Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies

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1 Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies THIRD EDITION CHAPTER 27 The Cardiovascular System Lesson 3: The Pathology of the Cardiovascular System

2 Lesson Objectives Upon completion of this lesson, students should be able to: 1. Define and spell the terms to learn for this chapter. 2. Discuss common disorders associated with the cardiovascular system.

3 Anemia Blood abnormally low number of red blood cells RBCs do not contain enough hemoglobin or hemoglobin present is abnormal Most common dysfunction of RBCs Affects 3.5 million Americans

4 Anemia Decreased production of healthy red cells by bone marrow Increased erythrocyte destruction (hemolysis) Blood loss from heavy menstrual periods or internal bleeding Vitamin and mineral deficiencies in diet

5 Iron-Deficiency Decreased iron levels, resulting in decreased hemoglobin production, causes decrease in capacity of RBCs to transport oxygen

6 Vitamin-Deficiency Anemia Vitamin B 12 essential for hemoglobin production Pernicious anemia: vitamin B 12 deficiency

7 Hemolytic Anemia Caused by premature destruction of RBCs by antibodies produced by immune system

8 Sickle Cell Anemia Known as hemoglobin S disease Caused by sickled red blood cells Serious, life-threatening, inherited anemia Causes physical pain

9 Aplastic Anemia One of the deadliest and rarest forms Unexplained failure of bone marrow to produce certain types of blood cells Bone marrow replaced with fat cells

10 Critical Thinking Question 1. What are the symptoms of aplastic anemia?

11 Anemia Fatigue Weakness Fainting; dizziness Breathlessness Heart palpitations and tachycardia

12 Anemia Headache Ringing in ears Difficulty sleeping Trouble concentrating

13 Sickle Cell Anemia Pain in abdomen, joints, bones Infections and heart failure Aplastic Anemia Bleeding in mucous membranes Infections with high fevers Paleness Dyspnea

14 Anemia Treatment depends on type and cause Injections of vitamin B 12 Oral dietary supplements Elimination of specific medications that suppress body's immune system Blood transfusions Analgesics Antibiotics

15 Aneurysm Abnormal widening or ballooning of portion of an artery Aorta (aortic) Brain (cerebral) Leg (popliteal artery) Spleen (splenic artery) Intestine (mesenteric artery)

16 Aneurysm Can be congenital or acquired Cause unknown Defects in artery wall may be factor High blood pressure, high cholesterol, and atherosclerotic disease may contribute

17 Aneurysm Signs and symptoms vary depending on location Near body's surface may be distinguished by swelling, throbbing mass Often no symptoms Frequently goes undetected until it is too late

18 Aneurysm Surgical intervention may be required to repair vessel and prevent rupturing Some people may be candidates for stent placement within affected vessel Healthy diet and regular exercise Maintaining healthy blood pressure and cholesterol levels

19 Arrhythmia Irregular heartbeat caused by disturbance of electrical conductivity of heart Tachycardia: abnormally fast heartbeat of more than 100 beats per minute Bradycardia: abnormally slow heart rate of less than 60 beats per minute

20 FIGURE 27-15A Examples of heart rhythms: normal.

21 FIGURE 27-15B Examples of heart rhythms: sinus bradycardia.

22 FIGURE 27-15C Examples of heart rhythms: ventricular tachycardia.

23 Arrhythmia Most caused by heart diseases Coronary artery disease (CAD) Heart valve disease Heart failure Infections such as endocarditis

24 Arrhythmia Dizziness Palpitations Shortness of breath Fatigue Weakness Angina (chest pain) Fainting

25 Arrhythmia Can be life threatening Often treated with medications Cardioversion Pacemaker

26 Arteriosclerosis Also known as hardening of the arteries Thickening and loss of elasticity of arteries Effects cannot be seen and symptoms not felt

27 Arteriosclerosis High blood pressure Recurrent kidney infections Impaired circulation by peripheral vascular disease Treatment Relieving symptoms and causes

28 Atherosclerosis Narrowing of arteries from buildup of fatty material and plaque within vessel Result of unhealthy lifestyle factors: obesity, high cholesterol, excessive alcohol consumption, poor diet

29 Atherosclerosis Leading cause of coronary artery disease (CAD) Arteries can narrow to point of total blockage

30 FIGURE An atherosclerotic artery.

31 Atherosclerosis Angina (chest pain) during exercise or other exertive activity Shortness of breath Fatigue If blockage is large, angina can occur with little or no activity

32 Atherosclerosis Angina decreases with rest and oxygen Prevention and reversal accomplished by making lifestyle changes Avoiding fatty foods Decreasing alcohol consumption Stopping smoking Engaging in physical exercise

33 Cardiac Tamponade Also known as cardiac compression Congestion of heart muscle Caused by blood or fluid collecting in pericardial sac that surrounds heart Prevents heart from properly functioning

34 Cardiac Tamponade Shortness of breath Pale or bluing skin Chest pain Dizziness Drowsiness Anxiety Feeling of impending doom

35 Cardiac Tamponade Immediate medical attention to remove fluid from pericardium Diuretic medications Oxygen therapy

36 Cardiogenic Shock Collapse of cardiovascular system Inability of heart to pump enough blood to body's organs Caused by arrhythmias, ruptured cardiac muscle, or tear in septal wall

37 Cardiogenic Shock Chest pain and pressure Change in consciousness Rapid breathing and pulse Heavy diaphoresis (perspiration) Lightheadedness Decreased urination

38 Cardiogenic Shock Emergency medical treatment necessary Medications to restore heart function and normal rhythm Oxygen therapy Pain medications

39 Cardiogenic Shock Cardiac stenting and catheterization may be necessary Heart surgery or insertion of pacemaker may be required

40 Endocarditis Inflammation of lining of heart, including heart valves Caused by bacterial infection Frequently affects patients with existing abnormal conditions of heart valves

41 Endocarditis Life-threatening condition Weakness, fever, diaphoresis, dyspnea, swelling in feet and legs Treatment: antibiotics

42 Myocarditis Inflammation of muscular layer of heart Caused by viral infection Exposure to bacteria and certain drugs, chemicals, allergens may also be causes

43 Myocarditis Signs and symptoms generally resemble those of the flu Treatment Anti-inflammatory medications, antibiotics, bed rest, low-sodium diet

44 Pericarditis Inflammation of pericardium membrane that surrounds heart Complication of viral, fungal, or bacterial infection

45 Pericarditis Deadly condition Sharp, stabbing chest pain Fatigue Fever Dyspnea, especially while lying down

46 Pericarditis Analgesics Diuretics Antibiotics or antifungals Pericardiocentesis to remove fluid around heart

47 Congestive Heart Failure Heart unable to pump sufficient blood to body's other organs Coronary artery disease History of heart attack Hypertension

48 Congestive Heart Failure Heart unable to pump sufficient blood to body's other organs Diseases or infections of heart valves Primary diseases and infections of heart muscle itself Heart defects present at birth

49 Congestive Heart Failure Shortness of breath and fatigue Swelling, or edema Fluid may collect in lungs Affects kidneys' ability to dispose of sodium and water

50 Congestive Heart Failure Increased frequency of urination at night Weight gain Cough Decreased appetite Irregular pulse

51 Congestive Heart Failure Rest Proper diet Maintaining healthy weight Modified daily activities Medications that help heart function more efficiently

52 Cor Pulmonale Also known as right-sided heart disease Result of prolonged hypertension of pulmonary arteries and right ventricle of heart Cause primarily related to lung disorders

53 Cor Pulmonale Pain toward front of chest Frequent fainting Peripheral swelling of legs and feet Coughing or wheezing

54 Cor Pulmonale Treatment seeks to relieve pulmonary problems that precipitate the disease Medications that improve pulmonary function In severe cases, lung or heart-lung transplant might be necessary

55 Coronary Artery Disease (CAD) Also known as coronary heart disease (CHD) Narrowing of coronary arteries that supply blood to heart Results from buildup of plaque on artery walls

56 Coronary Artery Disease (CAD) Decreased blood flow Left untreated, this progressive disease raises risk of myocardial infarction, heart attack, possibly sudden death

57 Coronary Artery Disease (CAD) Most common form of heart disease Leading cause of death in United States Obesity Unhealthy diet choices Lack of exercise

58 Coronary Artery Disease (CAD) Leading cause of death in United States Stress Genetic factors Hypertension Diabetes High levels of LDL cholesterol

59 Coronary Artery Disease (CAD) Shortness of breath Fatigue with exertion Squeezing sensation of heart Edema in ankles Overall tiredness and weakness

60 Coronary Artery Disease (CAD) Antihypertensive medications to treat high blood pressure Nitroglycerin Medications to lower cholesterol levels Advised lifestyle changes

61 Myocardial Infarction Also known as heart attack or cardiac arrest Blood supply to a part of myocardium has stopped, causing tissue damage or death

62 Myocardial Infarction Causes Atherosclerosis and blood clots Heart attack may or may not lead directly to cardiac arrest (total cessation of heartbeat and breathing)

63 FIGURE Cross section of a myocardial infarction.

64 Myocardial Infarction Angina pectoris Crushing or squeezing pain, with feeling of fullness, heaviness, or aching in center of chest Pain may radiate down left arm or into neck or back Men experience chest pain as symptom of MI more frequently than do women

65 Myocardial Infarction Shortness of breath Diaphoresis Pain or discomfort in arms, back, jaw Dizziness or fainting Nausea Sense of impending doom Cyanosis

66 Myocardial Infarction Emergency treatment started immediately Patient suffering a heart attack may still be conscious or able to respond to voice or touch, will be breathing, and have a pulse Cardiac arrest has occurred if patient is completely unresponsive, has no pulse, is not breathing

67 Myocardial Infarction If patient in cardiac arrest, cardiopulmonary resuscitation (CPR) and defibrillation within first few minutes increases survival rate Thrombolytics can stop some heart attacks in progress Angioplasty frequently performed to reopen blocked coronary arteries

68 Myocardial Infarction Stents used to hold arteries open allowing more blood flow Coronary artery bypass graft (CABG) is form of open heart surgery Key to heart attack survival as well as survival of cardiac arrest is immediate intervention

69 Hemophilia Hereditary deficiency of clotting factors Affects male children; rarely affects females Platelets unable to form clots to stop bleeding

70 Hemophilia Predisposes patient to hemorrhaging when cut or injured Treated by transfusing deficient clotting factor (replacement therapy)

71 Hypertension (HTN) High blood pressure American Heart Association five categories Normal Prehypertension Stage I Stage II Hypertensive crisis

72 Hypertension (HTN) Peripheral artery disease (PAD) Obesity Sedentary lifestyle High salt diet African-American descent

73 Hypertension (HTN) Diabetic High-stress or anxious life Excessive alcohol consumption Smoking Family history

74 Hypertension (HTN) Called the "silent killer" Intense headaches Fatigue Changes in vision Nosebleeds Possibly blood in urine

75 Hypertension (HTN) If untreated, can lead to serious conditions Kidney failure Stroke Heart attack Eye damage Peripheral artery disease

76 Hypertension (HTN) Antihypertensive and diuretic medications Dietary and lifestyle changes Exercise Smoking cessation

77 Prehypertension Individuals over 18 years old Adults at upper end of prehypertension blood pressure range twice as likely to progress to hypertension

78 Prehypertension Blood pressure ranges from 120/80 to 139/89 mmhg Lifestyle changes: reducing dietary fat and sodium, increasing exercise, limiting alcohol consumption

79 Hypotension Low blood pressure Blood pressure generally below 90/60 mmhg Blood flow to heart, brain, vital organs becomes inadequate

80 Hypotension Dehydration Heart failure or heart attack Changes in heart's rhythm (arrhythmias) Syncope (fainting)

81 Hypotension Anaphylaxis Severe blood loss (shock) Certain medications Drug overdose Sudden change in body position

82 Hypotension Blurred vision Weakness Confusion Dizziness or fainting Sleepiness Treatment Vasoconstrictors Increasing fluid and sodium intake

83 Leukemia Malignant cancer of bone marrow and blood Uncontrolled growth of abnormal cells, in this case white blood cells Can be acute or chronic

84 Leukemia Classified by type of leukocyte affected Lymphocytic leukemia: Strikes lymphoid cells Myeloid or myelogenous leukemia: strikes myeloid (bone marrow) cells

85 Acute Leukemia Progresses rapidly Marked increase of cells that do not develop normally and never become functional

86 Acute Leukemia These cells crowd out healthy blood cells, increasing risk of anemia and infection Lack platelets that help blood to clot May bleed extensively

87 Chronic Leukemia Worsens gradually Abnormal cells accumulate over time and affect other body tissues

88 Leukemia Excessive bruising Fatigue Weakness Dyspnea Bleeding of mucous membranes Bone and joint pain Abdominal pain Weight loss

89 Leukemia Abdominal bleeding Enlargement of lymph nodes, spleen, liver Frequent infections Treatment: Chemotherapy Radiation therapy Bone marrow transplantation

90 Stroke Also known as cerebrovascular accident (CVA) Blood supply to part of brain suddenly interrupted

91 Stroke Can occur from blockage of artery to brain caused by embolism or a thrombus Deprives an area of brain of blood flow, oxygen, and nutrients (ischemia)

92 Stroke Signs/symptoms generally occur suddenly Numbness or weakness on one side of body Confusion or trouble speaking Vision problems

93 Stroke Severe dizziness Loss of balance or coordination Severe headache Transient ischemic attack (TIAs) Considered precursors of stroke

94 Stroke Therapies to prevent first or recurrent stroke based on managing underlying risk factors Permanent neurological damage avoided with prompt treatment of underlying cause Post-stroke rehabilitation Drug therapy

95 Thrombophlebitis When blood clot causes inflammation in one or more veins, typically in lower extremities Clot in a deep vein increases risk of serious health problems (pulmonary embolism) Caused by prolonged inactivity Decreases blood flow through veins

96 FIGURE 27-18A Examples of thrombophlebitis. Superficial thrombophlebitis of the leg. Dr. P. Marazzi/Science Source

97 FIGURE 27-18B Examples of thrombophlebitis. Deep venous thrombosis (DVT) commonly affects the veins of the leg. SPL/Custom Medical Stock Photo

98 Thrombophlebitis Redness Swelling Warmth Tenderness Dull ache or pain in affected area Red, hard, tender cord present under surface of skin

99 Thrombophlebitis Applying heat to painful area Elevating affected limb Nonsteroidal antiinflammatory drugs Injection of blood-thinning medication Support stockings Varicose vein ligation or stripping Thrombectomy or bypass surgery

100 Transfusion Incompatibility Reaction If the wrong type of blood is administered to a patient, severe transfusion reaction can occur Signs and symptoms arise rapidly with collapse of cardiovascular system Symptoms of shock (confusion, restlessness, shortness of breath) are dramatic

101 Transfusion Incompatibility Reaction Transfusion of donor blood stopped immediately Normal saline infused into bloodstream intravenously Administration of antihistamines Frequent monitoring of vital signs Administration of epinephrine may be needed

102 Valvular Heart Disease Also known as mitral stenosis Inability of mitral valve to fully open Causes blood to flow improperly, causing buildup of blood in atria Can be congenital Often occurs in adults who suffered episodes of rheumatic fever

103 Valvular Heart Disease Heart murmur Fatigue Cough; frequent respiratory infections Discomfort with increased activity

104 Valvular Heart Disease Breathing difficulties and chest discomfort Edema of feet and legs Heart palpitations Treatment: medication to strengthen heart function

105 Varicose Veins Gnarled, enlarged veins Usually superficial veins in legs Caused by prolonged periods of standing, pregnancy, aging Valves in veins malfunction Visible, bulging veins often linked with symptoms such as tired, heavy, aching limbs

106 Varicose Veins Relief of symptoms Moderate exercise Avoiding long periods of standing Elevating the legs Wearing support stockings Removal of affected veins (ligation)

107 Questions?

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