Chapter 8 Cardiovascular System Diseases and Disorders
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1 Chapter 8 Diseases and Disorders Anatomy and Physiology Cardiovascular system - heart, arteries, and veins with blood Heart is the size of a man s fist Heart is four chambered and muscular Anatomy and Physiology Three layers of the heart Epicardium Myocardium Endocardium Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4 Diagnostic Tests Non-invasive procedures Auscultation Doppler Electrocardiogram Echocardiography Ultrasound arteriography Diagnostic Tests Cardiac Catheterization Invasive procedure to determine oxygen content and blood pressure X-rays To determine normal function of heart and vessels Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6 1
2 Diagnostic Tests Common X-rays Angiocardiography Angiography Venogram Blood Tests Enzymes including CPK, LDH Diseases of arteries Hypertension Indicator of development of cerebrovascular, cardiovascular, and kidney disease Chronic disease Leading cause of stroke and heart failure Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8 Diseases of arteries Hypertension Normal blood pressure is 120/80 Top number is systolic blood pressure measuring highest pressure in artery when ventricles contract Diseases of arteries Hypertension Bottom number is diastolic blood pressure that measures pressure in artery when ventricles relax Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10 Diseases of arteries Hypertension High blood pressure is greater than 140/90 Primary Hypertension - idiopathic with gradual onset Primary hypertension is also called essential hypertension Risk factors Heredity Diet Age Obesity Smoking Stress and type A personality Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12 2
3 Hypertension Treatment Anti-hypertensive medications Lifestyle changes Low salt diet Stress-reducing exercise Smoking cessation Diuretics Arteriosclerosis and atherosclerosis Loss of elasticity and thickening of artery wall Hardening of arteries is a lay term Deposits of fatty or lipid material in wall of artery is called plaque Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Arteriosclerosis and atherosclerosis Major areas affected by atherosclerosis Coronary arteries Cerebral arteries Aorta Peripheral arteries Risk factors of atherosclerosis Non-controllable factors Heredity Age Sex Diabetes Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16 Risk factors of atherosclerosis Controllable factors Diet Sedentary lifestyle Stress Cigarette smoking Hypertension Diagnosis of atherosclerosis - blood pressure, arteriograms, X-rays, doppler Treatment administered for symptoms Bypass surgery of occluded arteries and plaque removal Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18 3
4 Peripheral Vascular Disease (PVD) Caused by atherosclerotic plaque in arteries supplying blood to legs Intermittent claudication - muscle cramps that are relieved with rest and increase with activity Peripheral Vascular Disease (PVD) includes an endarterectomy If necrosis occurs, amputation or resection may be necessary Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20 Aneurysm Weakening in wall of artery creating a bulge or rupture Usually asymptomatic and discovered accidentally Aneurysm Aorta is most common place includes repairing aneurysm before rupture through resection and grafting Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 21 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22 Coronary Artery Disease Narrowing of arteries that supply blood to the myocardium Single leading cause of death in United States Commonly due to atherosclerosis Coronary Artery Disease Progressive narrowing of vessels may lead to ischemia of the heart muscle and symptoms Scar tissue replaces muscle Occlusion may progress slowly or suddenly as result of a thrombus or embolus Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24 4
5 Coronary Artery Disease Death of heart muscle is called a myocardial infarction Diagnosis is based on history, EKG, angiograms is aimed at increasing blood flow or decreasing oxygen needs Coronary Artery Disease Angina is treated with vasodilators Angioplasty Coronary artery bypass graft (CABG) Reduce atherosclerotic risk factors - diet, exercise, and no smoking Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26 Angina Pectoris Chest pain Lack of oxygen to heart Sign of impending myocardial infarction : decrease workload of heart and nitroglycerin Myocardial Infarction Heart attack Occurs when heart does not get enough oxygen Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28 Myocardial Infarction Classic symptoms Severe chest pain with diaphoresis and nausea Referred pain to neck, arm, and jaw with discomfort similar to bad or unrelieved indigestion Myocardial Infarction Immediate attention to prevent shock Relieve respiratory distress Decrease workload If cardiac arrest, CPR must be performed Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 29 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 30 5
6 Myocardial Infarction Oxygen and pain medication Medications to treat arrhythmias Clot busting medications Education needed on prevention by lifestyle changes: smoking cessation, diet, exercise Hypertensive Heart Disease Result of long-term hypertension Causes are disease or disorder causing chronic elevation in blood pressure : treating cause of hypertension Can only be controlled, not cured Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 31 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 32 Rheumatic Heart Disease Autoimmune disorder Caused by streptococcal throat infection All layers of heart and valves can be affected Rheumatic Heart Disease : prevention and treatment of streptococcal infections Rest during acute stage Valve replacement to correct deformity Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 33 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34 Congestive Heart Failure Heart fails to pump adequate blood supply Develops slowly and increases the workload of heart Symptoms Gradual increase in dyspnea Congestive Heart Failure Symptoms Tachycardia Tachypnea Neck vein distention Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 35 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 36 6
7 Congestive Heart Failure Symptoms Edema in ankles and lower legs Right sided leads to congestion of liver and spleen Left sided leads to congestion of lungs Congestive Heart Failure Diagnosis: history and physical, chest X-ray, EKG Decrease workload Diuretics Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 37 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 38 Congestive Heart Failure Salt and fluid restrictions Medications to strengthen and slow the heart such as digitalis Cardiomyopathy Disease of heart muscle Characterized by dilated, enlarged, thin, flabby heart muscle Incurable leading to congestive heart failure, myocardial infarction and death Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40 Carditis Inflammation of the heart such as pericarditis, myocarditis, endocarditis Often secondary to respiratory, urinary tract, or skin infection : rest, antibiotics, analgesics, and antipyretics Valvular Heart Disease Malfunction of heart valves Murmurs or abnormal heart sound Causes Congenital abnormalities or malformations Rheumatic fever Endocarditis Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 41 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42 7
8 Arrhythmias Abnormal heart rhythm Sinus rhythm is normal heart rhythm (60 to 120 beats per minute) Fibrillation - wild and uncoordinated Flutter - unusually fast heart rate (up to 350 beats per minute) Arrhythmias Heart block: interruption in conduction system Divided into first-, second-, or third-degreedegree Premature or early contractions (PVCs) may affect atria or ventricals : unnecessary provided person is asymptomatic Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44 Diseases of the Vein Phlebitis Inflammation of superficial veins Symptoms: pain, swelling, red-cord-like hardening along vein from injury toward heart Phlebitis Diseases of the Vein Analgesics Warm compresses Elevation of area above heart level Elastic stockings and exercise Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 45 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46 Diseases of the Vein Deep Vein Thrombophlebitis Clotting in vessels of legs, thighs, and pelvis Asymptomatic until embolization occurs Risk factors: immobility, dehydration, varicose veins Diseases of the Vein Deep Vein Thrombophlebitis Reduce clot and prevent embolization Anticoagulants Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 47 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 48 8
9 Diseases of the Veins Varicose Veins Dilated, tortuous, and elongated veins in legs Causes: prolonged sitting, standing, pregnancy, and obesity Diseases of the Veins Varicose Veins Symptoms: leg fatigue and cramps, thickening veins, edema, and fluid : elevate legs, walking, and use of support or elastic hose Vein stripping Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 49 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 50 Hemorrhage Abnormal loss of blood Acute or chronic Exsanguination: loss of circulating blood Internal bleeding can lead to anemia or shock due to blood loss Hemorrhage Low-pressure vessels lead to petechiae or ecchymosis of purpurap High-pressure vessels leads to squirting of bright red blood Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 51 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 52 Shock Extremely low blood pressure that leads to decreased tissue perfusion Shock Types of shock Cardiogenic Septic Hypovolemic Neurogenic Anaphylactic Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 53 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 54 9
10 Shock Symptoms Facial pallor Cool and clammy skin Cyanosis Tachycardia Tachypnea Shock Symptoms Altered mental status Syncope Unconsciousness Oliguria Anuria Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 55 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 56 Shock Rest in supine position Warm and quiet Elevate feet and legs above heart Rare Diseases Malignant Hypertension Cor Pulmonale Raynaud s Disease Buerger s Disease Polyarteritis Nodosa Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 57 Copyright 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED
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