Patho Cardio

- pulmonary circulation

- sends blood to the lungs to pick up oxygen

describe the right heart

- systemic circulation

- sends oxygenated blood to body tissue

describe the left heart

outer layer, reduces friction

what is the epicardium

composed of thick, muscular middle layer

what is the myocardium

contracts ot pump blood

what does myocardium do

smooth inner lining of the heart

what is endocardium

sac that surrounds and protects the heart

what is pericardium

small amount of fluid to reduce friction as the heart beats

what does the pericardium contain

brings blood from the upper body to right atrium

where does superior vena cava bring blood from and to

brings blood from the lower body to right atrium

where does inferior vena cava bring blood from and to

carries deoxygenated blood from right ventricle to lungs

where does pulmonary artery bring blood from and to

carries oxygenated blood from lungs to left atrium

where does pulmonary vein carry blood from and to

carries oxygenated blood from left ventricles to body

where does aorta bring blood from and to

receives blood from body

what does right atrium do

pumps blood to lungs

what does right ventricle do

receives blood from lungs

what does left atrium do

pumps blood to body

what does left ventricle do

septum

wall separating the right and left sides of heart preventing blood on each side from mixing

has to pump blood to body against higher pressure

why does left ventricle have the thickest wall

right atrium and right ventricle

where is tricuspid valve

right ventricle and lungs

where is pulmonary valve

left atrium and left ventricle

where is mitral or bicuspid valve

left ventricle and body

where is aortic valve

- relax and refill

- ventricles relax

- blood flows into ventricles

- AV valves are open

describe diastole

- squeeze and pump

- ventricles contract

- blood is pumped into the lungs and body

- semilunar valves are open

describe systole

- left anterior descending

- circumflex artery

what does the left coronary artery branch into

remove waste and return blood to the right atrium

what do coronary veins do

decreased coronary blood flow and decreased oxygen to myocardium

what two things cause ischemia

narrow pathway will be created to get blood and oxygen to the rest of the body

what is the collateral if the coronary arteries narrow

heart's natural pacemaker

what is the sa node

initiates the electricle impulse

what does sa node do

briefly delays the impulse

what is av node

oCarry the impulse through the ventricles

oCauses ventricular contraction

what do Bundle of His → Bundle branches → Purkinje fibers do

electrical activation → leads to contraction

what is depolarization

electrical recovery/resetting

what is repolarization

• P wave → atrial depolarization

• PR interval → electrical impulse travels from atria toward ventricles

• QRS complex → ventricular depolarization

• ST segment → ventricles remain depolarized

• T wave → ventricular repolarization

what are the waves of the ECG and what do each mean

amount of blood the heart pumps in 1 minute

what is cardiac output

heart rate x stroke volume (5L/min)

what is the formula and normal resting amount of cardiac output

amount of blood pumped out with each beat

what is stroke volume

amount of blood filling/stretching the ventricle

what is preload

resistance the ventricle must pump against (hypertension)

what is afterload and what affects it

strength of the heart's contraction (myocardial infarction)

what is contractility and what affects it

% of blood pumped out of the ventricle with each contraction (Normal EF ≈ 55-65%)

what is ejection fraction and what is the normal percent

1. preload

2. afterload

3. contractility

what 3 things affect stroke volume

baroreceptors

what detect changes in blood pressure

- inner lining of blood vessels

- helps regulate blood flow and clotting

what is the endothelium and what does it do

atherosclerosis and hypertension

what does endothelial damage contribute to

cardiac output and vascular resistance

what is blood pressure influenced by

decreased renal perfusion and BP, kidneys sense that body is not getting enough blood

what is RAAS activated by

vasoconstriction and fluid retention leads to increased blood volume and BP

what happens with RAAS

- blood pools in veins, veins become distended

- usually caused by in competent venous valves

- increased venous pressure = edema

describe varivose veins

- long term inadequate venous return

- venous stasis leads to decrease tissue oxygenation which leads to inflammation and tissue damage

describe chronic venous insufficiency

venous statis ulcers

what can chronic venous insufficiency progress to

- lower extremity edema

- aching, cramping or heavy legs

- skin changes: brown discoloration/hyperpigmentation

- dermatitis/itching

what signs and symptoms of chronic venous insufficiency

venous stasis ulcers

what is the most obvious sign of chronic venous insufficiency

- doppler ultrasound

- compression stockings

- exercise/ambulation

- wound care if ulcers develop

what are evaluations and treatments for chronic venous insufficiency

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

what does Venous Thromboembolism refer to

clot in deep vein

what is deep vein thrombosis

1. venous stasis - immobility

2. endothelial injury - surgery, trauma, IV devices

3. hypercoagulability - cancer, pregnancy, estrogen, inherited disorders

why do clots form in deep vein thrombosis

- unilateral leg swelling/edema

- pain/tenderness

- warmth redness

what are signs and symptoms of DVT

- sudden shortness of breath

- chest pain

- tachycardia/hypoxemia may occur

what are signs and symptoms of PE

Evaluation: D-dimer and Doppler ultrasound

how should DVT be evaluated

Early ambulation, pneumatic compression devices, and prophylactic anticoagulants

what are preventions for DVT

Anticoagulation

what are treatments for DVT

- no single identifiable cause

- develops from genetics and lifestyle

what is primary essential hypertension caused by

- underlying condition or medication

- •kidney disease, endocrine disorders, pregnancy, certain medications

what is secondary hypertension caused by

oVasoconstriction → ↑ resistance

oNa⁺ & water retention → ↑ blood volume

oSNS activation → ↑ HR + vasoconstriction

oRAAS activation → vasoconstriction + fluid retention

what are the major mechanisms of hypertension

vascular remodeling and organ damage

what sustained hypertension cause overtime

oBrain → TIA/stroke

oHeart → CAD, MI, LV hypertrophy, heart failure

oKidneys → renal damage/failure

oEyes → retinal damage/vision changes

oBlood vessels → atherosclerosis/aneurysm

what are the target organs and damages of them in hypertension

- malignant hypertension

- rapidly progressing hypertension (180/120)

- risk for acute organ damage

what is hypertensive crisis

electrolytes, glucose, lipids, and kidney function

what will labs include for hypertension

•↓ Sodium and high fat diet

• Regular exercise/stress reduction

• Weight management

• Smoking cessation

• Limit alcohol and caffiene

what are lifestyle treatments for hypertension

• Diuretics

• ACE inhibitors / ARBs

• Calcium channel blockers

what are medications for hypertension

- dehydration/volume loss

- medications

- prolonged immobility

- autonomic dysfuction

what are common causes of orthostatic hypotension

fall risk especially elderly

what is a major concern of orthostatic hypotension

o Change positions slowly

o Maintain hydration

o Treat underlying cause

o Compression garments if needed

what are ways to manage orthostatic hypotension

Aneurysm

localized dialtion or outpouching of a vessel wall or cardiac chamber

Thoracic aorta and Abdominal aorta (AAA)

where are common locations of Aneurysms

oHypertension

o Smoking

o Atherosclerosis/high cholesterol

o Older age

o Genetic/connective tissue disorders

o Less commonly related to: infection (like syphillis), inflammation, or trauma

what are major risk factors of aneurysms

Vessel wall weakens → stretches/dilates → risk for rupture

what happens in an aneurysm

heart beat in abdomen

what might you feel when there's an aneurysm

RUPTURE → hemorrhage & shock

what is major concern for aneurysm

aortic dissection of aneurysm

tear in inner aortic wall → blood separates wall layers

oSudden severe chest/back pain

oCan disrupt blood flow to vital organs

oMay cause MI, stroke, limb ischemia or shock

what are s/s of aortic dissection of aneurysm

• CTA / MRA

• Control BP & cardiovascular risk factors

• Prevent stress, coughing, and constipation

• Monitor small/stable aneurysms

• Surgical or endovascular repair when indicated

what are evaluations and treatments for aneurysms

Blood clot that forms and stays in a vessel

what is arterial thrombus

• May partially or completely block arterial blood flow

• Can break loose and become an embolus

what does arterial thrombus do

Material (often a clot) that travels through the bloodstream

what is arterial embolism

• Travels until it lodges in a smaller vessel

• Blocks blood flow → ischemia/infarction

what does arterial embolism do

oCerebral artery → Stroke

oCoronary artery → MI

oPeripheral artery → Limb ischemia

what are examples of arterial embolisms

Anticoagulants, thrombolytics, or removal of clot as indicated

how do you treat arterial embolism

Buerger Disease

Nonatherosclerotic inflammatory autoimmune disease of peripheral arteries

Inflammation + clotting → occlusion of small/medium arteries

what happens in Buerger Disease

smoking

what is Buerger disease strongly associated with

rubor skin color & pain/tenderness (affects hands and feet mainly)

what are s/s of Buerger disease

gangrene/amputation

what is severe consequences of buerger disease

stop smoking

what is the treatment of buerger disease

Raynaud Phenomenon

Episodes of excessive intermittent vasoconstriction

cold or stress

what is Raynaud Phenomenon triggered by

fingers and toes

what does Raynaud Phenomenon usually affect