2. Patient information
Mrs . Kottu sulochannamma
Age :75 years
Gender: female
IP no:1214
Department: cardiology
Date of admission :25/10/2022
History of present illness : shoulder joint pain , indigestion,mild headache,
Heavyness of chest
Past medical history: history of shortness breath ,chestpain, diabetes
mellitus, gastric acidity, hypertension
3. Social history
• Diet: mixed
• Sleep:disturbed
• Appetite:Normal
• Bowel and Bladder: Normal
Provisional diagnosis
Coronary artery disease .
8. Anatomy of the heart
• A hallow muscular organ located in
the thorax between two lungs.
• It has four chambers
• It has four valves
• Two atriums and Two ventricle
• Right side it receives blood from
the body and sends it to the
lungs(pulmonary)
• Left side receives blood from the
lungs and it sends it to the body
(systemic).
9. Heart
• the heart is surrounded
by the three membrane
called pericardium,
Myocardium and
epicardium
11. The pericardium
• The pericardium lies within the
middle mediastinum.
• It’s function is to restrict
excessive movement of the
heart as a whole and to serve as
a lubricated container in which
the different parts of the heart
can contract .
12. Heart wall
• Endocardium
1. Deepest layer of the heart
2. Smooth lining to reduce friction
of blood flow.
Myocardium
1. Myocardium is the middle layer
of the heart .
2. It is the thickest layer which lies
between the single cell
endocardium layer.
13.
14. The heart chambers
1. Four chambers
• Two atria ( right and left ).
• Two ventricle (right and left)
15. The heart chambers
Atria
Features
1. Atria are Small thin walled
Chambers .
Functions
1. Atria are the receiving
chambers for blood returning
to the heart from the
circulation.
• Atria push the blood into the
adjacent ventricles.
16. The heart chambers
Ventricle
Features
1. Make up most of the mass of the
heart.
2. The walls of the left ventricular 3x
thicker than those of the right one.
Functions
1. Discharging chamber of the heart.
2. Transfer blood to pulmonary
trunk(right ventricular) arota( left
ventricular).
17. • Right atrium receives
deoxygenated blood from
inferior vena cava below and
from the superior vena cava.
Right atrium
18. Right ventricle
1. Right ventricle receives blood
from the right atrium through
the tricuspid valve.
19. Left atrium
1. Left atrium receives
oxygenated blood from four
pulmonary veins which drains
posteriorly.
2. The mitral (bicuspid) valve
gaurds the passage of blood
from the left atrium to the left
ventricles.
20. Left ventricle
1. The wall of the left ventricle is
thicker than the right ventricle
but the structure is similar.
2. The thicker wall is necessary to
pump oxygenated blood at
high pressure through the
systemic circulation.
21. Heart valves
1. Heart valves ensure that
unidirectional blood flow
through the heart.
2. It composed of an
endocardium with a
connective tissue core
3. There are two major types of
valves
• Atrioventricular valves.
• Semilunar valves.
22. Atrioventricular Valves
• Atrioventricular valves lies ethe
atria and the ventricle.
• -R- AV – valve = tricuspid valve
• -L-AV – valve = bicuspid valve or
mitral valve.
• atrioventricular valves prevent
back flow of blood into the atria
when ventricles contract.
27. Arterial supply of the heart
• Arterial supply of the heart is
provided by the right and left
coronary artery, which arise
from the ascending arota
immediately above the arotic
valve .
Right coronary arteries
Branches
• Right marginal arteries (acute
Marginal arteries)
28. • Posterior interventricular artery (lies
in the post Iv Sulcus)
• Sinoatrial nodal artery
• Atrioventricular nodal artery.
Left coronary
artery
Branches
• Left anterior descending (LAD) or
anterior interventricular artery (lies in
anterior IV sulcus)
• Left marginal artery (Obtuse marginal
artery)
• Left circumflex artery.
29.
30. Venous drainage of the heart
1. Most blood from the heart
wall drains into the right
atrium through the coronary
sinus, which lies in the
posterior part of the
atrioventricular groove .
2. It is a continuation of the great
cardiac vein.
3. It open into the right atrium to
the left of the inferior vena
cava.
31. Nervous supply of the heart
1. The heart is innervated by sympathetic and parasympathetic fibers
of the autonomic nervous system via the cardiac plexuses situated
below the arch of the arota .
32. Coronary artery disease
• Definition: coronary artery disease is defined as narrowing or
blockage of the coronary arteries usually caused by atherosclerosis .
• etiology:
1. Smoking
2. High blood pressure
3. High cholesterol
4. Insulin resistance
5. Sedentary lifestyle.
40. Current drug chart
S.no Brand name Generic name Dose Route of
administratio
n
Frequency Category Indications
1 Pantocid Pantaprazole 40mg P/o OD Proton pump
inhibitors
Gastric acidity
2 Lopressor Metoprolol 50mg P/o OD Beta blockers Treatment for
angina
3 Nitro -bid Nitrosat 2.6mg P/o BD Vasodilator Treatment for
angina
4 Duolin Ipratropium
Salbutamol
0.5mg
2.5mg
P/N TID Anticholinergi
c
Beta 2
receptor
blockers
Treatment for
shortness of
breath
5 Budecort Budesonide 12.5mcg P/N TID Corticosteroid Treatment for
Shortness of
breath
6 Enoxaparin Heparin 3000 IU IV BD Anticoagulant Treatment to
the blood colt
In heart
41. Drug interactions
• Heparin and aspirin
which has risk of increasing bleeding.
• Metoprolol and quinidine
increased removal of metoprolol from the body.
42. Patient counseling
• About disease.
• Coronary artery disease also called coronary artery disease.
1. The arteries,get plaque on their inner wall, which can then become straved of
oxygen .
2. The plaque could rupture, leading to a heart attack (or) sudden cardiac death.
3. It’s mainly cause due to
• Hypertention
• DM
• Obesity
• Smoking
• High cholesterol