August 31st HES-1823-004
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August 31 2015 Cardiovascular Anatomy amp Physiology Learnind Obiectives Know the major components of the cardiovascular system 0 Know the path of blood ow through the heart 0 Know the major structures of the heart 0 Identify speci c arteries named in class 0 Know the function and location of the valves in the heart 0 Know what the electrocardiogram represents 0 Identify the QRS complex and know what it represents 0 Understand the components of the vascular system 0 Know the differences between arteries and veins 0 Know the determinants of blood pressure 0 Know the meaning of systole and diastole Understand cardiac output 0 Understand blood pressure terms and what they represent Cardiovascular system Components 0 The Heart distributes blood through the circulation Blood Vessels Arteries arterioles veins venules capillaries Blood carry nutrients ions wastes and gases The Heart Muscular organ enclosed in a brous sac weighs less than 05 kg 0 The Pump 0 During each cardiac cycle the heart contracts systole and relaxes diastole approximately 40 million beats per year at rest the heart pumps 1400 gallons of blood per day Heart Muscle o the walls of the heart are composed primarily of muscle This muscle is 39striated Individual myocytes muscle cells cannot contract independently like skeletal muscle both atria contract together then both ventricles contract together Heart Anatomv Ventricles 0 Right side of the heart receives deoxygenated blood from systemic circulation pumps deoxygenated blood to the lungs for oxygen through pulmonary circulation Left side of the heart receives oxygenated blood from the pulmonary veins pumps blood to the systemic circulation Interventricular septum a thick sold muscular wall that separates the right and left sides of the heart Both sides are composed of atrial and ventricular chambers atrioventricular AV valves separate the atria from the ventricles allow blood ow in one direction atriumgtventrice Receive and store blood while the ventricles contract thin walled saclike 70 of blood returning to the atria ows directly into the ventricles before the atrium contracts Atrial contraction forces the remaining blood into the ventricles Chambers whose contractions produce the pressure that drives blood though the pulmonary and systemic vascular systems and back to the heart Spiral and circular arrangements of bands of cardiac muscle quotwrings outquot blood from ventricles Valves in the Heart Atrioventricular AV valves separate the atria from the ventricles Pulmonary and aortic semilunar valves separate the right and left ventricle from the circulation respectively These valves prevent blood ow from moving in the opposite direction during the cardiac cycle Valve Position during Cardiac Cycle Event Semilunar Valves R Pulmonary AV Valves R Tricuspid L Mitral L Aortic Filling of Open Closed ventricle Building up Closed Closed pressure Expelling blood Closed Open Elispa af39 aarth valve v A quot PLlllm l l l39y valva 539 f apan aartit valve apen Tricuapid valve alased Mitral valve claaacl Sivatnle Ell p of pulmonary valve Pullnrlorlary quot closed Dstia mouths of left arlcll right coronary arteries opening lint attic sinus Right E il i ll y artery Aortic valve closed 39 K 39 Cusps of tendlinleae a aortic valve Tricuspidl value open Mi tiral valve open Diastole 0 Blood returning to the heart lls artia putting pressure against atrioventricular valves which are forced open 0 As ventriculars ll atrioventricle valve asps hang limply into ventriculars o Atria contract forcing additional blood into ventriculars o Ventriculars contract forcing blood against atrioventricular valave cusps Atrioventricular valaves close Papillary muscles contract and chordae tendines tighten preventing valve asps from entering the atria As ventricular contract and intraventricular pressure rises blood is pushed up against semilunar valves forcing them open 0 As ventriculars relax and tnraventricular pressure falls blood ows back from the arteries lling the cusps of semilunar valves and forcing them closed Heartbeat Coordination electro invents that trigger the heart 0 ef cient pumping of blood requires that the atria contract rst followed almost immediately by the ventricles heart muscle contraction is triggered b an electrical stimulus depolarization 0 this begin at the SA node located in the right atrium Electrocardiooram 0 an electrocardiogram ECG or EKG is the primary tool for evaluating the electrical events within the heart 0 many cardiac heart defeats alter the shape andor timing of the waves Summary of the Cardiac Cycle 0 Remember blood from right heart goes to the lungs o It has lower 02 content 0 Blood from left heart goes to the body o It has higher 02 content The Vascular System Arteries low resistance tubes transporting blood to various organs most causes are oxygenated blood 0 Arterioles responsible for the pattern of blood ow distribution to various organs 0 Capillaries sites of nutrient and uid exchange between blood and tissue Veins lowresistance conduits for blood ow back to the heart 0 The entire vascular system has one structural component in common a smooth singlelayer of endothelial cells endothelium which lines the inner surface of the vessels Blood Pressure Arterial blood pressure re ects the combined effects of arterial blood ow per minute ie cardiac output and the resistance of that ow offered by the peripheral vasculature Determinants of Blood Pressure Arterial blood pressure is determined by blood volume how much blood is in the arteries Pressure increases with increases volume 0 Vascular resistance are the arteries more dilated or constricted Pressure increases with increases vascular resistance arterioles are the major site of vascular resistance major determinant of BP Cardiac Output 0 cardiac output stroke volume heart rate 0 heart rate beats per minute bpm Stroke volume amount of blood pumped out of the heart with each beat Blood Pressure Terms Systolic BP 0 Diastolic BP 0 Mean Pressure 0 Pulse Pressure difference between systolic and diastolic pressure Svstolic Blood Pressure SBP 0 At rest in normotensive individual the highest pressure that is generated in the left ventricular averages 120 mm Hg SBP provides an estimate of the work of the heart and the force of blood exerted against the arterial walls Diastolic Blood Pressure DBP Pressure exerted against atrial walls during diastole of the cardiac cycle 0 Typically 7080 mm Hg Mean Arterial Pressure MAP 0 The average pressure during a cardiac cycle is not halfway value between SBP and DPB diastole lasts about twice as long as systole and this is taken into account MAP 23 DBP 13 SBP September 2 Hypertension and Heart Disease Leaning Objectives 0 Know the criteria for hypertension 0 Know the different types of hypertension 0 Understand how cardiac output and total peripheral resistance affect blood pressure 0 Understand the consequences of hypertension on the heart and blood vessels What is vaertension Arbitrarily de ned as a level of blood pressure BP at which a person has an increased risk of developing a morbid cardiovascular event or will clearly bene t from medical therapy 0 Associated with increased mortality and morbidity lncreases risk for heart disease stroke complications of advanced atherosclerosis Hypertension De ned 0 Hypertension Systolic BP 3 140 mmHg or o Diastolic BP 3 90 mmHg or 0 Taking antihypertensive medications El Prehypertension CI CI CI CI CI Systolic BP of 120139 mmHg Diastolic BP of 8089 mmHg Ideal Systolic BP lt120 mmHg Diastolic BP lt80 mmHg Types of Hypertension Risk Factors Essential hypertension no identi able cause Accounts for 95 of cases and may be affected by genetics environmental factors diet Secondary hypertension caused by speci c defect such as renal disease or endocrine abnormalities Isolated systolic hypertension SBP gt 140 mmHg and DBP lt 90 mmHg Malignant hypertension rapid development of extremely high BP DBP usually gt 140 associated with papilledema White coat hypertension elevated BP associated with seeing health care personnel Hypertension affects more than 50 million Americans 65 of the population 6574 years old men slightly ore than women AfricanAmericans develop hypertension at an earlier age and it is more severe Age Family history Race Gender Smoking Serum cholesterol High sodium intake in some individuals Low potassium intake Physical inactivity Obesity Excessive alcohol intake Glucose intolerance Prediabetic Renin over activity Hypertension Physiology 0 Increased BP must be due to a increase in cardiac output CO b elevated total peripheral resistance TPR c both 0 Hypertension is frequently associated with normal CO and elevated TPR Hypertension Symptoms Usually no symptoms 0 severe headache associated with the following symptoms indicated need for immediate medical treatment tHedness confusion vision changes anginalike chest pain heart failure blood in urine nosebeed irreguar heartbeat ear noise or buzzing tinnitus Hypertension Pathophysiology untreated hypertension leads to premature death Most frequent cause of death is heart disease followed by stroke and renal failure 0 Hypertension damages the endothelium which predisposes the individual to atherosclerosis The heart also has to do more work leading to left ventricular hypertrophy an important cause of heart failure Coronary Heart Disease CHD Learnind Obiectives understand the function of the coronary arteries and what occurs with atherosclerosis know the steps of progression for atherosclerosis know what ischemia and angina pectoris are understand what occurs during a heart attack 0 know the risk factors for heart disease 0 be able to identify the techniques used to identify a heart attack Coronary Arteries in addition to pumping blood the heart muscle needs its own blood supply 0 The arteries supplying the myocardium are the coronary arteries Coronary Heart Disease Coronary heart disease CHD is cause by narrowing of the coronary arteries that supply blood and oxygen to the heart AKA coronary artery disease CAD This causes insuf cient blood supply to the heart 0 Leading cause of death in US Trends 0 Mortality from heart disease decreased by 33 from 1990 to 2004 Ageadjusted death rate for men 50 higher than for women 0 Sharp increases in mortality rate starting age 35 Caucasian Americans have highest mortality rates 0 Risk increase with age regardless of other factors 0 55 of all myocardial infractions after age 65 o 85 of all related deaths after age 65 Development of CHD Atherosclerosis buildup of plaque in the major arteries of the body Underlying disease process for most cardiovascular disease Pathogenesis of atherosclerosis endotheia injury Lipids accumulate and precipitate formation of atheroma secondary brosis and calci cation Arterial endothelium progressively becomes thick rigid with irregular contour Atherosclerosis The beginning of atherosclerosis begins at a very early age Fatty streaks have been observed in 1 year old children Progression to an atheroma can occur at young ages 0 Formation of brous plaque occurs over a period of years to decades Manifestations of Heart Disease lschemia Angina Pectoris chest pain associated with ischemia 0 Myocardial infarction heart attack What is lschemia 0 Insuf cient blood ow to the heart 0 Results from severe narrowing of arteries o Most commonly occurs when heart demands extra oxygen Physical activity eating excitement or stress exposure to cold Myocardial infarction MI 0 during a myocardial infarction there is death of some heart muscle due to a blood clot causing a complete lack of blood ow atheroma ruptures causing a clot to form that stops blood ow occlusion Ml Signs and Svmbtoms 0 Pain is the most common symptom angina pectoris discomfort heaviness pressure aching burning numbness fullness squeezing or painful feeling usually in the chest May be felt in the left shoulder arms neck back orjaw Nausea and vomiting Faintness Sweating and clamminess Women often experience vague symptoms fatigue shortness of breath nausea and vomiting abdominal pain Mvocardial infarction Complications Arrhythmias irregular heartbeat 0 Heart failure 0 lntracardiac thrombi Pericarditis in ammation of the pericardium Cardiac rupture Papillary muscle dysfunction Ventricular aneurysm MI and Mortality Approximately 45 of those with an Ml will die within a year of their Ml faiure to recognize symptoms faiure to act on symptoms failure of timely transport to car facility 0 Many especially males deny symptoms 0 Average waiting time from the onset of symptoms to seeking medical assistance is two hours Sinoatrial node Atrioventricullar horde MI and mortality Sudden death from an MI is usually due to ventricular brillation uncoordinated ventricular contraction ineffective in producing ow Cardiopulmonary resuscitation CPR and de brillation is needed Tested over ventricular graph yl QFIS complex B Ventricular depolarization Ventricular repolarization Atrial depolarization P T G PQ Interval S T 5 Segment l I l Time s 0 02 04 116 08 QT Interval Copyright 2006 Pearson Education Il lC publishing as Benjamin Cummings Modi able Risk Factors 0 Hypertension Lipid pro le blood markers high levels of low density lipoprotein high triglyceride levels ow levels of high density lipoprotein 0 Physical inactivity Smoking 0 Diabetes type II high blood sugar Cholesterol in the Blood 0 Cholesterol is a fatty waxy substance found in foods animal products and synthesizes by the body o It is essential for synthesizing certain hormones and is found in cell membranes o It is carried by lipoproteins in the blood 0 The lipoproteins are classi ed by density and an imbalance in the ratio of these lipoproteins facilitates atherosclerosis 0 Ratio of total cholesterol to HDL cholesterol is better predictor or CV risk than individual cholesterol levels Modi able Risk Factors Obesity 0 Central fat distribution quotbeer belly waist to hip ratio gt 10 for men or gt 08 for women 0 Dietary factors 0 Environmental smoke exposure 0 Excessive alcohol use and stress Diagnosis Electrocardiogram ECG Ischemia andor M will cause changes in the shape and time of the ECG tracing Irregular heart rhythm arrhythmia May be transient ischemia or permanent MI changes Coronary angiography Xray examination of the blood vessels or chambers of the heart Identify where in the artery narrowing or occlusion is occurring Blood analysis Enzyme levels in blood can determine if tissue damage has occurred Cardiac Imaging Provides information about heart wall motion and ejection fraction Exercise stress test Exercise increase the heart s work and uncovers coronary artery blockages that may not be detectable at rest During a treadmill or bike test heart rate breathing blood pressure ECG are recorded Chest pain andor ECG changes can indicate myocardial ischemia Myocardial perfusion imaging thallium scan during treadmill test can locate ischemic areas in myocardium