pressure would be greater whereas if the measurement was taken in an
artery further from the heart the pressure would be less, and, BP in the veins is very
low in comparison, less than 20mmHg. 19

Units of BP: mmHg = millimetres of mercury

This unit expresses the pressure as an equivalent of the pressure that is exerted by a
column of mercury of a given height in millimetres. For example, a typical systolic
BP of 120mmHg means that the pressure the blood exerts on the artery wall is the
same as that exerted by a column of mercury 120mm high.
Blood pressure is very responsive to stress, posture and physical exercise, for example,
if you stand up very quickly from lying down you sometimes feel lightheaded. This is
because while lying down your BP is low as the heart does not have to work hard to
pump blood against gravity to your brain. When you stand up gravity has an
immediate effect on the blood, pushing it down to your legs and it can take the heart
several seconds to adjust to the change and increase the pressure to push the blood up

Page | 16
to the brain; during this time you can experience dizziness. Similarly, when you start
to perform exercise the heart has to work harder to pump more blood at higher
pressure to the working muscles.
Blood
The typical male has five to six litres of blood whereas a typical female has four to
five litres; this accounts for approximately 8% of total body mass. Blood is the
medium through which substances are moved around the body, this includes
hormones, nutrients, proteins, cells and gases such as O2 and CO2. Blood has evolved
some highly specialised methods of transporting these essential life materials. Firstly,
let’s look at what blood is made up of; if you place a blood sample in a test tube and 20
spin it in a centrifuge at several thousand revolutions per minute for several minutes
the heaviest components of blood will be pushed to the bottom of the tube and the
lighter ones will float to the top. If you then look at the tube you will see that the
blood has separated out into three distinct bands. In the bottom of the tube you will
see a dark red substance, these are the red blood cells or erythrocytes (e-rith ro-site;
erythro = red, cyte = cell). Next is a thin layer called the ‘buffy coat’ which is made
up of platelets and white blood cells or leukocytes (lu ko-site; leuko = white), finally
floating on the top is a straw coloured liquid called plasma.

CARDIOVASCULAR DISEASE AND THEIR TREATMENT

Cardiovascular disease is a group of conditions that affect your heart and blood vessels. It's
sometimes also called heart disease. Conditions that affect your heart and blood vessels can
include problems you're born with, heart valves that don't work they way they should, and
irregular heart rhythms. But when most doctors talk about cardiovascular disease, they are
talking about conditions in these four main categories:

1. Coronary artery disease (CAD) or coronary heart disease (CHD). This is when you have
a blockage or narrowing in your coronary arteries, which deliver oxygen-rich blood to
your heart. This blockage or narrowing is usually due to cholesterol plaques that build up
in your arteries and limit the amount of blood that can get to your heart muscle. CAD is

Page | 17
 the most common type of heart disease; about 33%-50% of people with cardiovascular
disease have CAD. The blockage can cause angina (chest pain), myocardial infarction (a
heart attack), and heart failure.

2. Cerebrovascular disease (CVD). These are conditions that affect the flow of blood to
your brain. CVD can cause a stroke and a transient ischemic attack (TIA), which is a
temporary stroke that's often a warning sign of an actual stroke.

3. Peripheral artery disease (PAD). This is when you have a blockage or narrowing in your
peripheral arteries, which send oxygen-rich blood from your heart to your arms and legs.
This can cause pain, trouble walking, and sores on your limbs that won't heal.

4. Aortic atherosclerosis. This is when you have a blockage or narrowing in your aorta,
which is the largest artery in your body. Your aorta runs from your heart to your pelvis,
and you can get a blockage anywhere along this length. The most common place, though,
is in the section that runs through your belly, or abdomen. When you have a blockage in
your aorta, you may not get enough oxygen-rich blood flowing to many of your organs.
You're also at an increased risk of an embolus, which is a sudden, complete block of your
aorta. This can be due to a blood clot (thromboembolism) or a cholesterol plaque
(atheroembolism). Thromboembolism is more common than atheroembolism. Aortic
atherosclerosis can also weaken the wall of your aorta, which raises your risk of an aortic
aneurysm. An aortic aneurysm is a bulge in your aorta that can be serious or life-
threatening if it bursts or splits.

Your symptoms will depend on which condition you have, but some common symptoms that
suggest you may have a heart issue include:

 Chest pain (angina)

 Chest pressure or discomfort

 Shortness of breath

Page | 18
  Dizziness or fainting

 Fatigue

Cardiovascular disease is the leading cause of death in the U.S. If you have symptoms, it’s
important for you to go to the doctor for a check-up. You can help keep your heart healthy by
working with your doctor to manage any health conditions you have and practicing a healthy
lifestyle.

Cardiovascular Disease Causes

Causes depend on the type of disease you have. For instance, causes by type of condition
include:

 Atherosclerosis (hardening of your blood vessels due to a buildup of plaques made from
fat, cholesterol, calcium, and other substances) causes coronary artery disease (CAD) and
peripheral artery disease (PAD).

 Having CAD, scarring of your heart muscle, certain medications, or genetic problems can
cause an arrhythmia (an irregular heartbeat).

 Rheumatic disease, certain infections, and aging can cause problems with your heart
valves.

Cardiovascular disease risk factors

People who get cardiovascular disease usually have one of more of the following risk factors:

 Tobacco use, including vaping

 Lack of exercise or physical activity

 Having excess weight or obesity

 Having a diet high in sodium, sugar, and fat

Page | 19
  Misuse of prescription or recreational drugs

 Family history of heart disease

 High blood pressure (hypertension)

Cardiomyopathies

Cardiomyopathy is the medical term for conditions that affect the muscle of your heart (called
the myocardium). Cardiomyopathy can make your heart stiff, enlarged, or thickened. This means
it can't pump blood to the rest of your body very well. It gets worse over time and can lead to
heart failure.

It can run in your family but can also be causedby many things, including coronary artery disease
(CAD), inflammation, infection in your heart muscle, and autoimmune connective tissue
conditions.

Symptoms include:

 Tiredness or fatigue

 Heart palpitations

 Chest pain

Coronary artery disease (CAD)

This is when one or more of your coronary arteries are narrowed or blocked due to the buildup of
plaque. Your coronary arteries are two major blood vessels that supply blood to your heart
muscle: the right coronary artery and the left main coronary artery. These main arteries branch
off to supply blood to the deeper tissues in your heart.

Congenital heart disease

Page | 20
This is a problem with how your heart forms before you are born. It keeps your blood from
flowing normally through your heart. Problems with how your heart form can include:

 A hole in the wall of your heart

 Problems with your blood vessels, such as too many or too few blood vessels, or blood
flowing too slowly, to the wrong place, or in the wrong direction

 Problems with your heart valves that help control the timing and direction of the flow of
your blood

Symptoms may start at birth or may appear later. The symptoms may vary and depend on a
number of things, such as your age, the type of defect you have, how severe your defect is, and if
you have more than one thing going on. If you have symptoms, they may include:

 Tiredness or fatigue

 Fast breathing or difficulty breathing

 Feeling unusually tired or out of breath during exercise

 Heart murmur

 Poor blood circulation

 Weak pulse or pounding heart

 Excessive sleepiness

 Cyanosis (when your skin, lips, or nails turn blue due to lack of oxygen)

Plaque is usually made up of cholesterol and other fats, proteins, and calcium, as well as some
blood cells and immune cells that encourage inflammation. Plaques start to build up when you
have damage to the lining of your arteries. Once it starts, it continues to grow over time.

Page | 21
Plaque tends to build up slowly. You may not have any symptoms until your arteries are
significantly narrowed so that your heart has to pump really hard to get blood to all the different
parts of your body. If you do have symptoms, the most common one is stable angina. This is
when you have chest pain or discomfort that comes and goes in a pattern, usually when you're
very stressed, filled with emotions, or during physical activity. This pain or discomfort usually
goes away when you rest or if you take the angina medicine nitroglycerin. The second most
common symptom is shortness of breath during even light exercise. In some cases, you may not
know you have CAD until you have a heart attack.

Heart failure

This is a chronic (long-term) condition where your heart can't pump blood well enough to keep
your body functioning as well as it should. Since your heart isn't able to move your blood well,
blood builds up in other parts of your body, usually your lungs, legs, and feet. It's also sometimes
called congestive heart failure.

Heart failure is a major health problem in the United States; it affects more than 6.7 million
people. And it's the leading cause of hospitalization in people older than 65. According to the
American Heart Association, the number of people diagnosed with heart failure in the U.S. is
projected to rise to 8.5 million by 2030.

Heart failure can be caused by many other cardiovascular diseases, including arrhythmia,
coronary heart disease (CAD), heart attack, cardiomyopathy, and congenital heart disease; as
well as having extra weight, kidney disease, and high blood pressure; and using alcohol, tobacco.

You may not have any symptoms, or you may only have mild symptoms. Symptoms can come
and go, although heart failure does tend to get worse over time. If you do have symptoms, they
can include:

 Shortness of breath, including waking up in the night with shortness of breath

 Chest pain

 Heart palpitations

Page | 22
  Fatigue when you're physically active

Heart valve disease

You have four heart valves that sit at the exit of each of your four heart chambers: the pulmonary
valve, aortic valve, mitral valve, and tricuspid valve. They keep your blood flowing in the right
direction as your heart beats.Your valves are made of small flaps of tissue called leaflets. When
your heart contracts, the leaflets open to allow blood to move forward to the next chamber. When
your heart relaxes, the leaflets close to prevent blood from flowing backward. There are several
kinds of valve disease, and you can have the same problem in more than one valve. Examples of
heart valve problems include:

 Valvular stenosis. This is when your leaflets get stiff, which means the leaflets is your
valve won't open as much when your heart contracts. It reduces the amount of blood that
your heart can move with each pump.

 Valvular insufficiency. This might be called regurgitation, incompetence, or a leaky

valve. It happens when your valve doesn’t close tightly enough, which allows blood to
leak backward. So your heart has to beat harder to make up for the backward leak.

 Valvular atresia. This is when your valves don't form correctly before you're born.

Heart valve disease can be caused by rheumatic fever, infective endocarditis (an infection of
your heart muscle), a heart attack, heart failure, degeneration of your heart valves over time, or a
thoracic aortic aneurysm.

You may not have any symptoms of heart valve disease until the problem gets bad enough to
make your heart work extra hard. If you do have symptoms, they can include:

 Shortness of breath that gets worse, especially when you exercise or lie down

 Heart palpitations

 Swelling of your ankles, feet, or abdomen (edema)

Page | 23
Pericarditis

This is inflammation in the sac that surrounds your heart (called the pericardium). It has many
causes. But about 90% of the time, your doctor may not be able to tell what caused it. Potential
causes include:

 An infection with a virus, bacteria, fungus, or parasite

 Autoimmune conditions, such as lupus, rheumatoid arthritis, or scleroderma

 Injury to your chest

 Kidney failure

 Lymphoma

 Medications that suppress your immune system (very rare)

 Certain genetic conditions, such as familial Mediterranean fever

The main symptom is sharp, stabbing chest pain that may get worse when you cough, swallow,
take a deep breath, or lie down flat. It may get better when you sit up or lean forward. You may
feel like you need to bend over or hold your chest to make breathing easier and more
comfortable. Other symptoms include:

 Pain in your back, neck, or left shoulder

 Difficultly breathing when you lie down

 A dry cough

Stroke

Strokes happen when part of your brain doesn't get enough blood, usually because of a blocked
artery or bleeding in your brain. When your brain cells can’t get the oxygen and nutrients they

Page | 24
need, they begin to die. This is a life-threatening medical emergency. If you have any signs or
symptoms of a stroke, you need to call 911 and get to the emergency room as soon as possible.

Your symptoms will depend on which part of your brain is affected, but they may include:

 Weakness or paralysis on one side of your body

 Difficulty speaking or loss of your ability to speak

 Slurred speech

 Loss of muscle control on one side of your face

 Sudden partial or total loss of one or more of your senses: vision, hearing, smell, taste, or
touch

 hich uses MRI or CT to make images of the blood vessels in your legs, neck, and head.

Cardiovascular Disease Treatments

Treatments for cardiovascular diseases will be based on your symptoms and the condition you
have. Common treatments include:

 Active surveillance, where your doctor will monitor you with tests over time without
medication, procedures, or surgeries. If your symptoms or condition worsens, they will
advise you on treatment options at that time.

 Medications, including ones that treat risk factors like blood pressure or cholesterol or
those used to break up clots

 Medical procedures or surgeries, such as heart valve surgery, coronary artery bypass graft
surgery, or having a balloon or stent placed

Page | 25
  Cardiac rehabilitation, which uses a supervised exercise program to help your heart get
stronger after after a heart attack, if you have heart failure, or after a heart procedure or
surgery

 Making lifestyle changes, such as changing your diet, increasing your exercise, and
quitting alcohol and tobacco

Cardiovascular Disease Complications

Left untreated, cardiovascular disease can have serious complications, including:

 Heart attack

 Stroke

 Sudden blocks in the arteries of your legs (acute limb ischemia)

 Aortic dissection, which is when the lining of your artery splits or tears

 Sudden cardiac arrest, which is an electrical issue with your heart where it either stops
beating or beats too fast to pump your blood

How to Prevent Cardiovascular Diseases

You can't prevent some types of cardiovascular disease, such as a congenital heart condition. But
you can help keep your heart as healthy as it can be and help prevent other types of
cardiovascular conditions by practicing a healthy lifestyle. For instance:

 Avoid all tobacco products.

 Manage your other health conditions, especially type 2 diabetes, high cholesterol, and
high blood pressure.

 Achieve and maintain a healthy weight.

Page | 26
  Eat a diet low in saturated fat and sodium.

 Exercise at least 30-60 minutes per day on most days.

 Reduce and manage your stress.

STROKE

An ischemic stroke occurs when the blood supply to part of the brain is blocked or reduced. This
prevents brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.
Another type of stroke is a hemorrhagic stroke. It occurs when a blood vessel in the brain leaks
or bursts and causes bleeding in the brain. The blood increases pressure on brain cells and
damages them.

Symptoms of stroke include:

 Trouble speaking and understanding what others are saying. A person having a stroke
may be confused, slur words or may not be able to understand speech.

 Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side
of the body. The person can try to raise both arms over the head. If one arm begins to fall, it
may be a sign of a stroke. Also, one side of the mouth may droop when trying to smile.

 Problems seeing in one or both eyes. The person may suddenly have blurred or blackened
vision in one or both eyes. Or the person may see double.

 Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness

and a change in consciousness may occur with the headache.

 Trouble walking. Someone having a stroke may stumble or lose balance or coordination.

Causes

Page | 27
There are two main causes of stroke. An ischemic stroke is caused by a blocked artery in the
brain. A hemorrhagic stroke is caused by leaking or bursting of a blood vessel in the brain. Some
people may have only a temporary disruption of blood flow to the brain, known as a transient
ischemic attack (TIA). A TIA doesn't cause lasting symptoms.

Ischemic stroke

Ischemic stroke

This is the most common type of stroke. It happens when the brain's blood vessels become
narrowed or blocked. This causes reduced blood flow, known as ischemia. Blocked or narrowed
blood vessels can be caused by fatty deposits that build up in blood vessels. Or they can be
caused by blood clots or other debris that travel through the bloodstream, most often from the
heart. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged
in the blood vessels in the brain.

Some early research shows that COVID-19 infection may increase the risk of ischemic stroke,
but more study is needed.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Bleeding
inside the brain, known as a brain hemorrhage, can result from many conditions that affect
the blood vessels. Factors related to hemorrhagic stroke include:

 High blood pressure that's not under control.

 Overtreatment with blood thinners, also known as anticoagulants.

Page | 28
 Bulges at weak spots in the blood vessel walls, known as aneurysms.

 Head trauma, such as from a car accident.

 Protein deposits in blood vessel walls that lead to weakness in the vessel wall. This is known
as cerebral amyloid angiopathy.

 Ischemic stroke that leads to a brain hemorrhage.

A less common cause of bleeding in the brain is the rupture of an arteriovenous malformation
(AVM). An AVM is an irregular tangle of thin-walled blood vessels.

Transient ischemic attack

A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke.
But a TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood
supply to part of the brain. The decrease may last as little as five minutes. A transient ischemic
attack is sometimes known as a ministroke.

A TIA occurs when a blood clot or fatty deposit reduces or blocks blood flow to part of the
nervous system.

Seek emergency care even if you think you've had a TIA. It's not possible to tell if you're having
a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a
partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of
having a stroke later.

Risk factors

Many factors can increase the risk of stroke. Potentially treatable stroke risk factors include:

Lifestyle risk factors

 Being overweight or obese.

Page | 29
 Physical inactivity.

 Heavy or binge drinking.

 Use of illegal drugs such as cocaine and methamphetamine.

Medical risk factors

 High blood pressure.

 Cigarette smoking or secondhand smoke exposure.

 High cholesterol.

 Diabetes.

 Obstructive sleep apnea.

 Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart
rhythm, such as atrial fibrillation.

 Personal or family history of stroke, heart attack or transient ischemic attack.

 COVID-19 infection.

Other factors associated with a higher risk of stroke include:

 Age — People age 55 or older have a higher risk of stroke than do younger people.

 Race or ethnicity — African American and Hispanic people have a higher risk of stroke
than do people of other races or ethnicities.

 Sex — Men have a higher risk of stroke than do women. Women are usually older when they
have strokes, and they're more likely to die of strokes than are men.

Page | 30
 Hormones — Taking birth control pills or hormone therapies that include estrogen can
increase risk.

Complications

A stroke can sometimes cause temporary or permanent disabilities. Complications depend on

how long the brain lacks blood flow and which part is affected. Complications may include:

 Loss of muscle movement, known as paralysis. You may become paralyzed on one side of
the body. Or you may lose control of certain muscles, such as those on one side of the face or
one arm.

 Trouble talking or swallowing. A stroke might affect the muscles in the mouth and throat.
This can make it hard to talk clearly, swallow or eat. You also may have trouble with
language, including speaking or understanding speech, reading or writing.

 Memory loss or trouble thinking. Many people who have had strokes experience some
memory loss. Others may have trouble thinking, reasoning, making judgments and
understanding concepts.

 Emotional symptoms. People who have had strokes may have more trouble controlling their
emotions. Or they may develop depression.

 Pain. Pain, numbness or other feelings may occur in the parts of the body affected by stroke.
If a stroke causes you to lose feeling in the left arm, you may develop a tingling sensation in
that arm.

 Changes in behavior and self-care. People who have had strokes may become more
withdrawn. They also may need help with grooming and daily chores.

Prevention

Page | 31
You can take steps to prevent a stroke. It's important to know your stroke risk factors and follow
the advice of your healthcare professional about healthy lifestyle strategies. If you've had a
stroke, these measures might help prevent another stroke. If you have had a transient ischemic
attack (TIA), these steps can help lower your risk of a stroke. The follow-up care you receive in
the hospital and afterward also may play a role.

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general,
healthy lifestyle recommendations include:

 Control high blood pressure, known as hypertension. This is one of the most important
things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood
pressure can help prevent a TIA or stroke in the future. Healthy lifestyle changes and
medicines often are used to treat high blood pressure.

 cardiovascular disease and diabetes.

 Eat a diet rich in fruits and vegetables. Eating five or more servings of fruits or vegetables
every day may reduce the risk of stroke. The Mediterranean diet, which emphasizes olive oil,
fruit, nuts, vegetables and whole grains, may be helpful.

 Exercise regularly. Aerobic exercise reduces the risk of stroke in many ways. Exercise can
lower blood pressure, increase the levels of good cholesterol, and improve the overall health
of the blood vessels and heart. It also helps you lose weight, control diabetes and reduce
stress. Gradually work up to at least 30 minutes of moderate physical activity on most or all
days of the week. The American Heart association recommends getting 150 minutes of
moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity a week.
Moderate intensity activities can include walking, jogging, swimming and bicycling.

 Lower the amount of cholesterol and saturated fat in your diet. Eating less cholesterol
and fat, especially saturated fats and trans fats, may reduce buildup in the arteries. If you
can't control your cholesterol through dietary changes alone, you may need a cholesterol-
lowering medicine.

Page | 32
 Quit tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to
secondhand smoke. Quitting lowers your risk of stroke.

 Manage diabetes. Diet, exercise and losing weight can help you keep your blood sugar in a
healthy range. If lifestyle factors aren't enough to control blood sugar, you may be prescribed
diabetes medicine.

 Maintain a healthy weight. Being overweight contributes to other stroke risk factors, such
as high blood pressure,

 Drink alcohol in moderation, if at all. Drinking large amounts of alcohol increases the risk
of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol also may interact
with other medicines you're taking.

 Treat obstructive sleep apnea (OSA). OSA is a sleep disorder that causes you to stop
breathing for short periods several times during sleep. Your healthcare professional may
recommend a sleep study if you have symptoms of OSA. Treatment includes a device that
delivers positive airway pressure through a mask to keep the airway open while you sleep.

 Don't use illicit drugs. Certain illicit drugs such as cocaine and methamphetamine are
established risk factors for a TIA or a stroke.

Preventive medicines

If you have had an ischemic stroke, you may need medicines to help lower your risk of having
another stroke. If you have had a TIA, medicines can lower your risk of having a stroke in the
future. These medicines may include:

 Anti-platelet drugs. Platelets are cells in the blood that form clots. Anti-platelet medicines
make these cells less sticky and less likely to clot. Themost commonly used anti-platelet
medicine is aspirin. Your healthcare professional can recommend the right dose of aspirin for
you.

Page | 33
 If you've had a TIA or minor stroke, you may take both an aspirin and an anti-platelet
medicine such as clopidogrel (Plavix). These medicines may be prescribed for a period of
time to reduce the risk of another stroke. If you can't take aspirin, you may be prescribed
clopidogrel alone. Ticagrelor (Brilinta) is another anti-platelet medicine that can be used for
stroke prevention.

 Blooding-thinning medicines, known as anticoagulants. These medicines reduce blood

clotting. Heparin is a fast-acting anticoagulant that may be used short-term in the hospital.

Slower acting warfarin (Jantoven) may be used over a longer term. Warfarin is a powerful
blood-thinning medicine, so you need to take it exactly as directed and watch for side effects.
You also need regular blood tests to monitor warfarin's effects.

CHF

Heart failure means that your heart can't pump enough oxygen-rich blood to meet your body's
needs. Heart failure doesn't mean that your heart has stopped or is about to stop beating. But
without enough blood flow, your organs may not work well, which can cause serious problems.

Heart failure can affect one or both sides of your heart:

 With right-sided heart failure, your heart is too weak to pump enough blood to your lungs to
get oxygen.
 With left-sided heart failure, your heart can't pump enough oxygen-rich blood out to your
body. This happens when the left side of your heart becomes either:
 Too weak to pump enough blood.

 Too thick or stiff to relax and fill with enough blood.

Left-sided heart failure is more common than right-sided heart failure.

What causes heart failure?

Heart failure can start suddenly after a medical condition or injury damages your heart muscle.
But in most cases, heart failure develops slowly from long-term medical conditions.

Page | 34
 Conditions that can cause heart failure include:

 Coronary artery disease

 Heart attack
 Heart valve diseases
 High blood pressure
 A blood clot in your lung
 Diabetes
 Certain severe lung diseases, such as COPD (chronic obstructive pulmonary disease)
 Obesity

Who is more likely to develop heart failure?

Heart failure can happen at any age. It happens to both men and women, but men often develop it
at a younger age than women. Your chance of developing heart failure increases if:

 Smoking
 Eating foods high in fat, cholesterol, and sodium (salt)
 Having an inactive lifestyle
 Alcohol use disorder (AUD)
 Illegal drug use
 You have other medical conditions that can affect your heart, including:
 Any heart or blood vessel conditions, including high blood pressure

 Serious lung diseases

 Infection, such as HIV or COVID-19

 Obesity

 Diabetes

What are the symptoms of heart failure?

The symptoms of heart failure depend on which side of your heart is affected and how serious
your condition has become. Most symptoms are caused by reduced blood flow to your organs
and fluid buildup in your body.. Fluid may leak from the blood vessels and collect in the tissues
of your body, causing swelling edema and other problem

Page | 35
 symptoms heart failure may include

 Feeling short of breath (like you can't get enough air) when you do things like climbing stairs.
This may be one of the first symptoms you notice.
 Fatigue or weakness even after rest.
 Coughing.
 Swelling and weight gain from fluid in your ankles, lower legs, or abdomen (belly).

 Difficulty sleeping when lying flat.

 Nausea and loss of appetite.

 Swelling in the veins of your neck.

 Needing to urinate (pee) often.

At first you may have no symptoms or mild symptoms. As the disease gets worse, your
symptoms will usually bother you more.

What other problems does heart failure cause?

Fluid buildup and reduced blood flow to your organs can lead to serious problems, including:

 Breathing problems from fluid in and around your lungs (also called congestive heart failure)
 Kidney or liver damage, including cirrhosis
 Malnutrition if fluid buildup makes eating uncomfortable or if your stomach doesn't get enough
blood flow to digest food properly
 Other heart conditions, such as irregular heartbeat and sudden cardiac arrest
 Pulmonary hypertension

How is heart failure diagnosed?

To find out if you have heart failure, your health care provider will

 Ask about your medical history, including your symptoms

 Ask about your family health history, including relatives who have had heart failure
 Do a physical exam
 Likely run heart tests and blood tests, including a brain natriuretic peptide (BNP) test

Page | 36
 In some cases, your provider may refer you to a cardiologist (a doctor who specializes in heart
diseases) for tests, diagnosis, and care.

What are the treatments for heart failure?

Your treatment will depend on the type of heart failure you have and how serious it is. There's no
cure for heart failure. But treatment can help you live longer with fewer symptoms.

Even with treatment, heart failure usually gets worse over time, so you'll likely need treatment
for the rest of your life.

Most treatment plans include:

 Taking medicine

 Eating less sodium and drinking less liquid to control fluid buildup

 Making other changes, such as quitting smoking, managing stress, and getting as much physical
activity as your provider recommends
 Treating any conditions that may make heart failure worse

You may need heart surgery if:

 You have a congenital heart defect or damage to your heart that can be fixed.

 The left side of your heart is getting weaker and putting a device in your chest could help.
Devices include:

 An implantable cardioverter defibrillator.

 A biventricular pacemaker (cardiac resynchronization therapy).
 A mechanical heart pump (a ventricular assist device (VAD) or a total artificial heart).
 Your heart doctor recommends a heart transplant because your heart failure is life-threatening
and nothing else is helping.
As part of your treatment, you'll need to pay close attention to your symptoms, because heart
failure can worsen suddenly. Your provider may suggest a cardiac rehabilitation program to help
you learn how to manage your condition.

Can heart failure be prevented?

Page | 37
 You may be able to prevent or delay heart failure if you:

 Work with your provider to manage any health conditions that increase your risk of developing
heart failure

 Make healthy changes in your eating, exercise, and other daily habits to help prevent heart
disease
DECLARATION
A declaration on cardiovascular disease and treatment acknowledges that it is a major global
health concern, affecting millions worldwide. The declaration emphasizes the importance of
prevention through healthy lifestyle choices, early diagnosis, and effective treatments, including
medication and in some cases, procedures like angioplasty or bypass surgery. It also highlights
the need for ongoing research and innovation to improve cardiovascular care.
Here's a more detailed breakdown:

1. The Severity and Prevalence of Cardiovascular Disease:

 Cardiovascular disease (CVD) is a leading cause of death globally, with over 17 million deaths
in 2015.

 CVD encompasses various conditions, including coronary artery disease, heart failure,
arrhythmias, and stroke.
 Up to 90% of CVD cases are preventable through lifestyle changes.

 Key preventive measures include:

o Healthy eating: Reducing sodium intake, increasing fruit and vegetable consumption.

o Regular physical activity: Engaging in regular exercise.

o Avoiding tobacco use: Quitting smoking is crucial.

o Limiting alcohol consumption: Avoiding excessive alcohol intake.

 Managing risk factors like high blood pressure, cholesterol, and diabetes is also essential.

3. Treatment:

 Lifestyle modifications:

Page | 38
 Continue with the preventive measures mentioned above, even after diagnosis, to manage
existing conditions.

 Medications:

Various medications are used to manage risk factors and treat specific conditions.

 Procedures:

Procedures like coronary angioplasty (balloon angioplasty and stent placement) and bypass
surgery may be necessary in some cases.

 Surgical interventions:
Heart valve surgery, pacemaker implantation, and heart transplantation are examples of surgical
options.

4. Importance of Early Diagnosis and Screening:

 Early detection and diagnosis are crucial for effective treatment and managing the progression of
CVD.

 Regular screenings, starting from the age of 20, are recommended, with the frequency and type
of screening depending on individual risk factors.

5. Research and Innovation:

 Ongoing research is essential to develop new and improved treatments for CVD.

 Modern treatments, including advanced procedures and technologies, are constantly evolve
CONCLUSION

Cardiovascular disease is the number one cause of mortality nation wide.The programs that our
available to the Hampton community have been helping decrease cardiovascular disease because
the number has decreased and his lower then the national average.We need to continue to make
programs to help lower the number of cardiovascular related deaths.Educating our patients is key
and letting them know about the programs.Programs need be targeted to lower blood pressure,

Page | 39
lower obesity, lower cholesterol, increase physical activity, lower sodium intake, lower saturated
fat in diet, and smoking caseation.

 The nature of nutrition determines predisposition to cardiovascular diseases;

 Dietary lecithin is a phospholipid that is present in eggs and meat;

 Metabolism of lecithin by gut flora and liver monooxygenase results into trimethylamine
oxide;

 Trimethylamine oxide causes atherosclerosis;

 Atherosclerosis consequently causes heart attack, stroke, coronary heart disease and other
cardiovascular disorders.

Heart diseases are increasing in the population due to the change in lifestyles. The nature of
nutrition that people consume is a determining factor of cardiovascular diseases. Cholesterol and
triglycerides are conventional causes of cardiovascular diseases; however, new evidence
suggests that metabolites of lecithin (phosphatidylcholine) contribute to the occurrence of
cardiovascular diseases. Gut flora usually metabolize lecithin into trimethylamine, which the
liver enzymes metabolize further into trimethylamine oxide. Trimethylamine oxide causes
atherosclerosis in blood vessels. The atherosclerosis consequently causes coronary artery disease,
heart attack, stroke, and other cardiovascular diseases by blocking the blood vessels. Poor flow
of blood and insufficient supply of oxygen due to blockage of blood vessels pose serious health
consequences. Hence, regulation of trimethylamine oxide using diet and antibiotics is imperative
in the prevention and management of cardiovascular disorders.

Page | 40
 REFRENCES

1. McArdle, WD, Katch, FI, and Katch, VL (2006) Exercise physiology: energy,
nutrition, and human performance . Baltimore, Maryland: Lippincott Williams and Wilkins.

2. Wilmore, JH, Costill, DL, and, Kenney, WL (2007) Physiology of sport and exercise
3 Greenfield ADM, Patterson GC. Reactions of the blood vessels of the human forearm to
increases in transmural pressure. J Cardiovasc Pharmacol 1982;

 4 Collier JG, Nachev C, Robinson BF. A new method for studying the pharmacology of
superficial veins in conscious man. Br J Pharmacol 1970;
 5 Franklin SS, Gustin W 4th, Wong ND et al. Hemodynamic patterns of age-related changes in
blood pressure.

 6 Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker
of cardiovascular risk in hypertensive patients. Hypertension 1999; 33: 1111–1117.

 7 Blacher J, London GM, Safar ME, Mourad JJ. Influence of age and end-stage renal disease on
the stiffness of carotid wall material in hypertension. J Hypertens 1999; 17: 237–244.

 8 Avolio A, Jones D, Tafazzoli-Shadpour M. Quantification of alterations in structure and

function of elastin in arterial media. Hypertension 1998.

 9 O'Rourke MF. Pulsatile arterial haemodynamics in hypertension. Aust NZ J Med 1976

Page | 41
 10 Wilkinson IB, Qasem A, McEniery CM, Webb DJ, Avolio A, Cockroft JR. Nitric oxide
regulates local arterial distensibility in vivo. Circulation 2002

 11 Dart AM, Kingwell BA. Pulse pressure – a review of mechanisms and clinical relevance. J
Am Coll Cardiol 2001; 37: 975–984.

 12 Gray GA, Webb DJ. The therapeutic potential of endothelin receptor antagonists in
cardiovascular disease. Pharmacol Ther 1996; 72: 109–148.

 13 Insel PA. Adrenergic receptors – evolving concepts and clinical implications. New Engl J
Med 1996; 334: 580–585.

 14 Van Zwieten PA. Adrenergic and cholinergic receptors. In Autonomic failure, a textbook of
clinical disorders of the autonomic nervous system, 4th edn, eds CJ Mathias, R.
BannisterOxford: Oxford University Press, 1999; 57–58.

 15 Lyons D, Roy S, Patel M, Benjamin N, Swift CG. Impaired nitric oxide-mediated

vasodilatation and total body nitric oxide production in healthy old age. Clin Sci 1997; 93: 519–
522.

 16 Elliott HL, Sumner DJ, McKean K, Reid JL. Effect of age on the responsiveness of vascular
alpha-adrenoceptors in man. J Cardiovasc Pharmacol 1982; 4: 388–392.

 17 Lakatta EG. Deficient neuroendocrine regulation of the cardiovascular system with advancing
age in healthy humans. Circulation 1993; 87: 631–636.

 18 Kihara M, Nakasaka Y, Mitsui Y, Takahashi M, Schmelzer JD. Ageing differentially

modifies sensitivity of nerve blood flow to vasocontractile agents (endothelin-1, noradrenaline
and angiotensin II) in sciatic nerve. Mech Ageing Dev 2000; 114: 5–14.

19 Konishi C, Naito Y, Saito Y, Ohara N, Ono H. Age related differences and roles of
endothelial nitric oxide and prostanoids in angiotensin II responses of isolated, perfused arteries
and veins of rats. Eur J Pharmacol 1997; 320: 175–181.

Page | 42
 20 Zhang XZ, Qiu C, Baylis C. Sensitivity of the segmental renal arterioles to angiotensin II in
the aging rat. Mech Ageing Dev 1997; 97: 183–192.

 21 Tschudi MR, Luscher TF. Age and hypertension differently affect coronary contractions to
endothelin-1, serotonin and angiotensins. Circulation 1995; 91: 2415–2422.

 22 Andrawis N, Jones DS, Abernethy DR. Ageing is associated with endothelial dysfunction in
the human forearm vasculature. J Am Geriatr Soc 2000; 48: 193–198.

 23 Hogikyan RV, Supiano MA. Arterial alpha-adrenergic responsiveness is decreased and SNS
activity is increased in older humans. Am J Physiol 1994; 266 (0): E717–E724.

 24 Moncada S, Radomski MW, Palmer RMJ. Endothelium derived relaxing factor: identification
as nitric oxide and role in the control of vascular tone and platelet function. Biochem
Pharmacol 1988; 37: 2495–2501.

 25 Palmer RMJ, Ashton DS, Moncada S. Vascular endothelial cells synthesize nitric oxide from
l-arginine. Nature 1988; 33: 664–666.

 26 Furchgott RF, Zawadski JV. The obligatory role of endothelial cells in the relaxation of
arterial smooth muscle by acetylcholine. Nature 1980; 288: 373–376.

 27 Egashira K, Inou T, Hirooka Y et al. Effects of age on endothelium-dependent vasodilatation

of resistance coronary artery by acetylcholine in humans. Circulation 1993; 88: 77–81.

 28 Gerhard M, Roddy MA, Creager SJ, Creager MA. Ageing progressively impairs endothelium
dependent vasodilatation in forearm resistance vessels of
humans. Hypertension 193096; 27: 849–853.

Page | 43