Cardiovascular System Disorders, Chapter 12

Circulatory System Composed of

Vessels, fluid, pump

Atrioventricular Valves

Tricuspid and bicuspid valves

Semilunar Valves

Pulmonary and Aortic Valves

What is the SA node responsible for?

Pacemaker and sinus rhythm

Where is the AV node located?

Bottom of the right atrium

What are the Purkinjie Fibers?

Terminal fibers of nerves in the heart

What controls the rate and force of contraction in the heart?

Medulla Oblongata

Baroreceptors

1. Detect pressure changes in BP.2. Located in the aorta and internal carotid arteries3. Hardening in arteries can alter how they detect pressure changes

Sympathetic Stimulation

increases HR (tachycardia)Cardiac accelerator nerve

Parasympathetic Stimulation

Vagus Nerve (CN X)Decreases HR (bradycardia)

Things that INCREASE HR

1. Increased thyroid hormone or epinephrine2. infection3. Elevated body temperature4. Increased environmental temp (esp in Humd)5. Exertion6. Smoking7. Stress Response8. Pregnancy9. Pain

Diastole

Relaxation of myocardium required for filling chambersBottom number in BP

Systole

Top number in BPContraction of myocardium, provides increased pressure to eject blood

Which side of the heart has Deoxygenated blood?

Right side

What is the Lub sound in heart?

Closure of AV valves

What is the Dub sound in heart?

Closure of semilunar valves

What are murmur sounds caused by?

Valves not functioning properly or closing completely

Pulse Deficit

difference in HR between apical and radial pulses

Cardiac Output

Blood ejected by a ventricle in 1 minCO= SV x HR

Preload

Amount of blood delivered by to heart by veinous return

Afterload

Force required to eject blood from ventriclesDetermined by peripheral resistance in arteries

What is BP directly proportional to?

Blood volume

When you increase BP there is....

a vasoconstriction leading to increased output.

When you decrease BP there is...

a vasodilation leading to decreased output.

Increased Output

Vasoconstriction and increased BP

Decreased Output

Vasodilation and decreased BP

Antiduretic hormone

Increased BP. Retains fluid.

Aldosterone

increased blood volumeIncrease in BP

Renin-angiotensin-aldosterone

VasoconstrictionIncreased BP

EKG

Useful in the initial diagnosis and monitoring of heart conditions

Auscultation

Listen to abnormalities or abnormal shunts of blood that cause heart murmurs.

Echo

Record heart valve movements, BFM and CO

Cardiac Stress Test

Used to assess general cardiac function

Cardiac Catheterization

1. Used to measure pressure and assess valve and heart function2. Can be a treatment.

Doppler Studies

1. Assess blood flow in peripheral blood vessels2. Record sounds of blood flow or obstruction

Most common blood clot site

Calf

Blood tests

Test serum levels of triglycerides, cholesterol, sodium, potassium, calcium and other electrolytes

Arterial Blood Gas (ABG)

checks current oxygen level and aid-base balance.When heart attack or myocardial infarction are suspected, they will check ABG.

General Treatment for Cardiac Disorders

1. Dietary Modifications2. Regular exercise program3. Cessation of smoking

General Treatment for Cardiac Disorders: Drugs

1. Vasodilators2. Beta Bockers3. Calcium channel blockers4. Digoxin5. Antihypertensive drugs6. Adrenergic blocking drugs7. ACE inhibitors8. Diuretics9. Anti-coagulants10.Cholesterol lowering drugs

Drugs: Vasodilators

Reduction of peripheral resistance

Drugs: Beta Blockers

Treat hypertension and dysrhythmiasReduction of anginaLopressor, Tenormin

Drugs: Calcium Channel Blockers

Decrease cardiac contractilityAntihypertensives and vasodilatorsWard off anginaex: Procardia, Cardizem

Drugs: Digoxin

Treatment for heart failureAntidysrhythmic for for arterial dysrhytmiasHave to look at blood serum levels to check for toxicity

Drugs: Diuretics

Remove excess sodium or waterTreat high BP or HFex: Diuril or LasixOn some you may develop low Potassium levels (Lasix)May take a potassium pill in conjunction

Drugs: Anti-coagulants

Inhibits clot formation.ex: Herparin, Coumadin

Drugs: Cholesterol Lowering Drugs (Hyperlipidemia Agents)

Reduce LDL levels and cholesterol levelsex: Zocor, Lipitor

Arterosclerosis

General term for all kinds of arterial changes1. Degenerative Changes in small arteries/arterioles2. Loss of elasticity3. Lumen gradually narrows4. Increased BP

Artherosclerosis

Presence of atheromas in large arteries.Plaques consisting of lipids, calcium, and clotsRelated to diet and exercise

Low Density Lipoproteins (LDL)

High in lipids, take fat from liver to cells

High Density Lipproteins (HDL)

Low in lipid content. Takes cholesterol away from peripheral cells. "Good"Part of normal catabolism in liver and extrection

Non-Modifiable Risk Factors of Artherosclerosis

Age, Gender, Genetics

Modifiable Risk Factors of Arthersclerosis

Obesity, sedentary lifestyle, Cigarette smoking, diabetes, poorly controlled hypertension, combo of contraceptives and smoking (in women)

Atherosclerosis Treatment

Weight loss, increase exercise, lower LDLs with diet, reduce sodium intake, control hypertension, stop smoking, antilipidemic drugs, surgery like a bypass.Just control modifiable risks

Descending Aorta Aneurism

Part of artery ruptures due to weak spot after blockage.Can bleed out in seconds.

Angina Pectoris

Occurs when there is a deficit of oxygen to meet myocardial needs.

Chest Pain Patterns: Classica/Exertional

with activity. Pain in shoulder.

Chest Pain Patterns: Variant Angina

Vasospasm occurs at rest

Chest Pain Patterns: Unstable Angine

Prolonged pain at rest. May precede MI

What relieves Angina Pectoris?

Rest and administration of coronary vasodilators (nitroglycerin)

Nitroglycerin

Acts by reducing systemic resistance, decreasing the demand for oxygen.

Mycardial Infarction

Occurs when artery is totally obstructed1. Arthersclerosis is most common cause2. Can be caused by thrombus from atheroma

Warning Signs of Heart Attack

1. Feeling of pressure or heaviness in chest2. Sudden shortness of breath, weaknees, or fatigue3. Nausea, indigestion4. Anxiety and fear5. Substernal, crusing, or radiating pain6. Women may have more mild pain or jaw pain

MI Diagnostic Tests

1.Change in ECG2.Serum levels of myosin and 3.cardiac troponin (elevated means heart tissue being damaged)4.ABG measurements in severe cases

Cardiogenic Shock

Heart cant pump enough blood to meet body's needs

MI Complications

1. Sudden Death2. Cardiogenic Shock3. CHF4. Rupture of necrotic heart tissue5. Thromboembolism causing a CVA

MI Treatment

1. Reduce cardiac demand2. Oxygen Therapy3. Analgesics4. Anticoagulants5. Thrombolytic agents6.Tissue Plasminogin Activator(dissolve clot)7. Medication8. Cardiac rehab

Cardiac Dysrhythmias (Arrhyhmias)

Deviations from normal cardiac rate or rhythm

Sick Sinus Syndrome

Marked by altering bradycardia and tachycardiaOften requires a pacemaker

Atrial Flutter

Atrial HR between 160 to 350 bpm

Atrial Fibrulation

> than 350 bpm, blood isn't evacuating atriumThrombus formation is a risk

Heart Blocks

Conduction excessivley delayed or stopped at AV node or bundle of His

First-degree Block

delay between atrial and ventricular contraction

Second-degree Block

2nd to 3rd atrial beat dropped from AV node

Third-degree Block

No transmission from atria to ventricles

Bradycardia

Regular rate, lower than 60 bpm

Tachycardia

Regular rate, fast, 100-160 bpm

Fibriliation

Rate over 300 bpm, uncoordinated muscle contraction

Premature ventricle contractions

additional ectopic beats

Bundle Branch Block

Delayed conduction in one bundle branch, wide QRS wave

Cardiac Arrest

No electrical impulses "Flat-lining

Congestive Heart Failure

heart is unable to pump out sufficient blood to meet metabolic demand of the body

Left Sided CHF

Pulmonary Edema or congestion. Disrupts normal lung function.May have white/pinkish sputum

Right Sided CHF

Edema in legs, liver, and abdominal organs due to venous pressure.Has visible signs to be able to monitor

S/S of CHF

1. Decreased blood supply to tissues2. Fatigue and weakness3.Shortness of breath4. Tachycardia5. Cutaneous and visceral vasoconstriction6. Daytime oliguria

Cor Pulmonale (Pulmonary Hypertension)

Hypertrophy of right ventricle.Caused by chronically increased resistance to pulmonary circulation.