high output failure
- inability of heart to supply body with blood-borne nutrients despite adequate blood volume and normal or elevated myocardial contractility
- metabolic needs aren't being met0
shock
- cardiovascular system fails to perfuse the tissues adequately
- rapid decrease in BP
- impaired oxygen use
- impaured glucose use
- aerobic --> anaerobic respiration
cardiogenic shock
- decreased cardiac output
- normal vascular blood volume
hypovolemic shock
- decrease in vascular blood volume
- fluid --> interstitial space --> vascular space
neurogenic shock
- any factor that inhibits sympathetic nervous system (spinal shock)
anaphlactic shock
- allergic reactions
- exposure to allergen
septic shock
- infectious organism in blood
- bacleriemia
multiple organ dysfunction syndrome
- progressive dysfunction of 2 or more organ systems
- result from an uncontrolled inflammatory response to severe illness or injury
pulmonary circulation
right heart"
pumps blood thru lungs
systemic circulation
left heart"
pumps blood to entire body (everything except lungs)
contains oxygenated blood
mediastinum
what makes up the heart
area above diaphragm and between lungs
heart wall
encloses heart and divides it into chambers
pericardium, myocardium, endocardium
pericardium
outer layer of the heart
prevents displacement
protects against infection
2 layers: parietal and visceral
pericardial cavity and fluid
myocardium
thickest; muscular layer of heart
endocardium
innermost layer of heart
contractile force
interventricular septum
separates right and left sides of heart
prevents blood from crossing
chambers of the heart
right atrium, left atrium, right ventricle, left ventricle
valves of the heart
atrioventricular (tricuspid and mitral) & semi-lunar (pulmonic and aortic)
atrioventricular valves
1. tricuspid valve: right heart
2. mitral valve: left heart
semi-lunar valves
open when pressure is increased; blood flows into circulation
close to prevent backflow
1. pulmonic valve (right heart)
2. aortic valve (left heart)
superior and inferior vena cava
great vessel
right heart
enter right atrium
pulmonary artery
great vessel
from right ventricle; enters pulmonary circulation
divide into right and left PA
transport deoxygenated blood
pulmonary veins
great vessel
carry oxygenated blood
from lungs to left atrium
aorta
great vessel
pumps blood to entire body
right heart blood flow
superior vena cava
right atriu
triscupid valve
right ventricle
pulmonary valve
pulmonary artery
lungs
left heart blood flow
lungs
pulmonary veins
left atrium
mitral valve
left ventricle
aortic valve
aorta
entire body
cardiac cycle
diastole and systole
diastole
relaxation
occurs when AV valves open
blood fills ventricles
capillary perfusion
systole
contractoin
ventricles contract
propels blood of pulmonary artery and aorta
AV valves close
coronary vessels
support metabolic needs of the heart
go across myocardium
right: extends around right heart to posterior
left: circumflex artery - provides blood to left atrium
coronary vessel flow
coronary arteries
collateral arteries
coronary capillaries
coronary veins (coronary sinus, great cardiac vein, posterior vein of LV)
coronary lymphatic vessels
collateral arteries
supply blood/O2 to myocardium
coronary capillaries
exchange O2 and nutrients
coronary lymphatic vessels
fluid to lymphnodes
cardiac action potentials
electrical impulses that travel thru myocardium
conduction system
special cells enable myocardium to transmit action potentions
SA node, AV node, Bundle of His, R/L Bundle Branches, Purkinje Fibers
sinoatrial node
primary pacemaker
atrioventricular node
conduction between atria and ventricles
bundle of his
AV bundle; gives rise to right and left bundle branches
purkinje fibers
terminal branches of RBB and LBB`
absolute refractory period
no new action potential can be initiated
follows depolarization
cardiac performance
heart rate x stroke volume
volume increases, cardiac output increases
preload and afterload
preload
left ventricular end-diastolic volume
frank-starling law of heart
frank-starling law of heart
direct relation between volume of blood in heart and force of contraction
afterload
resistance to ejection of blood from left ventricle
the load the muscle must move after it starts to contract
heart rate
speed of cardiac cycle
affected by: cardiovascular control center, neural reflexes, atrial receptors, hormones and biochemicals
medulla
cardiovascular control center
affects heart rate
neural reflexes
affects heart rate
bainbridge (increase) and baroreceptor (decrease)
atrial receptors
sits on atria and affects heart rate
hormones and biochemicals
affects heart rate
epinephrine (increase heart rate)
ecetocoline (decrease heart rate)
myocardial contracility
squeeze of heart", affected by:
stroke volume: L's of blood ejected from heart with each beat
inotropic agents: improve contracility of heart
O2 and CO2 levels
cardiac output
volume of blood flowing through systemic/pulmonary circuit in liters/min
heart rate x stroke volume
normal adult: 5L/min
systemic circulation
left heart; to entire body:
arteries
arterioles
capillaries
venules
veins
endothelium
lining of blood vessel
innermost
resistance to blood flow is related to diameter
lymphatic system
important for fluid balance
special vascular system that picks up excess fluid and returns it to bloodstream
flows: lymphatic fluid (H2O and dissolved proteins) to lymphatic veins/venules to right lymphatic duct to thoracic duct to afferent/efferent lymph
varicose veins
vein in which blood has pooled
distented, tortuous and palpable veins
"pertrude" thru skin
causes: trauma or gradual venous distention; long periods of standing
chronic venous insufficiency
inadequate venous return over a long period due to varicose veins or valvular incompetence
venous statis ulcers (cell death and necrosis)
deep venous thrombosis
disease of veins
thrombus
obstruction of venous flow leading to increased venous pressure
factors: Triad Virchow (venous stasis, venous endothelial damage, hypercoaguble states)
thrombus
blood clot attached to vessel wall
thromboembolis
detached/traveling blood clot
superior vena cava syndrome
progression occlusion of SVC that leads to venous distention of upper extremities and head
oncologic emergency
primary hypertension
0
prehypertension
121-139 or 80-89 BP
stage 1: >140-159 or >90-99
stage 2: >160 or >100
end-organ damage
other organs begin to shut down because of untreated hypertension
secondary hypertension
BP elevation caused by a systemic disease process that raises peripheral vascular resistance or cardiac output
isolated systolic hypertension
elevations of systolic pressure are caused by increase in cardiac output, total peripheral vascular resistance or both
complicated hypertension
chronic hypersensitive damage to walls of systemic blood vessels
smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis of tunica intima and media
malignant hypertension
rapidly progressive hypertension
diastolic pressure usually >140 mm Hg
orthostatic hypertension
postural"
decrease in both systolic and diastolic blood pressure upon standing
SYNCOPE
lack of normal blood pressure compensation in response to gravitational changes on the circulation
acute vs. chronic
syncope and fainting
aneurysm
disease of arteries/veins
local dilation or outpouching of a vessel wall or cardiac chamber
thrombus formation
blood clot that remains attached to vessel wall
thromboembolus
thrombophlebitis
arterial
venous
embolism
bolus of matter that circulates in the bloodstream
*dislodged thrombus, air bubble, amniotic fluid, aggregate of fluid, bacteria, cancer cells, or foreign substance
peripheral artery disease
artheroslerotic disease of the arteries that perfuse the limbs
intermittent claudication
*arteriosclerosis: abnormal thickening/hardening of vessel walls
arteriosclerosis
chronic disease if arterial system
abnormal thickening/hardening of vessel walls
plaque formation of lipid macrophages
smooth muscle cells and collagen fibers migrate to tunica intima
artherosclerosis
form of of arteriosclerosis
thickening caused by accumulation of lipid macrophages in arterial wall
plaque development
raynaud disease
peripheral artery disease
episodic vasospasm in arteries/arterioles of fingers, less commonly toes
primary vasospastic disorder with uknown origin
sensitive to cold and prolonged exposure to vibration
reversible
lack of good blood supply
secondary to othe
coronary artery disease
any vascular disorder that narrows/occludes the coronary arteries
most common cause: artherosclerosis
risk factors: dyslipidemia (increased lipid/fat level); hypertension; smoking; diabetes; obesity/sedentary lifestyle
myocardial ischemia
coronary artery disease; "heart attack"
local, temporary deprivation of coronary blood supply
stable angina, prinzmetal angina, silent ischemia (no symptoms)
fibrous plaque leads to angina (chest pain)
stable angina
current chest pain; can be reversible
prinzmetal angina
variable chest pain; occurs at rest (unpredictable)
transient ischemia
acute coronary syndrome
comes and goes
unstable angine
acute coronary syndrome
impending myocardial ischemia (heart attack)
sustained ischemia
acute coronary syndrome
irreversible; is a heart attack
myocardial infarction
acute coronary syndrome
prolonged ischemia causing irreversible damage
STEMI (ST elevation) or non-STEMI
myocardial infarction
sudden and extended obstruction of myocardial blood supply
subendocardial infarction - beneath endocardiu
transmural infarction - all 3 layers
cellular injury, cellular death, structural and functional changes (myocardial stunning and remodeling) and repa
acute pericarditis
disorder or pericardium
acute inflammation
severe chest pain, fever, increased heart rate
pericardial effusion
disorder or pericardium
fluid in pericardial space
tamponafe
disorder of pericardium
result of pericardial effusion
excessive fluid leading to heart compression
life-threatening
constrictive pericarditis
disorder of pericardium
fibrotic
encases heart in hard, rigid type shell
cardiomyopathies
disorder of myocardium
dilated/congestive: systolic dysfunction
hypertrophic: thickening; increased size of cells
restrictive: decreased ability to fill chambers with blood
valvular dysfunction
disorder of endocardium
v. stenosis, v. regurgitation, mitral valve prolapse
valvular stenosis
disorder of endocardium
shrinking/narrowing of aortic or mitral valves
valvular regurgiation
disorder of endocardium
backflow of blood into aortic, mitral or tricuspid valves
mitral valve prolapse
disorder of endocardium
cusps billow upward into left atrium
rheumatic fever and heart disease
diffuse inflammatory disease caused by a delayed immune response to infection by group A beta-hemolytic streptococci
febrile illness: inflammation of joints, skin, nervous system and heart
left untreated --> rheumatic heart disease (esp. right heart)
valv
ineffective endocarditis
inflammation of endocardium
agents: bacteria, viruses, fungi, rickettsiae, parasites
pathogenesis: 1. "prepared" endorcardium (damaged) 2. adherence of blood-borne microorganism 3. proliferation/growth of microorganism
dysrythmias
disturbance of heart rhythm
range: occassional "missed" or rapid beats to severe disturbances that affect the pumping ability of the heart
caused by: abnormal rate of pulse generation or abnormal pulse conduction
tachycardia
dysrhythmia
fast heart rate
100-150 BPM
exercises, septic shock, blood loss
flutter
dysrhythmia
fast hear rate
>250 BPM
fibrillation
dysrhythmia
fast; >300 BPM
can lead to cardiac arrest
bradycardia
dysrhythmia
slow; <150 BPM
asystole
without heart rate
0 BPM
cardiac arrest
heart failure
several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood borne nutrients
right and left, high output failure
left heart failure
congestive"
systolic: inability of heart to generate adequate cardiac output to perfuse tisues
diastolic: pulmonary congestion despite normal stroke volume and cardiac output
right heart failure
common cause: diffuse hypoxic pulmonary disease
can result from increase in left ventricular filling pressuer that's reflected back into the pulmonary circulation
more respiratory symptoms