CerebroVascular Disease and

Coronary artery Disease

Dr Masona-Mutiti
Cerebrovascular Disease-Stroke
• An abrupt onset of focal neurologic deficit that last at least 24 hours
and and is of presumed vascular origin
• Transient ischaemic attack-lasts less than 24hrs
• 2 types of strokes-Ischaemic-88%,Haemorrhagic 12%
• Hemorrhagic more fatal
Non Modifiable Risk Factors

• Age

• Gender

• Race

• Family history of stroke

• Low birth weight

Modifiable Risk Factors
• Hypertension—single most important risk factor for ischemic stroke
• Atrial fibrillation—most important and treatable cardiac cause of stroke
• Diabetes
• Dyslipidemia
• Cigarette smoking
• Alcohol
• Sickle cell disease
• Postmenopausal hormone therapy
• Lifestyle factors—associated with stroke risk
•    Obesity
•    Physical inactivity
•    Diet
Atherosclerosis
Pathophysiology-Ischaemic
• Atherosclerosis
• In carotid atherosclerosis, progressive accumulation of lipids and
inflammatory cells in the intima of the affected arteries, combined
with hypertrophy of arterial smooth muscle cells, results in plaque
formation.
• Eventually, sheer stress may result in plaque rupture, collagen
exposure, platelet aggregation, and clot formation.
• The clot can remain in the vessel, causing local occlusion, or travel
distally as an embolism, eventually lodging downstream in a cerebral
vessel.
• In the case of cardiogenic embolism, stasis of blood in the atria or
ventricles of the heart leads to the formation of local clots that can
become dislodged and travel directly through the aorta to the
cerebral circulation.
• The final result of both thrombus formation and embolism is an
arterial occlusion, decreasing cerebral blood flow and causing
ischemia distal to the occlusion.
• Normal cerebral blood flow averages 50 mL/100 g per minute,
• Cerebral blood vessels dilate and constrict in response to changes in blood
pressure, but this process can be impaired by atherosclerosis, chronic
hypertension, and acute injury, such as stroke.
• When local cerebral blood flow decreases below 20 mL/100 g per minute,
ischemia ensues,
• when further reductions below 12 mL/100 g per minute persist, irreversible
damage to the brain occurs, which is called infarction.
• Tissue that is ischemic but maintains membrane integrity is referred to as the
ischemic penumbra because it usually surrounds the infarct core.
• This penumbra is potentially salvageable through therapeutic intervention
• Reduction in the provision of nutrients to the ischemic cell eventually
leads to;
1- Depletion of adenosine triphosphate [ATP]),
2-Accumulation of extracellular potassium, intracellular sodium and
water ,
3-Cell swelling and eventual lysis.
4-The increase in intracellular calcium
5- The critical step is damage to the mitochondria and neuronal
damage
Hemorrhagic stroke
1- Subarachnoid haemorrhage-blood enters the subarachnoid space
(where cerebrospinal fluid is housed) owing to either trauma, rupture
of an intracranial aneurysm, or rupture of an arteriovenous
malformation
2- Intracerebral haemorrhage-when a blood vessel ruptures within the
brain parenchyma itself, resulting in the formation of a hematoma.

3- Subdural hematomas-when a blood vessel ruptures within the brain

parenchyma itself, resulting in the formation of a hematoma.
Symptoms and signs
• Weakness on 1 side of the body
• Inability to speak, loss of vision, vertigo, falling
• Altered level of consciousness
• IS-Usually no pain
• HS-Associated with severe headache
Diagnosis-CT SCAN,Ischaemic
Haemorrhagic CT Scan
Management
• T-PA( Tissue Plasminogen Activator)
• Aspirin
• Statin
• Bp control
• Surgery
• Physiotherapy
Ischaemic Heart Diseases
Ischaemic Heart Disease
• Due to disruption of blood supply to the heart muscle
• Coronary atherosclerotic plaque formation that leads to an
imbalance between oxygen supply and demand resulting in
myocardial ischaemia.
• Infarct is when the muscle is dead
Blood Supply-Heart
Risk factors
• Hypertension
• Smoking,
• Diabetes,
• lack of exercise,
• Obesity,
• high blood cholesterol-dyslipidaemia
• Valvular heart disease and Congestive cardiac Failure
Symptoms
• Chest pain or discomfort which may travel into the shoulder, arm,
back, neck, or jaw.
• Occasionally it may feel like heartburn.
• Usually symptoms occur with exercise or emotional stress, last less
than a few minutes, and improve with rest.
• Shortness of breath
• Sweating
• Nausea and vomiting
• Dizziness
Diagnosis

• Cardiac Enzymes
• Electrocardiograph, At rest and during exercise
• Chest XR
• Coronary Angiogram
Normal ECG
Cardiac enzymes after infarct
Treatment
• Nitrates
• Aspirin/Antiplatelet agents
• Statins
• Bp Control
• Surgical intervention-CABG-Coronary Artery Bypass
Graft/Percutaneous Coronary I ntervention(PCI)