Complex Health: Exam 2

cardiovascular disease

is the top cause of death worldwide for adults; it claims the life of one person every 37 seconds.

circulatory systems

• Circulates blood through a network of blood vessels (arteries, capillaries, and veins).

  • Pulmonary System » Right Heart

  • Systemic System » Left Heart

lymphatic system

• Complements the circulatory system's function.

  • Drains excessive interstitial fluid from tissues.

  • Returns fluid back into the bloodstream.

  • Routes via the internal jugular and subclavian veins.

arteries

• Thick-walled structures transporting oxygenated blood.

• Includes the aorta (largest) and smaller arterioles (embedded in tissue)

• Composed of three distinct layers

  • tunica intima

  • tunica media

  • tunica adventitia (or externa)

capillaries

• Sites of fluid movement and diffusion.

  • Exchange oxygen and nutrients for cellular use

  • Remove carbon dioxide and metabolic waste

  • Gas diffusion

veins

• Return deoxygenated blood to the heart.

  • Formed by merging capillaries into venules

  • Venules merge further to form larger veins

  • Have valves

pulmonary arteries

the only artery carrying deoxygenated blood

pericardium

• Tough fibrous sac encasing the heart.

  • Fibrous: Outer layer

  • Serous: Inner layer (epicardium)

• Epicardium, is further subdivided into the visceral and parietal layers. Between these layers is the pericardial cavity.

fist

The heart is the size of your _______.

myocardium

The thick middle muscular layer that contains the heart muscle

endocardium

Innermost layer lining chambers and covering heart valves

coronary arteries

• supply arterial blood directly to the heart muscle

• Originates from the aorta just above the aortic valve

right coronary artery

• Supplies the right side of the heart (RCA).

• SA Node: Provides key blood supply to the sinoatrial node

SA node

What does the right coronary artery primarily supply?

left coronary artery

• Main artery (LCA) bifurcates into two key branches:

  • LAD: Supplies the anterior wall of the heart.

  • Circumflex: Circles left to feed the lateral wall.

cardiac conduction system

composed of specialized cells that are capable of spontaneously initiating an electrical impulse (automaticity), responding to an electrical impulse (excitability), and propagating these impulses from one cell to another (conductivity).

SA node, atria, AV node, bundle of His, bundle branches, purkinje fibers, ventricles

Write down the path of the conduction pathway.

sodium and potassium

At the cellular level, electrical activity is due to the exchange of ions (________________) across cellular membranes.

electrical cardiac conduction

is facilitated by the movement of ions across the cell membrane that is unique to cardiac cells

at rest (polarized)

• Sodium outside, potassium inside

• Inside of cell has a negative charge compared to outside

• A reversal of these charges occurs when the move. This is called depolarization.

depolarization

• Sodium moves into the cell, potassium moves out

• Cell becomes positive, leading to contraction

• Reverts to polarized state once complete

repolarization

• Ions return to their normal positions.

• Cell goes back to its resting state (recovery)

sodium goes outside to in, potassium goes inside to out

What happens to Na and K during pumping?

cardiac cycle (heartbeat)

The complete sequence of one heartbeat, coordinating contraction and relaxation to pump blood throughout the body. It is depend on the heart rate

diastole

Resting + Filling

• Atria and ventricles are relaxed.

• Ventricles fill with blood.

• AV valves are open

• Pressure is low in ventricles

atrial systole

Active Filling

• Atria contract

• Forces remaining blood into the ventricles.

• “atrial kick”

ventricular systole

Contraction

• Ventricles contract.

• Pumps blood to the lungs and body

• Rising pressure in the ventricles closes the AV valves, and forces the semilunar valves open

cardiac output

the total volume of blood pumped by the heart per minute, typically measuring about 5 to 6 liters per minute at rest in a healthy adult.

preload

the initial stretching of the heart muscle cells (cardiac myocytes) right before contraction, determined by the volume of blood in the ventricles at the end of filling (end-diastolic volume).

afterload

the resistance or pressure the ventricles of the heart must overcome to eject blood during a contraction.

decreased, increased

• Preload is _________ by a reduction in the volume of blood returning to the ventricles.

• Preload is ________ by increasing the return of circulating blood volume to the ventricles.

pulmonary vascular resistance (PVR)

the resistance that blood must overcome to flow from the pulmonary artery through the lungs to the left side of the heart.

• low resistance

systemic vascular resistance (SVR)

the force or resistance that the heart must overcome to pump blood through the body's blood vessels.

• high resistance

right side of the heart

the half of the heart—consisting of the right atrium and right ventricle—that receives oxygen-poor blood from the body and pumps it to the lungs

left side of the heart

the half of the organ made up of the left atrium and the left ventricle that receives oxygen-rich blood from the lungs and pumps it out to the rest of the body.

stiffer and less flexible system, less effective pumping, reduced blood flow, higher risk of arrhythmias, decreased cardiac output

Describe aging changes of the cardiovascular system.

hormone therapy

• For transgender people, __________ may lower or not change MI risk.

• May increase risk of VTE (blood clots).

smaller

The female heart is __________ with __________ coronary arteries; blockages happen easier.

heart rate, stroke volume, and ejection fraction

Females often have higher resting ________________ and _______.

10, estrogen

CAD Timing occurs ~__ years later in females; _____ may play a role.

lipids, BP, weight, insulin

Both sexes die of heart problems at similar rates; monitor _______________ and _____.

lymphatic system

• closely linked to cardiovascular system.

• Components:

  • Lymph

  • Lymph Vessels

  • Lymph Nodes

• It collects interstitial fluid (lymph) and returns it to the cardiovascular system, helping maintain preload and volume

hypertensive emergency

An acute complication of HTN, defined as a severe increase in BP (commonly >180/120 mm Hg) associated with potentially life-threatening target organ damage.

Example damage: MI, ischemic stroke, hemorrhagic stroke, or pulmonary edema

MI, ischemic stroke, hemorrhagic stroke, pulmonary edema

What are examples of hypertensive emergency damage?

nonadherence to treatment, acute kidney failure, brain hemorrhage or stroke, eclampsia, drug misuse

What are possible causes of hypertensive emergency?

female biologic sex, obesity, history of CAD or HTN, high number of prescribed drugs, treatment nonadherence

What are risk factors of hypertensive emergency?

admit to ICU, monitor blood pressure closely, and initiate intravenous medications immediately

Describe the protocol for hypertensive crises.

arterial line

• a catheter that healthcare providers place in an artery, typically in your wrist, to continuously monitor your blood pressure. This helps in emergency situations and high-risk surgeries. Providers also place arterial lines when you need frequent blood draws to check oxygen, carbon dioxide and pH levels.

• helpful for accurate monitoring but should not delay treatment.

• Necessary for assessment of target organ damage and precise parenteral administration.

enalaprilat, esmolol, fenoldopam, hydralazine, labetalol, nicardipine, hydrochloride

Name the medications for a hypertensive crisis.

coronary artery disease (CAD)

a common type of heart disease. It affects the main blood vessels that supply blood to the heart, called the coronary arteries. In CAD, there is reduced blood flow to the heart muscle. A buildup of fats, cholesterol and other substances in and on the artery walls, a condition called atherosclerosis, usually causes coronary artery disease. The buildup, called plaque, makes the arteries narrow.

• the most common type of cardiovascular disease

cardiovascular disease (CVD)

is the leading cause of death in the United States and globally.

• Accounts for > 17.9 million deaths globally

• Expected to increase to > 23.6 million by 2030

atherosclerosis

• Buildup of lipids (LDL) and fibrous tissue in arterial walls, causing narrowing and reduced blood flow to the myocardium.

• Repetitious inflammatory response to injury to the artery wall

• Also causes: Thickening, hardening, stiffness, and loss of elasticity

coronary artery disease, carotid artery disease, hypertension, abdominal aortic aneurysm, peripheral arterial disease

Name the causes of major cardiac disorders.

males >45, postmenopausal people, higher make risk under 55, equalizes after 55, african, mexican, native, and asian americans, first-degree relative with premature heart disease

What are non-modifiable risk factors for atherosclerosis?

diabetes, HTN, smoking, obesity, physical inactivity, high cholesterol, unhealthy diet, alcohol use, and stress.

What are modifiable risks of atherosclerosis?

arterial narrowing, thrombus formation, blood flow obstruction to the myocardium

Symptoms and complications of atherosclerosis depend on ______________, ____________, and _______________________.

myocardial infarction (MI), unstable angina, sudden cardiac death, stroke

What are critical outcomes of atherosclerosis?

identify and control risk factors (HTN, DM), medications, heart-healthy diet, exercise, lifestyle modifications

How to treat and manage atherosclerosis?

earlier; menopause

Men often develop CAD ____; women's risk increases post-________.

20

CAD is the most common heart disease in the U.S., affecting about 1 in __ adults age _+.

coronary heart disease (CHD) and ischemic heart disease (IHD)

CAD is also commonly referred to as?

stable angina

• Chest pain occurring with activity or stress.

• Relieved by rest or Nitroglycerin

unstable angina (emergency)

• Chest pain occurring at rest.

• Follows a worsening or unpredictable pattern

myocardial infarction (heart attack)

• Complete or severe blockage of a coronary artery

• Leads to permanent heart muscle damage.

acute coronary syndrome (ACS)

• Sudden, dramatic reduction in blood flow.

• Includes Unstable Angina, NSTEMI, and STEMI.

coronary artery disease (CAD)

an umbrella term for conditions caused by reduced blood flow to the heart.

angina pectoris

• chest pain or pressure caused by myocardial ischemia, which occurs when the heart muscle receives insufficient oxygen-rich blood.

• It typically results from atherosclerosis narrowing the coronary arteries, preventing blood flow from meeting increased demand during exercise, stress, or exertion.

stable angina

Predictable pain occurring during physical activity or stress.

• Short duration

• Relieved by rest

• Relieved by Nitroglycerin

nitroglycerin

What medication relieves angina pectoris?

unstable angina

Medical Emergency

Sudden, unpredictable chest pain that can occur even at rest.

• Longer duration

• Not relieved by rest

• Unpredictable pattern

chest, jaw, shoulder, back, arm

Angina pectoris is felt in the _______, _______, ________, ______, or _____.

unstable angina

Treat ________________ like an MI, until you know.

myocardial oxygen demand, oxygen supply

Medical management of CAD and angina aim to decrease ____________ and increase __________.

acute coronary syndrome

• Umbrella term to describe unstable angina, NSTEMI, and STEMI

• Term used to describe a range of conditions associated with sudden, reduced blood flow to the heart

• Ischemia and Infarction are different

myocardial infarction (heart attack)

• Common cause is atherosclerosis, though other causes exist.

• Permanent destruction of myocardium occurs due to reduced blood flow from a ruptured plaque and thrombus occlusion.

• Process: Ischemia (oxygen deprivation) → Cellular Injury → Infarction (cell death).

• In unstable angina, the plaque ruptures but the artery is not completely occluded. EKG/ECG and blood work :Normal

• Damage depends on the specific coronary artery affected and the duration of reduced flow.

two; death; permanent heart damage

Most people who have a heart attack wait _____ hours or more after their symptoms begin before they seek medical help, a delay that can result in ________ or ___________.

NSTEMI

• Partial occlusion of major vessel or complete occlusion of minor vessel

• Reversible heart damage

• Ischemia

• Caused by non-occlusive thrombus; no ST elevation on 12-lead ECG

STEMI

• Complete occlusion of a major coronary vessel

• Irreversible full heart muscle damage

• Necrosis

• Caused by an occlusive thrombus; creates ST-elevation in leads facing infarction

sudden chest pain despite rest/meds, angina, abnormal heart sounds, diaphoresis, cool, pale skin, nausea, vomiting

What are clinical manifestations of myocardial infarction?

American College of Cardiology, American Heart Association

Which organizations were responsible for creating the best protocol for cardiac emergencies?

EKG, oxygen (above 93%), monitored bed, IV access, chest xray, bedside echocardiogram

What is the initial patient care of unstable angina?

serum cardiac biomarkers

released into the blood from the necrotic heart muscle

troponin, creatine kinase, myoglobin

Name serum cardiac biomarkers.

cbc, bmp, bun, creatinine, liver, pt, pttt, inr, c-reactive protein, lipid panel, nbp

What are other labs for unstable angina?

elevation, depression

The EKG for STEMI includes an ST ______, while an NSTEMI includes ST ________.

12 lead EKG, chest x-ray

What are the standard assessments for an unstable angina?

echocardiogram, stress testing, cardiac catheterization

What are the specialized assessments for unstable angina?

aspirin (162-324mg), nitroglycerin (may start IV), oxygen, morphine (be careful), beta blockers

What are initial medications for angina?

heparin, antiplatelets, beta blocker, ace inhibitors, antiarrrhythmics

What are medications for unstable angina/NSTEMI?

statins, stool softeners, diuretics, ACE, remember SAAB

What are LATER medications for unstable angina/NSTEMI?

statin, aspirin, ACE inhibitor, beta-blocker

What does SAAB stand for?

percutaneous coronary interventions

• treat angina and CAD most commonly include balloon angioplasty with intracoronary stent implantation.

• Door-to-balloon time should be less than 90 minutes (time is muscle!).

dissection, perforation, abrupt closure, or vasospasm of the coronary artery, acute myocardial infarction (MI), acute arrhythmias (e.g., ventricular tachycardia), cardiac arrest

What are procedural complications of percutaneous coronary interventions?

bleeding at insertion site/retroperitoneal bleeding, hematoma, pseudoaneurysm, loss of pulse

What are vascular complications of percutaneous coronary interventions?

for signs of recurrent angina, vital signs, HR, rhythm, catheter insertion site for signs of bleeding

How do you monitor for a patient post PCI?

neurovascular assessment, IV heparin, bed rest, Tband

What are assessments and protocol of post-PCI?

fibrinolytics

dissolve dangerous blood clots by converting plasminogen into plasmin, an active enzyme that breaks down the fibrin mesh of a clot.

• Only for STEMI

• Can’t get a PCI > 120 minutes

12

Fibrinolytics should be given less than ______ hours of angina symptoms.

30 minutes

Fibrinolytics are given IV within __________ of arrival to the ED.

bleeding and reperfusion (ST return)

What do you monitor in a fibrinolytic?