Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 8 Cardiovascular System...

Chapter 8

Cardiovascular System Diseases and Disorders

Anatomy and Physiology

• Cardiovascular system– Heart, arteries, and veins with blood

• Heart– Size of man’s fist

– Four-chambered

– Muscular

The Heart

Anatomy and Physiology

• Heart:– Three layers

• Epicardium

• Myocardium

• Endocardium

Animation

Click Here to Play the Heart Animation

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

Diagnostic Tests

• Common x-rays:– Angiocardiography

– Angiography

– Venogram

• Blood tests– Enzymes

• Creatine phosphokinase (CPK)

• Lactate dehydrogenase (LDH)

Diseases of Arteries

• Hypertension– Indicator of development of cerebrovascular,

cardiovascular, and kidney disease

– Chronic disease

– Leading cause of stroke and heart failure

• Hypertension– Normal blood pressure

• 120/80

– High blood pressure• Greater than 140/90

• Hypertension– Top number

• Systolic

• Measures highest pressure in artery when ventricles contract

– Bottom number• Diastolic

• Measures pressure in artery when ventricles relax

• Hypertension– Primary

• Idiopathic with gradual onset

• Also known as essential hypertension

• Hypertension– Risk factors:

• Heredity

• Diet

• Age

• Obesity

• Smoking

• Stress and type A personality

• 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

– Also known as hardening of arteries

– Plaque• Deposits of fatty or lipid material in wall of artery

• Atherosclerosis– Major areas affected:

• Coronary arteries

• Cerebral arteries

• Aorta

• Peripheral arteries

• Atherosclerosis– Risk factors:

• Non-controllable factors– Heredity

– Age

– Sex

– Diabetes

• Atherosclerosis– Risk factors:

• Controllable factors– Diet

– Sedentary lifestyle

– Stress

– Cigarette smoking

– Hypertension

• Atherosclerosis– Diagnosis by blood pressure, arteriograms, x-rays, and

doppler

– Symptomatic treatment:• Bypass surgery of occluded arteries and plaque removal

• Peripheral vascular disease (PVD)– Caused by atherosclerotic plaque in arteries supplying

blood to legs

– Intermittent claudication• Muscle cramps relieved with rest and increased with activity

• Peripheral vascular disease (PVD)– Treatment:

• Endarterectomy

– If necrosis occurs, amputation or resection may be necessary

• Aneurysm– Weakening in wall of artery leading to bulge or rupture

– Usually asymptomatic and discovered accidentally

– Aorta• Most common location

– Treatment:• Repairing aneurysm before rupture through resection and grafting

Types of Aneurysms

• Coronary artery disease– Narrowing of arteries that supply blood to 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

heart muscle and symptoms

– Scar tissue replaces muscle

– Occlusion may progress slowly or suddenly as result of thrombus or embolus

• Coronary artery disease– Myocardial infarction

• Death of heart muscle

– Diagnosis by history, electrocardiogram (EKG), and angiograms

– Treatment:• Aimed at increasing blood flow or decreasing oxygen needs

• Coronary artery disease– Treatment:

• Angina treated with vasodilators

• Angioplasty

• Coronary artery bypass graft (CABG)

• Reduction of atherosclerotic risk factors– Diet

– Exercise

– Smoking

Diseases of the Heart

• Angina pectoris– Chest pain

– Lack of oxygen to heart

– Sign of impending myocardial infarction

– Treatment:• Decrease workload of heart

• Use nitroglycerin

• Myocardial infarction– Heart attack

– Occurs when heart does not get enough oxygen

– 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– Treatment:

• Give immediate attention to prevent shock

• Relieve respiratory distress

• Decrease workload

• If cardiac arrest, cardiopulmonary resuscitation (CPR) must be performed

• Myocardial infarction– Treatment:

• Oxygen and pain medication

• Medications to treat arrhythmias

• Clot-busting medications

• Education on prevention by lifestyle changes– Smoking cessation

– Diet

– Exercise

• Hypertensive heart disease– Result of long-term hypertension

– Causes:• Disease or disorder causing chronic elevation in blood pressure

– Treatment:• Treat cause of hypertension

• Can only be controlled

– No cure

• Rheumatic heart disease– Autoimmune disorder caused by streptococcal throat

infection

– All layers of heart and valves can be affected

• Rheumatic heart disease– Treatment:

• Prevention/treatment of streptococcal infections

• Rest during acute stage

• Valve replacement to correct deformity

• Congestive heart failure (CHF)– Heart fails to pump adequate blood supply

– Develops slowly and increases workload of heart

– Symptoms:• Gradual increase in dyspnea

• Tachycardia

• Tachypnea

• CHF– Symptoms:

• Neck vein distention

• Edema in ankles and lower legs

• Right-sided leads to congestion of liver and spleen

• Left-sided leads to congestion of lungs

• CHF– Diagnosis by history and physical, chest x-ray, and EKG

– Treatment:• Decrease workload

• Diuretics

• Salt and fluid restrictions

• Medications to strengthen and slow heart– E.g., digitalis

Animation

Click Here to Play Congestive Heart Failure Animation

• Cardiomyopathy– Disease of heart muscle

– Characterized by dilated, enlarged, thin, flabby heart muscle

– No cure

– Leads to CHF, myocardial infarction, and death

• Carditis– Inflammation of heart

• E.g., pericarditis, myocarditis, endocarditis

– Often secondary to respiratory, urinary tract, or skin infection

• Carditis– Treatment:

• Rest

• Antibiotics

• Analgesics

• Antipyretics

• Valvular heart disease– Malfunction of heart valves

– Murmurs or abnormal heart sound

– Causes:• Congenital abnormalities or malformations

• Rheumatic fever

• Endocarditis

• Arrhythmias– Abnormal heart rhythm

– Sinus rhythm is normal heart rhythm• 60 to 120 beats per minute

– Fibrillation• Wild and uncoordinated

• Arrhythmias– Flutter

• Unusually fast heart rate– Up to 350 beats per minute

– Heart block• Interruption in conduction system

• Arrhythmias– Divided into first-, second-, or third-degree

– Premature or early contractions (PVCs) may affect atria or ventricles

– Treatment:• Unnecessary if asymptomatic

Diseases of the Veins

• Phlebitis– Inflammation of superficial veins

– Symptoms:• Pain

• Swelling

• Red, cord-like hardening along vein toward heart

• Phlebitis– Treatment:

• Analgesics

• Warm compresses

• Elevation of area above heart level

• Elastic stockings

• Exercise

• Thrombophlebitis– Clotting in vessels of legs, thighs, and pelvis

– Asymptomatic until embolization occurs

– Risk factors:• Immobility

• Dehydration

• Varicose veins

Phlebitis and Thrombus

• Deep vein thrombophlebitis (DVT)– Treatment:

• Reduce clot

• Prevent embolization

• Use anticoagulants

• Varicose veins– Dilated, tortuous, and elongated veins in legs

– Causes:• Prolonged sitting or standing

• Pregnancy

• Obesity

• Varicose veins– Symptoms:

• Leg fatigue and cramps

• Thickening veins

• Edema

• Fluid

• Varicose veins– Treatment:

• Elevate legs

• Walk

• Use support or elastic hose

• Strip vein

Trauma

• Hemorrhage– Abnormal loss of blood

– May be acute or chronic

– Exsanguination• Loss of circulating blood

– Internal bleeding can lead to anemia or shock due to blood loss

Trauma

• Hemorrhage– Low-pressure vessels lead to petechiae or ecchymosis of

purpura

– High-pressure vessels lead to squirting of bright red blood

Trauma

• Shock– Extremely low blood pressure that leads to decreased tissue

perfusion

Trauma

• Shock– Types:

• Cardiogenic

• Septic

• Hypovolemic

• Neurogenic

• Anaphylactic

Trauma

• Shock– Symptoms:

• Facial pallor

• Cool and clammy skin

• Cyanosis

• Tachycardia

• Tachypnea

Trauma

• Shock– Symptoms:

• Altered mental status

• Syncope

• Unconsciousness

• Oliguria

• Anuria

Trauma

• Shock– Treatment:

• Rest in supine position

• Move to warm, quiet environment

• Elevate feet and legs above heart

Rare Diseases

• Malignant hypertension

• Cor pulmonale

• Raynaud’s disease

• Buerger’s disease

• Polyarteritis nodosa

Effects of Aging

• Decreased contractility of heart muscle

• Decreased elasticity of vessels

• Thickening of valves– Becoming sclerotic

Animation

Click Here to Play Ventricular Fibrillation Animation

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 8 Cardiovascular System...

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