THECARDIOVASCULAR SYSTEM ANDCARDIOVASCULAR DISEASES
OBJECTIVES• Understand the cardiovascular system including the heart and blood vessels• Recognize the heart’s chambers, valves, electrical system and cycle• Understand circulation including being able to follow a red blood cell through each chamber and vessel in order• Understand cardiovascular disease including the risk factors• Recognize the signs and symptoms of a myocardial infarction
CASE 1A – MR. JACKSON• Mr. Jackson, 58 years old, presents to the ER with a “restrictive sensation” and 8/10 crushing pain in the center of his chest.• The pain radiates to his back, he is sweating and he is feeling slightly short of breath• This all started about 90 minutes ago when he was having lunch with his wife. Before that he felt fine.
CASE 1B – MR. JACKSON• BP: 155/90 Pulse: 76 Respirations: 18• History • Hypertension: diagnosed in 2001, managed with a “water pill” • Overweight: BMI = 29 • Exercise: Walks 5 miles 3 times each week • Smoking: never • Alcohol: rarely • Hyperlipidemia diagnosed in 2007, managed by diet• What do you suspect?• There will be three cases during this lecture that will be discussed at the end
INTRODUCTION• Cardiovascular disease refers to any disease of the heart and/or blood vessels• Heart Disease is the leading cause of death in U.S.• 1 in 3 American adults have at least one type of cardiovascular disease• Hypertension: the “silent killer”
DEMOGRAPHICS High Heart • Age increases the risk Blood Disease of cardiovascular Pressure disease • Men are at a greaterCaucasi 22.2% 11.4% risk than womenan • Over 50 y.o., systolicAfrican 31.7% 10.2% blood pressureAmerica greater than 140ns mmHg is a bigger riskHispanics 20.6% 8.8% factor than diastolic blood pressureAsians 19.5% 6.9%
THE CARDIOVASCULAR SYSTEM• Made up of the heart and blood vessels• Blood is pumped from the right heart to the lungs to receive oxygen• Oxygenated blood is pumped from left heart to rest of body
THE HEART• The heart works as a pump to send oxygenated blood to the body and deoxygenated blood to the lungs• The heart has 4 chambers connected by valves• Pressure differences allow the blood to flow from the atria to ventricles
BLOOD VESSELS ANDTHE FLOW OF BLOOD • Artery = a blood Unidirectional Closed vessel that carries Circulatory Path blood Away from the Aorta heart Artery • Vein = a blood vessel Arteriole that carries blood Capillary (tissue) towards the heart Venule Vein • Capillary: site of Vena Cava exchange Right Atrium (RA) Right Ventricle (RV) Pulmonary Artery Capillary (lungs) Pulmonary Vein Left Atrium (LA) Left Ventricle (LV) Aorta
ELECTRICAL CURRENTS OF THE HEART • Can spontaneously generate action potentials • Sinoatrial (SA) node initiates the action potential • Current travels to the Atrioventricular (AV) node (P wave) • Current then travels from AV node to cardiac muscle via the Purkinje fibers (QRS complex) • The ventricles repolarize and prepare for next action potential (T wave)
THE CARDIAC CYCLE• LV pressure exceeds RV pressure and mitral valve closes• Pressure in the left ventricle builds• LV pressure exceeds pressure in aorta, aortic valve opens and blood rushes into aorta• Once pressure returns to levels below that in aorta, aortic valve closes• Pressure continues to drop until LV pressure is less than RV pressure and mitral valve reopens• The right heart works by the same mechanism
SYSTEMIC CIRCULATION• Oxygenated blood • Carbon dioxide and pumped from the left toxins are delivered ventricle to the rest of the body via the aorta and from the tissues to arteries blood in the capillaries• Arteries deliver blood to • This blood capillaries in tissues (deoxygenated) travels• Oxygen and other through veins and nutrients are delivered to the tissues in the returns to the right side capillaries of heart • Deoxygenated blood is pumped to the lungs by the right ventricle
PULMONARY CIRCULATION• Deoxygenated blood is • Oxygenated blood pumped from the right returns to the left atrium ventricle to the lungs via the pulmonary veins via the pulmonary (only oxygenated veins artery (only in body) deoxygenated artery in body)• The lungs remove carbon dioxide from the deoxygenated blood and use oxygen from inhaled air to oxygenate the blood
CASE 2A – MR. BRADY• Mr. Brady, a 34 year old man, presents to the ER with 7/10 sharp pain on the left side of his chest that radiates into his neck• The pain gets worse when he uses his left arm or moves too much• It started about 6 o’clock this morning when the pain woke him up and he called 9-1-1, it is now 7 am.• Mr. Brady, who is an accountant, moved by himself yesterday
CASE 2B – MR. BRADY• BP: 124/76 Pulse: 70 Respirations: 16• History • Asthma • Normal Weight: BMI = 22 • Exercise: “Do video games count?” • Smoking: never • Alcohol: 3-4 beers per week • Normal blood lipids at his last check up, two years ago• What do you suspect?
CARDIOVASCULAR DISEASE RISK FACTORSUncontrollable Controllable• Age • Hypertension• Sex • Obesity• Family History • Diabetes • Cigarette Smoking • Physical Inactivity • High Cholesterol
BLOOD PRESSURE• What is blood pressure? – The force of blood against the walls of the arteries• Systolic blood pressure – Force of blood in the arteries as the heart beats• Diastolic blood pressure – Force of blood in the arteries as the heart relaxes• More on this next week!
HYPERTENSION• Blood pressure greater than 140/90 mmHg • Normal BP is 120/80 mmHg• “The Silent Killer”• Risk factor for: • Stroke • Heart Attack • Heart Failure
HYPERTENSION (HIGH BLOOD PRESSURE) Systolic (mmHg) Diastolic (mmHg) Normal Less than 120 Less than 80Prehypertensive 120-139 80-89 Stage 1 140-159 90-99 Hypertension Stage 2 Greater than 160 Greater than 100 Hypertension
CHOLESTEROL• Cholesterol is a fat-like substance made in the liver and found in foods we eat• Body needs some cholesterol (digest fat)• High Density Lipoprotein (HDL) • “Good” cholesterol • Helps remove the bad cholesterol in blood • Want >60 mg/dL• Low Density Lipoprotein (LDL) • “Bad” cholesterol • Causes the build-up of plaque in arteries • Want <100 mg/dL• Total cholesterol should be <200 mg/dL
ATHEROSCLEROSIS• Plaque build up in the walls of arteries• Narrow artery = less blood flow• Risk factor for: • Coronary Artery Disease • Heart Attack • Stroke
CORONARY ARTERY DISEASE• Most common cardiovascular disease• Greatest cause of death in U.S.• The heart is a big muscle and needs blood too!• Occurs when plaque builds up in the arteries that feed the heart
CASE 3A – MRS. SIMMONS• Mrs. Simmons, a 63 year-old woman, who presents as your third possible cardiac patient during your ER shift• After lunch yesterday, she started feeling unusually fatigued and nauseous but went about her day as usual.• After dinner she had some pain in her chest and took some aspirin that did not help much.• This morning she woke up feeling short of breath and the chest pain had increased.
CASE 3B – MRS. SIMMONS• BP: 146/88 Pulse: 92 Respirations: 20• History – Hypertension: diagnosed in 2008, managed – Obese: BMI = 32 – Exercise: Walks the dog sometimes – Smoking: smoked in high school and college – Alcohol: glass of wine with dinner – Hyperlipidemia diagnosed in 2000, managed by lipitor – Type II Diabetes diagnosed in 2011, managed by diet• What do you suspect?
HEART ATTACK (MYOCARDIAL INFARCTION)• Occurs when part of the heart receives too little blood or oxygen to function properly• Signs and Symptoms: • Chest discomfort – “feels like an elephant on my chest” • Upper body discomfort – pain or discomfort in the arms, shoulders, neck, back, jaw • Shortness of breath • Cold sweat, nausea, lightheadedness• IF YOU OR SOMEONE YOU KNOW HAS THESE SYMPTOMS, CALL 9-1-1 IMMEDIATELY
HEART ATTACKS IN WOMEN• Men and women do not respond to heart attacks in the same way• Women are less likely to believe they are having a heart attack• Women do not always have chest pain or other cardiac symptoms • Indigestion and extreme fatigue • Nausea, vomiting, fainting
PREVENTING HEART DISEASE ON YOUR OWN• Don’t use tobacco• Avoid excessive alcoholconsumption• Good nutrition and exercise.• Watch your weight• Manage your stress
PREVENTING HEART DISEASE WITH MEDICAL ASSISTANCE• Regular checkups• Control blood pressure• Control cholesterol• Control diabetes
IMPACT OF SMOKING• Cigarette smokers are 2-4 times more likely to develop cardiovascular disease• Smoking causes more deaths from cardiovascular disease than from lung cancer• On average, male smokers die 13.2 years earlier and female smokers 14.5 years earlier than non-smokers• New Jersey Quitline • 1-866-657-8677
CASE STUDY CONCLUSIONS • Each patient had some symptoms and some risk factors for an acute myocardial infarction • Each patient warranted emergency attention and were evaluated for a cardiac problem • Review each case and take your best guess:1. Mr. Jackson2. Mr. Brady3. Mrs. Simmons
MR. JACKSON• Acute Myocardial Infarction • A classic MI picture, older male, hypertension, hyperlipidemia, crushing pain, sweating, SOB • He does exercise and he manages his risk factors but it was not enough • Rapid recognition and treatment give a good prognosis
MR. BRADY• Pulled Chest Muscle • Probably due to his usual inactivity followed by a day of heavy awkward lifting • He needs friends to help • His inactivity is a risk factor and even if you suspect the patient’s pain is musculoskeletal, you should evaluate for cardiac problems!
MRS. SIMMONS• Acute MI • Risk factors: DM, smoking, hypertension, hyperlipidemia , obesity • Presentation is often varied for women • She should have sought help sooner • Luckily, it is a minor MI with a good prognosis
SUMMARY• Cardiovascular disease is the leading cause of death in the U.S.• Controllable v. Uncontrollable Risk Factors• Know the signs and symptoms• IF YOU OR SOMEONE YOU KNOW HAS THESE SYMPTOMS, CALL 9-1-1 IMMEDIATELY