arts and sceince unit 5

cardiopulmonary physiology involves delivery of

a: deoxygenated blood to the right side of heart + pulmonary circulation

b: oxygenated blood from lungs +left side of heart to rest of body

right ventricle pumps to

pulmonary circulation

left ventricle pumps to

systemic circulation

The circulatory system exchanges...

respiratory gases, nutrients, and waste products between the blood and tissues

myocardial pump

Two atria and two ventricles

As the myocardium stretches, the strength of the subsequent contraction increases (Starling's law).

myocardial blood flow

Myocardial blood flow must supply sufficient oxygen and nutrients to the myocardium

blood flow through the heart

Rt atria -->

Tricuspid -->

Rt ventricle -->

Pulmonic valve -->

Lungs -->

Lt atria -->

Mitral valve -->

Lt ventricle -->

aortic valve -->

aorta -->

Body

S1 heart sound

closure of the mitral and tricuspid valves

S2 heart sound

Closure of the semilunar valves (pulmonary and aortic)

coronary artery circulation

Coronary arteries supply the myocardium with nutrients and remove wastes.

2 facts about left coronary artery

1. most abundant blood supply

2. feeds the left ventricular myocardium

what part of the heart does the most work

left ventricle

systemic circulation

-circulation that supplies blood to all the body except to the lungs

-removes waste from tissue

blood flow regulation

cardiac output

stroke volume

preload

afterload

cardiac output

Volume of blood pumped by heart per minute.

whats a normal cardiac output

5-6L of blood per minute

cardiac output in older adults may be affected by

-increased arterial wall tension

-moderate myocardial hypertrophy due to increased systolic pressure

cardiac index

The adequacy of the cardiac output for an individual. It takes into account the body surface area (BSA) of the patient.

stroke volume

The amount of blood ejected from the heart in one contraction.

preload

volume of blood in ventricles at end of diastole

afterload

the amount of resistance to ejection of blood from the ventricle

myocardial contractility

-Heart muscle's ability to contract effectively.

conduction system

Electrical impulses from nerves that stimulate contraction and relaxation of heart

normal sinus rhythm

heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute

what is an ECG

A recording of the electrical activity of the heart

arrythmia

Abnormal heart rhythm

dysrythmias

irregular heart rhythms

when can dysrhythmias occur

vavular abnormalities, anxiety, drug toxicity, caffeine, alcohol, or tobbaco use

bradycardia

slow heart rate (less than 60 bpm)

whats tachycardia

fast heart rate greater than 100 bpm

ventricular tachycardia

A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest.

ventricular fibrillation

Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest.

asystole

-absence of contractions of the heart

-flat line

altered cardiac output

left sided heart failure

right sided heart failure

left sided heart failure

impaired functioning of left ventricle as a result of increased pressure or pulmonary congestion

symptoms of left sided heart failure

**L for lungs

Pulmonary congestion

• cough

• crackles

• wheezes

• hemoptysis

• tachypnea

S3 heart sound

Restlessness

Confusion

Tachycardia

Exertional dyspnea

Fatigue

Cyanosis

Paroxysmal nocturnal dyspnea

right sided heart failure

impaired functioning of right ventricle characterizied by venous congestion in systemic circulation

right sided heart failure primarily occurs due to

-pulmonary disease

-long term left sided failure

symptoms of right sided heart failure

weight gain, distended neck veins, peripheral edema

*the blood "backs up" in circulation

myocardial ischemia

loss of blood supply to heart muscle tissue of myocardium due to occlusion of coronary artery; may cause angina pectoris or myocardial infarction

angina pectoris

-chest pain that results when the heart does not get enough oxygen

-usually during periods of activity

acute coronary syndrome

unstable angina, NSTEMI, STEMI

unstable angina

chest pain that occurs while a person is at rest and not exerting himself

myocardial infarction

the occlusion of one or more coronary arteries caused by plaque buildup (heart attack)

myocardial infarctions can be classified as

-NSTEMI

-STEMI

NSTEMI (non-ST-segment elevation myocardial infarction)

partial blockage of blood flow in a coronary artery

STEMI (ST-elevation-myocardial-infarction)

complete obstruction of blood flow in coronary artery

symptoms of heart attack

pressure/pain in the chest, shoulder pain, sweating, nausea, shortness of breath

men vs women heart attack symptoms

men: chest pain, left arm pain, and jaw pain

women: anxiety, indigestion, fatigue, pressure/tightness

hypoxia

inadequate tissue oxygenation at the cellular level

what can cause hypoxia

blood loss, high altitudes, lung disorders, and strenuous exercise

signs and symptoms of hypoxia

decreased LOC, dizzy, behavioral changes, increased pulse, increased rate and depth of respirations, blood pressure elevated early on, cyanosis and respiratory decline are late stages

cyanosis

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

changes to the cardiac systems older adults

-thickening of ventricular wall= decr cardiac output

-blood flow from heart to body decreases

-vessels become more calcified = possible hypertension

positive life style practices that promote cardiopulminary health

-maintain ideal body weight

-exercise

-do not smoke

-monitor BP and cholesterol

changes of pulmonary system in older adults

-decreased chest wall compliance/elasticity

-decr alveolar surface area

-decr cilia

diagnostic testing of cardiopulmonary system

X-ray, blood samples, or TB skin testing

risk factors for heart disease

-older age

-smoking

-hypertension

-obesity

how does the sympathetic nervous system impact BP

-increase HR and contractility

-widespread vasoconstriction

-promotes release of renin from kidneys

changes in BP are sensed by what receptor

baroreceptors

hypertension

sustained elevation of systemic arterial BP

-systolic greater than 140

-diastolic greater than 90

isolated systolic hypertension

sustained elevation in systolic pressure with a reading greater than 140 but diastolic is not high

primary hypertension

-exact cause unknown

-contributing factors: increased SNS activity, overproduction of sodium-retention hormones, diabetes mellitus, and obesity

secondary hypertension

elevated BP with a specific cause that often can be identified and corrected

causes of secondary hypertension

-congenital narrowing of the aorta

-renal disease

-endocrine disorders

-neurological disorders

risk factors for primary hypertension

-age

-heavy alcohol consumption

-cigarette smoking

-family history

-obesity

clinical manifestations of hypertension

-known as the silent killer, symptoms not seen until it becomes severe

-secondary symptoms may include: fatigue, palpitations, angina, headaches, and dyspnea

complications of hypertension can affect what two main systems

1. cardiac

2. cerebrovascular

hypertensive heart diseases include

1. coronary artery disease

2. left ventricular hypertrophy

3. heart failure

cerebrovascular diseases that can be caused by hypertension include

1. atherosclerosis

2. peripheral arterial disease

3. nephrosclerosis

4. retinal damage

diagnosis of hypertension (interprofessional care)

-history + examination

-routine lab tests

-12 lead ECG

-urine sample

modifiable factors for hypertension

-sedentary lifestyle

-poor dietary habits

-abdominal obesity

-smoking

-diabetes

-diet

common drugs used to treat hypertension

Diuretics (thiazide, loop, potassium-sparing)

Calcium channel blockers

ACE inhibitors

Angiotensin 2 receptor blockers

Aldosterone receptor antagonists

Beta-adrenergic blockers

renin inhibitors

resistant hypertension

failure to reach goal BP in patients who are taking full doses of an appropriate three-drug therapy regimen that includes a diuretic