5007PM- cardiovascular system

what does it contain?

heart, blood vessels, veins, arteries, blood etc.

true or false: IS IT A CLOSED SYSTEM?

TRUE

WHAT IS IT ROLE?

TRANSPORT O2 AND NUTRIENTS

REMOVE GASEOUS WASTE

REGULATE BODY TEMP

ASSOCIATED WITH LYMPHATIC SYSTEM

WHAT ARE THE DIVISIONS

PULMONARY

SYSTEMATIC

CEREBRAL

CORONARY

PORTAL

SEE 400PM FOR MORE NOTES

CARDIO CONDITIONS WE MAY SEE AS A PARAMEDIC

 

• Angina (stable & unstable)

• Myocardial infarction

• Heart failure (CCF, LVF)

• Atrial fibrillation

WHERE WOULD YOU SEE AN INFERIOR INFARCT?

V2 AND V1

WHERE WOULD U SEE A ANTERIOR INFARCT

V3 AND V4

WHERE WOULD YOU SEE A LATERAL INFART

V5 AND V6

WHAT IS ANGINA

• CHEST PAIN WHEN BLOOD SUPPY TO HEART IS STOPPED

• ARTERIES HARDEN AND NARROW

• TRIGGERED BY STRESS AND PHYSICAL ACTIVITY

WHAT IS STABLE ANGINA

• Brought on by obvious trigger e.g exercise 

• Isn't life threatening

• Increased risk of MI or stroke

WHAT IS UNSTABLE ANGINA

• Unpredictable

• No obvious trigger

• Happen whilst resting

• Medical emergency

• Sudden and rapid deterioration - increase risk of MI/stroke

how does myocardial ischemia develop?

coronary blood flow don’t meet myocardial oxygen demand

what is angina a result from?

• Reduction of coronary blood flow caused by fixed or dynamic epicardial coronary arterey

• Abnormal constriction or relaxation of coronary microcultion

• Reduced oxygen IN blood

what causes angina?

chemical and mechanical stimulation of sensory afferent nerve

WHAT DO THE SENSORY AFFERENT NERVE THAT ARE AFFECTED IN AGINA END IN?

coronary vessels and myocardium

what does angina cause?

• Myocardial cells to switch from aerobic to anaerobic

• metabolism progressive impairment of metabolic, mechnical and electrical functions

HOW DOES ANGINA AFFECT METABOLISM

metabolism progressive impairment of metabolic, mechnical and electrical functions

TRUE OR FALSE - arteriosclerosis is a common cause of epicardial coronary artery stenosis (angina pectorosis)

TRUE

HOW IS ARTERIOCLEROSIS CAUSED?

Cant increase their coronary blood flow during stress to manage myocardial metabolic demand

WHAT IS PRINZMETAL ANGINA?

defined as resting angina associated with ST-segment elevation

WHAT IS PRINSMETAL ANGINA CAUSED BY

focal coronary artery spasm.

WHAT IS ANGINA A DSYFUNCTION OF?

of small coronary arteries and arterioles is called microvascular angina

WHAT DOES CORONARY SPASMS REDUCE

Coronary spasm can also reduce CFR significantly

WHAT DOES CORONARY SPASMS CAUSE

dynamic stenosis of coronary arteries. 

WHAT ARE THE POSSIBLE CAUSES OF ST SEGMENT DEPRESSION?

D- drooping valve (MV prolapse)

E- enlargement of the left ventricle

P - potassium loss

R - reciprocal ST depression (inferior MI)

E- encephalon haemorrhage

S - Subendocardial infarct

S - subendocardial ischemia

E- embolism (pulmonary)

D - dilated cardiopathy ( S- shock T- Toxicity)

WHAT IS A SUBENDOCARDIAL INFARCT

(MI that involves the inner most layer and part of middle layer of myocardium but no extend to epicardium)

WHAT ARE THE S&S OF SEGMENT DEPESSION?

• Pain or discomfort in chest

• Tight, dull heavy pain

• Spread to arm, chest, neck etc.

• Breathlessness

• Nausea

WHAT IS THE TREATMENT FOR ST ELEVATION?

 

• GTN

• Aspirin

• Oxygen

• ECG monitoring

WHAT DOES GTN STAND FOR?

 glyceryltrinitrate

WHAT IS GTN

• Group of medications called nitrates

• Relax and widen the blood vessels - increased bloody supply to heart

• Available in tablet form or spray

• Experience headaches, dizziness, flushing

• Eases pain within 2-3 minas

• Second dose taken after 5 mins 

WHAT IS A COMPLICATION OF GTN

• Heart attack and strokes

• Stress of living with a LT condition can impact emotional health

WHAT IS MYOCARDIAL INFARCTION?

• Reduced blood flow to coronary arteries

• Causes myocardial ischemia. Injury and necrosis's

• Fails to deliver enough blood to the heart

WHAT ARE THE CORONARY ARTERIES?

• LEFT CORONARY ARTERY

• CIRCUMFLEX ARTEREY

• RIGHT CORONARY ARTERY

• LEFT ANTERIOR DESCENDING ARTERY

• AORTA

WHAT DOES THE LEFT CORONARY ARTERY DO?

• Supplies- septum & anterior wall of the left ventricle

• Occlusion = anterior MI

WHAT DOES THE CIRCUMFLEX ARTERY DO?

• Left circumflex

• Supplies - lateral wall of left ventricle

• Occlusion= lateral MI

WHAT DOES THE RIGHT CORONARY ARTERY DO?

• Supplies- right atrium, right ventricle and the septum

• Left side of the heart

• Occlusion inferior MI

WHAT IS AN MI?

OCCLUSION OF ONE OR MORE ARTERY

WHAT CAN AN MI STEM FROM?

• Atherosclerosis

• Thrombosis

• Platelet aggregation

• Coronary artery stenosis or spasm

WH- WHAT DOES UNJURY OF THE ENDOTHELIAL LINING CAUSE?

White cell attraction and early inflammatory response

WHAT IS ATHEROGENESIS?

• Early sub-endothelial lipid deposition

WHAT HAPPENS DURING EARLY LIPID DEPOSITION IN ATHEROGENSIS

• Cholesterol migrates underneath the intimal layer of the artery wall

• Recognises as a foreign substance and cause activation of white blood cells (macrophages)

WHAT DOES ATHROGENSIS ACTIAVATE

WHITE BLOOD CELLS (MACROPHAGES)

WHAT DO WHITE CELLS DO?

DIGEST LIPIDS AND EXPAND TO BECOME FOAM CELLS

WHAT HAPPENS WHEN SITE OF INJURY IS WEAKENED (MI)?

• Platelet adhesion causes platelet plugs to form surface of fibrous [plaques

• Causes further transient occlusion of the affected coronary artery

WHAT HAPPENS ONCE THE CAPILLARY RUPTURES?

• Leads to haemorrhage and thrombosis

• Results in a partial or transient reduction of blood flow

WHATS THE FINAL RESULT OF AN MI?

Complete coronary artery occlusion

WHY IS MYOCARDIAL PERFUSION IMPORTANT?

• CELLS CAN EXTRACT AS MUCH O2 AS IT NEEDS IRRESPECTIVE TO WHAT IT DELIVERS

TRUE OR FALSE- CELLS CONSUME 45% OXYGEN DELIVERED TO IT

FALSE- 25% OF OXYGEN CINSUMPTION

WHAT DIES AEROBIC METABOLISM PRODUCE?

• PRODUCE ATP

• CELLULAR ENERGY PRODUCTION

WHAT DOES ATP STAND FOR?

adenosine triphosphate

WHAT IS AEROBIC METABOLISM?

602+ GLUCOSE = 6C02+6H2O+32 ATP+ HEAT (417 KCAL)

WHAT IS ANAEROBIC METABOLISM?

GLUCOSE= 2 LACTIC ACID+ 2ATP+ HEAT (32KCAL)

WHAT DOES LACTIC ACID CAUSE?

• Vasoconstriction - systemic vascular resistance

• Myocardial cell death

WHAT DOES LACTIC ACID DECREASE?

• Inotropy

• Stroke volume

• Cardiac output

• Blood pressure

WHAT DOES HYPO-PERFUSION STIMULATE?

Adrenaline glands to release epinephrine, norepinephrine

WHAT DOES EPINEPHRENE AND NOREPINEPHINE CAUSE

INCREASED HR (CHRONOTROPHY) AND PERIPHERAL VASOCONSTRICTION

WHAT DOES PERIPHERAL VASOCONTRICITION CAUSE

INCREASED MYOCARDIAL OXYGEN DEMAND

WHAT ARE THE RISK FACTORS FOR AN MI?

• Hypertension

• Hyperlipidaemia

• Depression

• Lupus

• Diabetes

• Kidney failure

• Peripheral vascular disease

• Previous heart attack

• Stroke/TIA

• Sleep apnoea

WHAT LIFESTYLE CHOICES INCREASE RISK OF CAD?

• Smoking

• Obesity - high fat diet

• Stress

• Lack of exercise

• Cocaine use

WHAT ARE THE S&S OF CAD/MI?

• Persistent crushing substernal pain that radiates to left arm, jaw, neck, shoulder blades

• Described as a heavy squeezing, crushing

• Persist more than 12 hours

• Feeling of impending doom

• Sweaty, clammy

• Increased RR (SOB)

• Nausea/vomiting

• Fatigue

• Indigestion

• Cool extremities - delayed cap refill in fingers 

• Anxiety

• Restlessness

• Confusion - due to hypoxia

HOW TO TREAT MI/CAD?

• Cannulation

• Aspirin

• Oxygen - below 94

• GTN - only if BP above 90

• Pain relief - morphine (BP above 90), Entonox

• Take them to PCI (if fits criteria)

WHAT MIGHT THE ECG SHOW?

• ST segment is at baseline - NORMAL!

• ST segment is elevated - STEMI

• ST segment is depressed

WHAT DOES II, III AND AVF LEAD SHOW?

Inferior wall Vt ventricle

WHAT DO I & AVL LEAD SHOW?

 High lateral wall Lt ventricle

WHAT DOES V1 AND V2 LEAD SHOW?

Rt ventricle, septum wall

WHAT DOES V3 AND V4 LEAD SHOW?

Anterior wall Lt ventricle

WHAT DOES V6 AND V5 SHOW?

Lateral wall Lt ventricle

WHAT DO BLOOD TESTS SHOW?

WHAT ARE MI TREATMENT GOALS?

• Relieve chest pain

• Stabilise heart rhythm

• Reduce cardiac workload

• Take to PCI- stent etc.

WHAT ARE BETA BLOCKERS?

• Slow heart rate and reduce workload

• Used to control abnormal heart rhythms and symptoms of heart failure

WHO SHOULD YOU BE CAUTION OF WHEN PRESCRIBING ASPRIN

people with resp problems

WHAT IS BETA 1 RECEPTOR?

IT….

• Increased inotropy

• Increased chronotropy 

WHAT HAPPENS WHEN BETA 1 RECEPTOR IS STIMULATED

• increased membrane permeability

WHERE BETA 1 RECEPTORS FOUND

• Found in SA node, AV node and myocardium

WHAT IS A BETA 2 RECEPTORS?

• Decreased systematic vascular resistance

WHERE IS BETA 2 RECEPTORS FOUND

• Found in smooth muscle, blood vessels, bronchi and skeletal muscles

WHAT IS A ACE INHIBITOR?

angiotensin converting enzyme inhibitors

TRUE OR FALSE- ACE INHIBITORS END IN “PRIL”

FALSE

E.G

• Captopril

• Enalapril

• Lisinopril

• Perindopril

• Ramipril

WHAT HAPPENS IN ACE?

• Medulla identifies a low BP

• Afferent arteriole in nephron release enzyme renin into blood

• Liver produces plasma protein- angiotensinogen

WHAT IS ANTOTENSINOGEN

PLASMA PROTEIN

WHAT DO ASPRINS DO?

• Thins the blood

• Lowers risk of blood clots in coronary arteries

WHAT DO CLOPIDOGREL DO?

• Post MI patients

• Minimum of 14 days

• 12 months for post PCI, stent

• LT therapy for most

WHAT DO NITRATES DO?

• Relaxes muscles in walls of blood vessels - cause them to dilate

• Improve amount of oxygen rich blood to heart

WHEN ARE NITRATES EFFECTIVE

• Good for preventing angina in LT

• May become less effective when using LT

WHAT ARE SOME OTHER MEDICATIONS TO TREAT CAD?

• DIRETICS

• STATINS

WHAT ARE DIRETICS

• acts on the kidneys to increase output of salt in urine and water

WHAT ARE STATINS

• reduces level hypertriglyceridemia produced by the liver (bad cholesterol)

WHAT IS CARDIAC REHAB

• Secondary prevention

• Helps heart recover in controlled and supervised manner

• Restoring exercise capacity and endurance

WHAT ARE CARDIAC REHAB AIMS

• Limit effects that HD has on body

• Limits psychological impact

• Lowers risk of heart attack and death

• Can help slow/stop CAD

WHAT IS ATRIAL FIBRILLATION

• Abnormal fast irregular heartbeat

• Abnormal heartbeat rhythm - arrhythmia

• Normal resting HR 60-100

• Fast HR - 140-180

WHAT IS FAST AF HR

140-180

WHAT MAY BE A RISK OF AF

• Take medication to thin blood to stop a blood clot

• Clot may travel in blood vessels and cause a stroke

WHAT HAPPENS IN AF?

• Normal controlling timer is overridden by random electrical impulses that fire off from heart muscle in the atria

• Atria quiver randomly (fibrillate)

• Only some impulses pass through ventricles - random and haphazard

WHAT HAPPENS IN A NON AF HEART

• Contractions controlled by electrical system keeps four chambers contract normally, in correct order

HOW MANY TIMES DO VENTRICLES CONTRACT

• Ventricles contract 50-180 times (usually 140-180)

• Ventricles contract in a vary of force

HOW MANY CHAMBERS ARE THERE AND WHAT IS IT MADE OF?

4 CHAMBERS MADE OF SPECIAL HEART MUSCLE

WHAT ARE THE THREE TYPES OF AF

• Paroxysmal AF

• Persistent AF

• Permeant AF

WHAT IS PAROXYSMAL AF

• Have episodes that come and go

• Come on suddenly

• Stop suddenly without treatment within 7 days (usually 2 days)

• Heart beat goes back to normal

• Period of time between episodes can vary greatly

• It stops on its own- can take treatment to make it stop quicker!