Cardiovascular System

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1 Cardiovascular System

2 » The heart, arteries, veins, and capillaries.

3 1. Brings oxygen and nutrients to cells 2. Removes metabolic waste products

4 In the pulmonary circulation, blood picks up oxygen and gives off carbon dioxide In the systemic circulation, blood gives off oxygen (and other nutrients) to cells and picks up carbon dioxide (and other waste products).

5 80Ue-AMo&NR=1

6 » Aorta» Arteries» Arterioles» Capillaries» Venules» Veins» Vena Cava

7 Label drawings

8 1MC1hcE Circulatory song

10 Above 120/80 Hypertension Above 120/80 Elevated systolic/diastolic pressures on two/three consecutive occasions Above 120/80 Above 120/80 Above 120/80

11 +Pre-hypertension is / Hypertension stage 1 is / Hypertension stage 2 is >160/>100

12 » Types: Essential or Primary (90%) Secondary (renal disease, pheochromocytoma )

13 » Signs and symptoms? No symptoms!

14 » Risk factors: Obesity Diabetes Smoking Sedentary lifestyle High saturated fat diet High sodium intake Low calcium, potassium, and magnesium Aging Family history

16 » Increase fluid» Increase rate of heart» Increase force of contraction of the heart» Increase resistance to blood flow

17 Cardiac Output (CO) CO = Heart Rate x Stroke Volume Resistance refers to the friction to blood flow in the vessels. The smaller the vessel, the greater the resistance

18 the autonomic nervous system using baroreceptors the Renin-Angiotensin-Aldosterone pathway using: Hypothalamic-pituitary axis (increases in thirst, and release of vasopressin) Arterioles (increases in resistance) Proximal, distal tubules and collecting duct of the kidneys (Na+ reabsorption) Adrenal cortex (Na+ reabsorption)

19 Release of Vasopressin

21 Angiotensinogen (in the liver) Renin( from the kidneys) Angiotensin I the blood stream) Angiotensin-Converting Enzyme (from the lungs ) Angiotensin II

24 Dehydration Thirst Drinking water Urination Water produced by oxidation Sweat Breathing (expiration) Blood loss

26 Where does the water in the body come from? How is water lost?

27 List the percentage of the intake and output.

29 40% Intracellular fluid (ICF) contained in cells Interstitial fluid (IF) fluid in spaces between cells Plasma the fluid portion of the blood

30 » Hypovolemia (too little fluid in the blood) Seen in: + Dehydration + Vomiting/Diarrhea + Hemorrhage S & S: + Orthostatic hypotension + Tachycardia + Thirst» Hypervolemia (too much fluid in the blood) Seen in: + Heart failure + Renal failure S & S: + Hypertension + Bounding pulse + Acute weight gain Tx: + Oral or IV fluids Tx: + Sodium and water restriction + Diuretic

33 » Minerals in your blood and other body fluids that carry an electric charge.» Electrolytes impact: the amount of water in your body, the acidity of your blood (ph), your neurologic and muscle function» You get them from the foods you eat and the fluids you drink.

36 » Management of essential hypertension: Stop smoking Weight loss Exercise Low saturated fat, high fiber diet that is low in sodium Stress management Anti-hypertensive medication» Management of secondary hypertension: Surgical repair of abnormality

37 » Heart attacks» Strokes» Congestive Heart Failure» Chronic Kidney Failure» Blindness

39 NIH: Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

40 » Development is a life long process that begins with the fatty steaks seen on arterial walls.

41 Draw the heart along with the coronary arteries.

42 Atherosclerosis of the coronary arteries

43 Risk factors include: Diabetes Hypertension Obesity Cigarette Smoking Sedentary lifestyle High saturated fat, low fiber diet Hyperlipidemia + Increased Triglycerides + Increased Total Cholesterol + Increased LDL Cholesterol Decreased HDL Cholesterol Originally identified during the Framingham Study Advanced age Family history of heart disease

45 » Signs and Symptoms: Angina (Chest pain that resolves with rest or nitroglycerin) Shortness of breath Fatigue Dizziness

47 American Heart Association: This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia. Acute myocardial ischemia is chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease.

48 » Caused by atherosclerosis and embolus

49 Occlusion of a vessel results in 3 stages of tissue damage: 1. Ischemia (reversed if oxygen flow improved or oxygen demand reduced) Stable Angina 2. Injury 3. Infarction (tissue death) Myocardial Infarction

51 » Signs and Symptoms: Substernal tightness radiating to left neck and jaw, as well as left shoulder and arm Shortness of breath Lightheadedness Sweating Nausea» In women, diabetics, and elders there may not be the chest pain, but they may feel fatigue along with the other symptoms

52 » v=o9t25smyz3a&feature=related ube.com/watch? v=i_izvabhexy

53 » Workup: Monitor with EKG Blood Troponin (Troponins have the greatest sensitivity and specificity in detecting an MI, and elevated serum levels are considered diagnostic of MI) Blood CPK (CK-MB levels begin to rise within 4 hours after MI, peak at hours, and subside over 3-4 days)

54 » tch?v=qnbuhmogdni

55 » Treatment includes: (911) Oxygen Bed rest Tissue Plasminogen Activator (tpa)..ideally w/in 90 minutes of arrival at ER Coronary Angioplasty +/- stent Beta blocker Nitroglycerin Morphine Aspirin/Plavix

57 H Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion [V1] Slowly progressive atherosclerotic plaques Rupturing -- forming new clots -- forming new heart attacks -- its when I First learned about angiolplasty Its like bypass without cracking the thoracic Minimally invasive -- for -- cardiac patients Chest pain at rest along with EKG changes -- rising Troponins -- high creatine kinases Transmural infarcts -- ST elevations H Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion [V2] Nitro was being used for vasodilation Relieving even the pain the student doc was facing But it wouldn't decrease the mortality rating Like aspirin and heparin and beta blockading would 12 hours -- my heart was still racing too late for tpa -- the clot was still not breaking We was way past the point prevention Stenting was the intervention -- it was a miracle invented H Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion V3 Cause part of the heart had no movement Gotta get reperfusion Angiogram locates the occlusion Stent placement -- drug-elluding Aspirin -- clopidegrol -- what we not losing Gonna get him discharged on Welbutrin But -- if the clot is not moving Gonna defy the laws of Newton H Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion V4 II, III, avf intrusion Like a right ventricular contusion Rapid IV fluid infusion You know where we got to move him In the CCU -- heart attacks back to back Add ace inhibitors and the statins stat With metoprolol -- and that is that Before the beeper on the heart monitor goes out of whack. H Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Chest pain, shortness of breath Hypotension, Confusion Means you're just not Getting enough perfusion Copyright Pramanik Bharadwaj, M.D., All Rights Reserved.

59 » The heart can t pump enough blood to meet the body s metabolic needs. It results in intravascular and interstitial volume overload and poor tissue perfusion.

60 » Caused by: Coronary Artery Disease Hypertension

61 » Class I: Minimal (no limitation of activity)» Class II: Mild (slight limitation of physical activity, comfortable at rest)» Class III: Moderate (marked limitation of physical activity, comfortable at rest)» Class IV: Severe (unable to perform physical activity without discomfort, may even have discomfort at rest)

63 Signs and symptoms of Left-sided heart failure + Dyspnea + Limitation of physical activity + Episodes of dyspnea at night Signs and symptoms of Right-sided heart failure Weight gain Peripheral edema

64 » Causes of Left-sided Failure: Hypertension Left ventricular infarction» Causes of Right-sided Failure: Left-sided failure Right ventricular infarction Pulmonary embolism Pneumonia

65 » Bed rest» Diuretic

67 » Stenosis or occlusion of arteries in the limbs» Leg pain, ulcers

72 » Outpouching or dilation of a weakened arterial wall

74 »Usually silent» Pulsating mass in the peri-umbilical area of the abdomen associated with a bruit over the aorta.» Persistent abdominal and back pain

75 » Results in profuse bleeding (50% of people with a ruptured AAA survive)

77 » Blood clot (platelets, fibrin, red and white blood cells).» Caused by: Damage to the inner wall (endothelium) of a blood vessel Increase in the coagulability of blood

78 Thrombus formation in a vein

80 » Predisposing factors: Prolonged immobilization Trauma Surgery (major abdominal or pelvic surgery) Childbirth Obesity Hormonal Contraceptives (estrogen)

82 » Signs and Symptoms: Pain (especially with dorsiflexion of the foot Swelling Redness

84 A substance that travels through the blood stream from one location in the body to another. It s generally make up of a blood clot from a thrombus, although can be made of fat, bacteria, or tumor cells.

» From the venous circulation Comes from deep vein thrombosis» From the arterial circulation Come from the left side of the heart (arrhythmia, valvular heart disease, myocardial infarction, heart

86 » From the venous circulation Comes from deep vein thrombosis» From the arterial circulation Come from the left side of the heart (arrhythmia, valvular heart disease, myocardial infarction, heart failure, or endocarditis) Travels to the right side of the heart, then the pulmonary system, and lodges in a capillary where it causes pulmonary infarction. Infarction of the brain (stroke), kidney and extremities (arterial occlusive disease)

89 Sudden onset of persistent neurologic deficit Occurs suddenly without warning

90 Sudden onset of loss of function (movement, feeling, speaking, et.) because of an interruption of blood flow to the portion of the brain responsible for controlling that function. It can also manifest as a sudden onset of dizziness, confusion, or severe headache.

93 25% of the heart s output of blood goes to supply the brain without oxygen from the blood the neurons die.

94 There are two types of strokes: Ischemic blockage of artery from a thrombus of embolism Hemorrhagic rupture of an artery

97 Risk factors: Hypertension Cigarette smoking Diabetes Mellitus Hyperlipidemia Obesity Sedentary life style

98 For Ischemic stroke» tpa can reverse the stroke if given 3 6 hours from the symptoms» Antiplatelet medication is given if it s been 6 hours or more, in order to prevent recurrent strokes» Plavix» Aspirin» Physical/occupational/speech therapy

99 VITALS: BP 120/80 or less P ~ 70 R ~ 14 T = 98.6F» HDL > 45» LDL < 100» Total Cholesterol < 200» Triglycerides < 150» BUN/Cr: ~ 10/1» Fasting Glucose ~ 100» HgA1c ~6

100

101 » Exchange CO2 (on expiration) for O2 (on inspiration)

102 » Includes: Nose Mouth Pharynx Larynx

103 » Includes: Trachea Bronchi Lobules + Bronchioles + Alveolar ducts + Alveolar sacs

104 1. Label the drawing 2. Share the results with the class

105 » Air moves in an out of the respiratory tract by the contraction and relaxation of the respiratory muscles: Sternocleidomastoid muscle Intercostal muscles Diaphragm

106 » For there to be effective exchange of O2 for CO2, ventilation and perfusion at the alveolar level must be matched rro0&feature=related

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108 » Bluish discoloration, of the oral mucosa, lips, fingers, nail beds

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110 » A reaction to inhaled allergens, which cause rhinitis and conjunctivitis, seasonally or yearround

111 Exposure to an allergen T-cells instruct B-cells to create antibodies against the allergen B-cells create antibodies (IgE type) IgE antibodies attach themselves to mast cells (release histamine) Mast cell-ige complex remain in the body for years, ready to react with the same allergen

congestion sinus pain and headache» Pruritis of the

112 » Paroxysmal sneezing» Pale, cyanotic, edematous (boggy) nasal mucosa» Profuse watery rhinorrhea» Nasal congestion sinus pain and headache» Pruritis of the nose, throat and eyes» Red, edematous eyelids and conjunctivae

113 » Avoid allergens» Antihistamines» Inhaled intranasal steroids» Cromolyn» Leukotriene inhibitors» Desensitization

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116 » A chronic inflammatory airway disorder, characterized by airflow obstruction and airway hyper-responsiveness to certain stimuli, extrinsic or intrinsic triggers.

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118 » Extrinsic triggers Animal dander Secretions from cockroaches Dust mites Pollen Mold Viral infections Feather pillows Cigarette smoke Cold air Temperature or humidity variations Food additives Certain foods: Shellfish, peanuts

119 » Intrinsic triggers Anxiety Emotional stress Strenuous exercise Gastro-esophageal Reflux Disease (GERD) Coughing Laughing Fatigue Endocrine changes

Bronchospasms Edema of the airway mucosa Increased mucus secretion http://www.youtube.

120 Bronchospasms Edema of the airway mucosa Increased mucus secretion 8zKLvQ&feature=related

121 » Sudden: Dyspnea Wheezing Tightness in the chest» Productive cough» Rapid respiration» Rapid pulse» Use of accessory respiratory muscles

122 VA9C_aCH7F0&feature=related

123 » Mild intermittent: (<2 times/week), nighttime symptoms < 2/month, FEV1 ~ 80% of predicted

124 » Mild persistent: (>2 times/week), nighttime symptoms > 2 times/month, FEV1 ~ 80% of normal» Moderate persistent: Symptoms occur daily, exacerbations more than two times/week, bronchodilator therapy is used daily, nighttime symptoms more than once/week, FEV % of normal» Severe persistent: Symptoms occur continuously, exacerbations occur frequently and limit physical activity, nighttime symptoms are frequent, FEV1 <60%

125 » Avoid triggers» Desensitize to triggers» Develop Cardio-pulmonary endurance» Hydration» Monitor with FEV1 with peak flow meter v=lhvbh0o6u8c» Short acting Bronchodilator for rescue» Corticosteroid for maintenance (alone or with long acting bronchodilator)» Mast cell stabilizer» Leukotriene modifier CAUTION: Do not take Aspirin, or other non-steroidal anti-inflammatory drugs, and do not take beta-blockers

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128 Green Zone: 80 to 100 percent of your usual or "normal" peak flow rate signals all clear. Yellow Zone: 50 to 80 percent of your usual or "normal" peak flow rate signals caution. Your airways are narrowing and may require extra treatment. You and your healthcare provider should have a plan for yellow zone readings. Red Zone: Less than 50 percent of your usual or "normal" peak flow rate signals a Medical Alert. Severe airway narrowing may be occurring. Take your rescue medications right away. Call 911 or get a ride to the emergency room.

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131 How to Use a Metered-Dose Inhaler Shake the inhaler after removing the cap. Breathe out for 1 or 2 seconds. Put the inhaler in your mouth or 1 to 2 inches from it and start to breathe in slowly, like sipping hot soup. While starting to breathe in, press the top of the inhaler. Breathe in slowly until your lungs are full. (This should take about 5 or 6 seconds.) Hold your breath for 4 to 6 seconds. Breathe out and repeat the procedure. If this method is difficult, a spacer can be used.

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134 » Chronic Bronchitis and» Emphysema Main cause is smoking

135 » Inflammation of the bronchi caused by: Cigarette smoking Respiratory tract infection Prolonged exposure to irritants, noxious gases, organic or inorganic dusts

136 » Results in: Hypersecretion of mucus Chronic productive cough for at least 3 months, and occurring at least two years in a row. Rhonchi

137 » The permanent destruction of the alveolar walls.

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139 » Signs and Symptoms: Exertional dyspnea Tachypnea Barrel-shaped chest Use of accessory muscles for inspiration and abdominal muscles for expiration Clubbed fingers

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143 » Obstruction of a pulmonary artery by a dislodged thrombus, usually from a deep vein in the leg.

144 » This is the most common pulmonary complication in a hospitalized patient.

145 Sudden severe dyspnea Tachycardia Anxiety Blood-tinged sputum

146 » Immobilization» Obesity» Use of Hormonal Birth control» Deep vein thrombosis

147

Function of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration)

Function of the Respiratory System Exchange CO2 (on expiration) for O2 (on inspiration) Upper Respiratory Tract Includes: Nose Mouth Pharynx Larynx Function: Warms and humidifies the inspired air Filters