Lp 12 cardiovascular

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Lp 12 cardiovascular

  1. 1. VTT 235/245 Ana tomy &P a thology La b for Ve te rina ry Te chnicia ns Ca rdiova s cula r S ys te m I. Ca rdia c S ys te m II. Circula tory S ys te m
  2. 2. Ca rdia c S ys te mThe ma jor function of the CVS is tra ns porta tion, with blood be ing the tra ns port ve hicle .Circula tory P a ths - Systemic Circulation- is blood flow to a nd from mos t pa rts of the body. Pulmonary Circulation- is blood flow to a nd from the lungs , during which it picks up oxyge n a nd re turns it to the he a rt.
  3. 3. Ca rdia c S ys te mCircula tory P a ths - Coronary Circulation- blood flow to the he a rt mus cle its e lf. Portal Circulation- a ve nous s ys te m in which blood re turns from the inte s tine s a nd proce e ds to the live r be fore re turning to the he a rt. * * Venous System- re turns blood to the he a rt. Arterial System- ca rrie s blood a wa y from the he a rt.
  4. 4. He a rtA mus cula r, four cha mbe re d orga n tha t drive s the circula tory s ys te m.Lie s in the mediastinum.Base- top of the he a rt.Apex- bottom of the he a rt.
  5. 5. He a rt…The oute r la ye r of the he a rt is ca lle d the pericardium.The pe rica rdium cons is ts of 2 la ye rs : An oute r fibrous pericardium- ma de of tough, fibrous CT tha t prote cts the he a rt a nd loos e ly a tta che s it to the dia phra gm. An inne r serous pericardium- which is a ls o ma de of 2 la ye rs : Inner Visceral layer(epicardium) Outer parietal layer
  6. 6. He a rt…Ins ide the s a c forme d by the pe rica rdium is the thicke s t la ye r of he a rt tis s ue , the myocardium.Be twe e n the cha mbe rs a nd the myoca rdium is a thin me mbra nous lining ca lle d the endocardium.
  7. 7. He a rt…Compartments- the he a rt ha s 4 cha mbe rs . The 2 a tria re ce ive blood a nd pump it down into the re s pe ctive ve ntricle s , which pump it a wa y from the he a rt.Right Atrium- compa rtme nt re ce iving de oxyge na te d blood. Interatrial septum- the wa ll s e pa ra ting the a tria . Fossa Ovale- a re mna nt of the fe ta l fora me n ova le .
  8. 8. He a rt…Right Ventricle- compa rtme nt re ce iving blood from the right a trium. The right ve ntricula r wa ll is thinne r be ca us e le s s pre s s ure is re quire d to move blood through the lungs tha n through the body. Ventricular septum- s e pa ra te s the ve ntricle s .
  9. 9. He a rt…Left Atrium- the compa rtme nt re ce iving oxyge na te d blood from the lungs via the pulmona ry ve ins .Left Ventricle- compa rtme nt re ce iving oxyge na te d blood from the le ft a trium a nd s e nding it out the a orta to the body (s ys te mic circula tion). The le ft ve ntricula r wa ll is thicke r be ca us e of the highe r pre s s ure re quire d for s ys te mic circula tion.
  10. 10. He a rt…Ve ntricula r S tructure s - Papillary Muscles- mus cula r proje ctions s e rving a s a tta chme nts for the chorda e te ndine a e of the AV va lve s . Chordae Tendineae- tough s tra nds a nchoring the fre e e dge s of the AV va lve s to the pa pilla ry mus cle s .
  11. 11. He a rt…Va lve s - AV Va lve s - pre ve nt ba ckflow into the a tria during ve ntricula r (s ys tole ) contra ctions . Right AV (tricus pid) va lve Le ft AV (bicus pid/mitra l) va lve “Tri” before you “bi” !!! S e mi-luna r va lve s - Aortic P ulmona ry
  12. 12. Ma jor Ve s s e lsCranial Vena Cava- the la rge ve in re turning blood from the he a d, ne ck, a nd thora cic limbs to the right a trium.Caudal Vena Cava- la rge ve in re turning blood from pa rt of the thora x, vis ce ra , a nd the ca uda l pa rt of the body to the right a trium.
  13. 13. Ma jor Ve s s e ls …Pulmonary Trunk- the la rge ve s s e l ca rrying blood from the right ve ntricle to the pulmona ry a rte rie s , a nd thus , to the lungs .Pulmonary Arteries- the two bra nche s of the pulmona ry trunk ca rrying blood to the right a nd le ft lung lobe s .
  14. 14. Ma jor Ve s s e ls …Pulmonary Veins- the nume rous ve s s e ls e mptying oxyge na te d blood into the le ft a trium.Aorta- ma jor outflow from the le ft ve ntricle into the s ys te mic circula tion.
  15. 15. Ca rdia c CycleBoth a tria contra ct a t virtua lly the s a me time .Blood e nte rs the a tria while the y a re re la xe d.The atrioventricular (AV) valves a re ope n s o blood flows ra pidly through the ve ntricle s .Approxima te ly 70% of ve ntricle filling occurs during this pha s e .
  16. 16. Ca rdia c Cycle …The a tria the n contra ct, which is ca lle d a tria l s ys tole , a nd the ve ntricle s fill comple te ly.Ne xt, both ve ntricle s contra ct a nd the AV va lve s a re force d to clos e , producing the firs t a udible he a rt s ound.P re s s ure on the ve ntricle s ca us e the s e mi-luna r va lve s to ope n a nd blood is e je cte d into the pulmona ry a rte ry a nd a orta .
  17. 17. Ca rdia c Cycle …This contra ction is ca lle d ventricular systole.The s e mi-luna r va lve s clos e producing the s e cond he a rt s ound.The cycle is re pe a te d with the pe riod of re la xa tion ca lle d diastole.
  18. 18. How Blood P umps Through the He a rt The Right Atrium, re ce ive s “de oxyge na te d blood" from the body. Blood will be pus he d through the tricus pid va lve to the Right Ve ntricle , the cha mbe r which will pump to the lungs through the pulmonic va lve to the P ulmona ry Arte rie s , providing blood to both lungs . Blood is circula te d through the lungs whe re ca rbon dioxide is re move d a nd oxyge n a dde d. It re turns through the P ulmona ry Ve ins , which e mpty into the Le ft Atrium, (oxyge na te d blood) a cha mbe r which will pus h the Mitra l Va lve ope n. Blood the n pa s s e s into the Le ft Ve ntricle . Although it doe s nt a lwa ys look like it in dra wings done from this a ngle , this is the la rge s t a nd mos t importa nt cha mbe r in the he a rt. It pumps to the re s t of the body. As it pumps , the pre s s ure will clos e the mitra l va lve a nd ope n the a ortic va lve , with blood pa s s ing through to the Aorta , whe re it will be de live re d to the re s t of the body.
  19. 19. He a rt Ra te & Ca rdia c OutputCardiac output- the a mount of blood tha t le a ve s the he a rt.De te rmine d by: Stroke Volume- the a mount of blood e je cte d with e a ch ca rdia c contra ction. Heart Rate- how ofte n the he a rt contra cts .
  20. 20. Conduction S ys te mEa ch comple te contra ction a nd re la xa tion is ca lle d a cardiac cycle.Two ma in pa rts - Systole- whe n the he a rt mus cle contra cts a nd blood is e je cte d from the a tria to the ve ntricle s a nd out the a orta . Diastole- the he a rt re la xe s a nd re fills with blood.
  21. 21. Conduction S ys te m…The impuls e come s from the SA node. A s pe cia lize d a re a of ca rdia c mus cle ce lls tha t pos s e s the a bility of a utoma tica lly ge ne ra ting the e le ctrica l impuls e s tha t trigge r the re pe a te d be a ting of the he a rt.
  22. 22. Conduction S ys te m…The S A node ge ne ra te s a n e le ctrica l curre nt by the move me nt of ca tions a cros s the oute r me mbra ne s of it’s ce lls .
  23. 23. Conduction S ys te m…This proce s s ca lle d depolarization, ge ne ra te s a n e le ctrica l curre nt which ca us e s the he a rt mus cle to contra ct.Ca rdia c mus cle ca n tra ns mit a n impuls e from one ce ll to a nothe r, s o e le ctrica l impuls e s a nd contra ctions s pre a d a cros s the he a rt like a wa ve .Afte r the impuls e is ge ne ra te d in the S A node , it s pre a ds in a wa ve a cros s both a tria , ca us ing the to contra ct a nd pus h blood through the AV va lve s into the ve ntricle s , which a re s till re la xe d.
  24. 24. Conduction S ys te m…The impuls e tra ve ls to the AV node whe re it e ncounte rs a s light de la y. This is the only conduction route from the a tria to the ve ntricle s . The de la y pe rmits the a tria to comple te the ir s ys tolic contra ction be fore ve ntricula r s ys tole be gins .Afte r the AV node , it tra ve ls to the s pe cia lize d fibe rs in the ve ntricle s ca lle d the bundle of His & the Purkinje fibers.
  25. 25. P a thology
  26. 26. He a rt Fa ilureWhe n blood re turning to the he a rt ca nnot be pumpe d out a t a ra te ma tching the body’s ne e ds .Ma ny ca us e s e xis t.Mus t de te rmine if the fa ilure is a re s ult of myoca rdia l dys function (pump fa ilure ) or circula tory fa ilure (la ck of circula ting fluid volume .Conge s tive He a rt Fa ilure - whe n the fa iling he a rt a llows fluid conge s tion a nd e de ma to a ccumula te in the body.
  27. 27. Congestive Heart FailureA de ge ne ra tive dis e a s e whe re the va lve le a fle ts be come knobby a nd thicke ne d. Re gurgita ting blood ca us e s e nla rge me nt of the le ft a trium a nd le ft ve ntricleMitra l re gurgita tion mos t common ca us e ; 30% of s ma ll bre e d dogs > 10 ye a rs old a re a ffe cte dP re dis pos e d bre e ds include Ca va lie r King Cha rle s S pa nie ls , P oodle s , Mini S chna uze rs , Chihua hua s , Cocke r S pa nie ls , Da chs hunds , Bos ton Te rrie rs , & Fox Te rrie rsP rogre s s ion of the dis e a s e ca n ta ke ye a rs
  28. 28. CHF (cont)P re s e nt with ta chypne a , ha rs h lung s ounds , ins pira tory cra ckle s tha t progre s s to cra ckle s /whe e ze s throughout re s pira tion with a dis tinguis ha ble he a rt murmurCHF a nima ls a re lite ra lly drowning in the ir own fluids .
  29. 29. P a te nt Ductus Arte rios is (P DA)- Mos t common conge nita l he a rt de fe ct of dogs The duct be twe e n the le ft pulmona ry a rte ry a nd the de s ce nding a orta in the fe tus doe s not clos e a t birth Re s ults in le ft s ide d CHF The re s ulting murmur is ofte n re fe rre d to a s a “ma chine ry murmur”.
  30. 30. Va lvula r S te nos is A na rrowing of one of the he a rt va lve s Ma y be a ortic or pulmonic Ca us e s va rious type s of murme rs
  31. 31. P e rs is te nt Right Aortic ArchP RAAThe mos t common va s cula r ring a noma lyCa us e s a n obs truction of the e s opha gusRe gurgita tion, a nd a s pira tion pne umonia a re s ome s igns in young we a ning a nima ls
  32. 32. P a te nt Ova le Fora me n A.K.A. Inte ra tria l S e pta l De fe ct Fa ilure of the ope ning be twe e n the two fe ta l a tria to clos e .
  33. 33. Chronic Mitra l Va lve Ins ufficie ncyCMVI is the mos t commonly e ncounte re d a cquire d ca rdia c dis orde rs in the dog.One of the mos t common ca us e s is chronic pe riodonta l dis e a s e . Ba cte ria living in ta rta r a re s howe re d into the bloods tre a m, colonizing on the va lve le a fle ts of the he a rt. The s tiff, ma lforme d le a fle ts fa il to clos e s ufficie ntly during s ys tole , re s ulting in re gurgita tion ba ck up into the a trium.
  34. 34. Ca nine Dila te d Ca rdiomyopa thyOne of the mos t common a cquire d ca rdiova s cula r dis e a s e s of dogs .P rima rily a dis e a s e of olde r, ma le la rge & gia nt bre e d dogs .The dis e a s e involve s the dila tion of a ll four cha mbe rs of the he a rt.This dila tion (ca us e d by we a k, thin, & fla bby ca rdia c mus cle ) re s ults in: A de cre a s e in ca rdia c output. An incre a s e in ca rdia c a fte rloa d (blood le ft in the he a rt in dia s tole ).
  35. 35. DCM…The e xa ct ca us e is unknown, a lthough vira l, nutritiona l, immune -me dia te d, a nd ge ne tic ca us e s ha ve be e n propos e d.DCM re s ults in impa ire d s ys tolic function of the ve ntricle s a nd, the re fore , de cre a s e d s troke volume . The volume of blood e je cte d from the he a rt with e a ch contra ction.
  36. 36. DCM…The e ffe ct on the a nima l is one of low- output circula tory fa ilure , e xhibite d by: We a kne s s Exe rcis e intole ra nce S yncope S hock
  37. 37. DCM…Dogs with DCM fre que ntly e xpe rie nce the de ve lopme nt of a tria l fibrilla tion, which furthe r contribute s to a de cre a s e in ca rdia c output. S igns of a tria l fibrilla tion include ra pid, irre gula r he a rt rhythms or s udde n de a th.
  38. 38. Ca nine Hype rtrophic Ca rdiomyopa thyAn uncommon ca nine dis e a s e .The le ft ve ntricula r mus cle a trophie s de cre a s ing the filling ca pa city of the ve ntricle a nd ofte n blocking the outflow of blood during s ys tole .
  39. 39. Fe line Dila te d Ca rdiomyopa thyAfte r the a s s ocia tion of the dis e a s e with ta urine de ficie ncy, a dditiona l ta urine wa s a dde d to comme rcia l die ts a nd the incide nce of the dis e a s e s ignifica ntly de cre a s e d.The pa thologic condition is s imila r to DCM in dogs .Evide nce ha s be e n found of a ge ne tic pre dis pos ition to DCM in ca ts fe d ta urine -de ficie nt die ts .
  40. 40. Fe line Hype rtrophic Ca rdiomyopa thyThe mos t common fe line he a rt dis e a s e .Cha ra cte rize d by hype rtrophy of the le ft ve ntricle .Compromis e of the le ft ve ntricula r cha mbe r re s ults in impa ire d dia s tolic re la xa tion, re duction of ve ntricula r filling, a nd ultima te ly a n impa irme nt in ca rdia c output.Ca ts with HCM ma y e xpe rie nce he a rt fa ilure , a rte ria l e mbolis m, a nd s udde n de a th.
  41. 41. Ca nine He a rtworm Dis e a s eThe fe ma le mos quito s e rve s a s a n inte rme dia te hos t for Dirofila ria immitis .The s e microfila ria de ve lop in the mos quito for 2-3 we e ks a nd a re the n inje cte d into the s kin of a dog through a bite .The infe ctive la rva e migra te within the s kin of the ne w hos t for a bout 100 da ys .
  42. 42. Ca nine He a rtworm Dis e a s e …Young a dults e nte r the va s cula ture a nd migra te to the he a rt whe re the y ma ture into a dults .S ix months a fte r the initia l bite , the microfila ria ca n be de te cte d in the blood.The pre s e nce of the pa ra s ite s re s ults in right-s ide d he a rt e nla rge me nt a nd pulmona ry hype rte ns ion.
  43. 43. Fe line He a rtworm Dis e a s eCa ts a re s ome wha t re s is ta nt to D. immitis infe ction, ha ving fe w a dult worms , which a re e limina te d from the hos t within 2 ye a rs .Mos t s ymptoms in the ca t re la te to the re s pira tory s ys te m (cough, dys pne a ) or GI s ys te m (vomiting, a nore xia ).S udde n de a th of a n a s ymptoma tic ca t is fa irly fre que nt.Ata xia , blindne s s , a nd s e izure s ca n a ls o occur.
  44. 44. MurmursHe a rt murmurs a re a bnorma l s ounds ca us e d by bloodflow turbule nce . Due to va lvula r or non-va lvula r proble ms .S ys tolic murmur- occurs be twe e n the 1 st & 2 nd he a rt s ounds .Dia s tolic murmur- occurs be twe e n the 2 nd & 1 st he a rt s ounds .
  45. 45. Murmurs …Va lvula r murmurs - a s ound due to a le a ky or na rrowe d va lve . Le a ky (ins ufficie ncy) murmur Na rrowing (s te nos is ) murmurNon-va lvula r murmurs - us ua lly occur due to s ome type of a cquire d de fe ct. P a te nt Ductus Arte rios us Inte ra tria l or Inte rve ntricula r s e pta l de fe ct
  46. 46. Dia gnos tics
  47. 47. The Ele ctroca rdiogra m ECG, EKG
  48. 48. Applica tionsExa ct dia gnos e s of a rrhythmia s he a rd on a s culta tion.Acute ons e t of dys pne aS hockFa inting or s e izure sMonitoring during a nd a fte r s urge ryAll ca rdia c murmursCa rdiome ga ly found on ra diogra phsCya nos is
  49. 49. Re me mbe r…DEP OLARIZATION: a he a rt mus cle contra ction in re s pons e to e le ctrica l s timuli. Occurs whe n e le ctrolyte s move a cros s the ce ll me mbra ne . S odium-pota s s ium pumpREP OLARIZATION: he a rt mus cle re la xa tion occurs whe n the e le ctrolyte s move ba ck a cros s the ce ll me mbra ne re nde ring the ce ll re a dy for the ne xt e le ctrica l impuls e .
  50. 50. Ele ctroca rdiogra mA gra phic re cording of e le ctrica l pote ntia ls produce d by the he a rt mus cle during diffe re nt pha s e s of the ca rdia c cycle . Ea ch portion of the EKG is like a vis ua l “picture ” of a s pe cific a re a of the he a rt.
  51. 51. The Comple xP wave- corre s ponds to a tria l de pola riza tion. Ma y be a pos itive or ne ga tive de fle ction.QRS Comple x- corre s pond to ve ntricula r de pola riza tion.T wa ve - re pre s e nts ve ntricula r re pola riza tion. Ma y be pos itive or ne ga tive de fle ctions . Eve ry QRS comple x MUS T be followe d by a T wa ve .
  52. 52. Le a d S ys te msA le a d s ys te m a llows you to look a t the he a rt from diffe re nt a ngle s .Lead I- be s t for de te rmining a tria l functionLead II- de te rmine s the function of the whole he a rtLead III- be s t for te s ting the le ft s ide of the he a rt* * * Lead II is the most often used* * *
  53. 53. Le a d S ys te ms …
  54. 54. ***Atta chme nt of the Le a ds ***BLACK le ft fore a rmWHITE right fore a rmRED le ft re a r le gGREEN right re a r le gBROWN che s t/grounding
  55. 55. Me a s uring the EKG (The Old Wa y)
  56. 56. EKG ABNORMALITIES
  57. 57. Quick & Dirty Guide to EKG Abnorma litie sP wave: incre a s e d in a mplitude or dura tion- a tria l e nla rge me nt.R wave: incre a s e d in a mplitude - le ft ve ntricula r e nla rge me nt.S wave: incre a s e d in a mplitude - right ve ntricula r e nla rge me nt.
  58. 58. Arrhythmia sAn a rrhythmia is a n a bnorma lity in the ra te , re gula rity, or s ite of origin of the ca rdia c impuls e .A dis turba nce in conduction of the impuls e s uch tha t the norma l s e que nce of a ctiva tion of the a tria a nd ve ntricle s is a lte re d.
  59. 59. Arrhythmia Inte rpre ta tionS te p 1: De te rmine the he a rt ra te . Is it ra pid? S low? Norma l?S te p 2: As s e s s the rhythm. S ca n the EKG print out for a bnorma litie s .S te p 3: Ide ntify the P wa ve s . A norma l P wa ve indica te s the impuls e origina te d in the S A node . Abs e nce of P wa ve s s ignifie s a tria l fibrilla tion or a tria l s ta nds till. P wa ve s ma y be s upe rimpos e d on the QRS comple x in va rious s upra ve ntricula r ta chyca rdia s .
  60. 60. Arrhythmia Inte rpre ta tion…S te p 4: As s e s s the QRS s ha pe & dura tion. Abnorma litie s in the s ha pe ca n s ugge s t a dis turba nce of ve ntricula r impuls e s .
  61. 61. Arrhythmia Inte rpre ta tion…S te p 5: Look a t the re la tions hip be twe e n the P wa ve s a nd the QRS comple xe s . Norma lly, the re s hould be one P wa ve for e ve ry QRS comple x with a cons ta nt P -R inte rva l. Long P -R inte rva ls indica te a n AV conduction de la y (1° AV block). A P wa ve not followe d by a QRS comple x indica te s 2˚ AV block. P -R inte rva ls tha t va ry indica te 3˚ AV block.
  62. 62. Norma l S inus Rhythm P wa ve s a re pos itive . QRS comple xe s a re norma l with a cons ta nt P -R inte rva l. This is NORMAL.
  63. 63. S INUS IMP ULS EDIS TURBANCES
  64. 64. S inus ArrhythmiaAn irre gula r rhythm origina ting in the S A node .Re pre s e nte d by a lte rna ting pe riods of s lowe r & more ra pid he a rt ra te s .Us ua lly re la te d to re s pira tion: He a rt ra te incre a s e s with ins pira tion a nd de cre a s e s with e xpira tion.A fre que nt norma l finding in the dog.
  65. 65. S inus Arrhythmia … Ofte n s e e n in bra chyce pha lic bre e ds or in chronic re s pira tory dis e a s e s , in which va ga l tone is incre a s e d by uppe r a irwa y obs truction. Atropine e limina te s re s pira tory induce d S A.
  66. 66. S inus Arrhythmia …
  67. 67. S inus Bra dyca rdia A re gula r rhythm, with a s low he a rt ra te . In ca ts , it is ofte n a s s ocia te d with a s e rious unde rlying dis orde r, which re quire s imme dia te a tte ntion. Ca us e s - intuba tion, hypothe rmia , & re s pira tory dis e a s e .
  68. 68. S inus Ta chyca rdiaA re gula r s inus rhythm, with a fa s t he a rt ra te .The mos t common a rrhythmia in dogs a nd ca ts .P hys iologic ca us e s include : e xe rcis e , pa in, or proce dure s involving re s tra int.P a thologic ca us e s include : fe ve r, hype rthyroidis m, s hock, a ne mia , infe ction, CHF, & hypoxia .Drugs include : a tropine a nd e pine phe rine .
  69. 69. S inus Ta chyca rdia …
  70. 70. S UP RAVENTRICULARIMP ULS E DIS TURBANCES
  71. 71. Atria l P re ma ture Contra ctionsCa us e d by impuls e s origina ting from a s ite othe r tha n the S A node .The he a rt ra te is us ua lly norma l.The P -R inte rva l ma y be long.A pa us e us ua lly follows a n AP C.S e e n in both dogs a nd ca ts , us ua lly a re s ult of a tria l e nla rge me nt (e .g., mitra l ins ufficie ncy, ca rdiomyopa thy).
  72. 72. Atria l P re ma ture Contra ctions …
  73. 73. Atria l Ta chyca rdiaA ra pid re gula r rhythm origina ting from a s ite othe r tha n the S A node .Thre e or more AP C’s .
  74. 74. Atria l Fibrilla tionCa us e d by nume rous dis orga nize d a tria l impuls e s bomba rding the AV node .Ha s a ra pid a nd tota lly irre gula r a tria l a nd ve ntricula r ra te .No P wa ve s .Commonly s e e n in conditions a s s ocia te d with a tria l e nla rge me nt, or dia lte d ca rdiomyopa thy.
  75. 75. Atria l Fibrilla tion…
  76. 76. VENTRICULAR IMP ULS E DIS TURBANCES
  77. 77. Ve ntricula r P re ma ture Contra ctionsCa rdia c impuls e s initia te d in the ve ntricle s ins te a d of the S A node .As s ocia te d with we a kne s s , e xe rcis e intole ra nce , & s udde n de a th.QRS comple xe s a re typica lly wide a nd biza rre .P wa ve s a re dis s ocia te d from the QRS comple x.
  78. 78. Ve ntricula r P re ma ture Contra ctions …A VP C is us ua lly followe d by a pa us e .Commonly s e e n in la rge bre e d dogs with ca rdiomyopa thy, e s pe cia lly boxe rs a nd Dobie s .Common in ca ts with ca rdiomyopa thy; occa s iona lly s e e n in ca ts with hype rthyroidis m.
  79. 79. Ve ntricula r P re ma ture Contra ctions …
  80. 80. Ve ntricula r P re ma ture Contra ctions …
  81. 81. Ve ntricula r Ta chyca rdiaThre e or more VP C’s in a row.The ve ntricula r ra te is >150 bpm.QRS comple xe s a re wide a nd biza rre .The re is no re la tions hip be twe e n the P wa ve s a nd the QRS comple xe s . The P wa ve s ma y pre ce de , be hidde n within, or follow the QRS comple xe s .
  82. 82. Ve ntricula r Ta chyca rdia …
  83. 83. Ve ntricula r Fibrilla tionOccurs whe n the ce lls of the ve ntricula r myoca rdium de pola rize in a cha otic a nd uncoordina te d ma nne r.No puls e ca n be fe lt a nd ca rdia c output a pproa che s ze ro.No QRS comple xe s or P wa ve s .
  84. 84. Ve ntricula r Fibrilla tion… As s ocia te d conditions include : S hock, Myoca rdia l infa rction, Ele ctrolyte & a cid- ba s e imba la nce s , Aortic s te nos is Hypothe rmia
  85. 85. Ve ntricula r As ys toleIndica te s the a bs e nce of a ny pa ce ma ke r impuls e s .S ubs e que ntly, the re is no de pola riza tion or contra ction of the ve ntricle s .No puls e ca n be fe lt a nd ca rdia c output a pproa che s ze ro.P wa ve s ma y be pre s e nt if the a nima l ha s comple te AV block.
  86. 86. Ve ntricula r As ys tole …No QRS comple xe s .
  87. 87. IMP ULS E CONDUCTION DIS TURBANCES
  88. 88. Atria l S ta nds till Cha ra cte rize d by a n a bs e nce of P wa ve s . P a tie nts ha ve S A node function, but impuls e s do not ca us e myocyte a ctiva tion. Ca us e s include hype rka le mia a nd a tria l dis e a s e .
  89. 89. Firs t-De gre e AV BlockA de la y in the conduction of a n impuls e through the AV node a nd bundle of His .Us ua lly cha ra cte rize d by a prolonge d P -R inte rva l.Ge ne ra lly s e e n in olde r pa tie nts s e conda ry to de ge ne ra tive cha nge s in the conduction s ys te m.
  90. 90. Firs t-De gre e AV Block…
  91. 91. S e cond-De gre e AV Block Cha ra cte rize d by a n inte rmitte nt fa ilure or dis turba nce of AV conduction. One or more P wa ve s a re not followe d by QRS comple xe s . P -R inte rva l is ofte n va ria ble .
  92. 92. Third-De gre e AV BlockThe ca rdia c impuls e is comple te ly blocke d in the re gion of the AV junction.The P wa ve is norma l.The QRS comple x is wide a nd biza rre .The re is no conduction be twe e n the a tria a nd ve ntricle s .
  93. 93. Third-De gre e AV Block…
  94. 94. II. Circula tory S ys te m
  95. 95. Circula tory S ys te mCons is ts of the he a rt, blood ve s s e ls , a nd lympha tics . Blood a cquire s oxyge n in the lungs , nutrie nts from the dige s tive tra ct, a nd hormone s from e ndocrine gla nds .Blood Vascular System- cons is ts of blood, he a rt, a rte rie s , ca pilla rie s , & ve ins .
  96. 96. Circula tory S ys te m…Artery- a ve s s e l ca rrying blood a wa y from the he a rt. Ge ne ra lly thicke r a nd s tronge r tha n ve ins .Capillary- a micros copic ve s s e l tha t joins othe rs to form a n e xte ns ive ne twork. P os itione d be twe e n a rte rie s a nd ve ins . The y a llow e xcha nge of ga s s e s a nd nutrie nts be twe e n the blood a nd inte rs titia l fluid.
  97. 97. Circula tory S ys te m…Veins- ve s s e ls ca rrying blood towa rds the he a rt. Thinne r-wa lle d, the y ca rry a gre a te r volume tha n a rte rie s .
  98. 98. Circula tory S ys te m…Arte rie s  a rte riole s  ca pilla rie s  ve nule s  ve ins
  99. 99. Circula tory S ys te m…Va lve s in ve ins e ns ure tha t blood tra ve ls only in the dire ction of the he a rt.Cons triction a nd re la xa tion a llow the va s cula r s ys te m to dire ct blood to diffe re nt pa rts of the body, a nd to ma inta in blood pre s s ure whe n blood volume or ca rdia c output is de cre a s e d.
  100. 100. Nota ble Ve s s e lsRe me mbe r… for e ve ry a rte ry ta king fre s h blood to the body, the re is a ve in to ca rry de oxyge na te d blood ba ck to the he a rt– jus t like on a nd off ra mps to the “ma jor highwa y!
  101. 101. Fe line Thromboe mbolis m a .k.a . a s a ddle thrombus Cla s s ic pre s e nta tion is pos te rior pa re s is with we a k or a bs e nt puls e s in the re a r limbs ; foot pa ds a re pa le , a nd the toe na ils won’t ble e d whe n quicke d; the ga s trocne mius a nd tibia l mus cle s a re rock ha rd by 10-12 hrs pos t-clot Aggre s s ive thrombolytic the ra py ma y be ins titute d if the clinicia n fe e ls the thrombus is re ce nt (2-4 hrs ) a nd the he a rt dis e a s e is ma na ge a ble but the prognos is is s till gua rde d
  102. 102. Fe line Thromboe mbolis m (cont) Mos t common s ite is a t the a ortic trifurca tion Clinica l s igns de pe nd on the de gre e of he a rt dis e a s e a nd the s ite of thromboe mbolis m It ma y be the firs t s ign of he a rt dis e a s e or s ome time s ca ts will s how s e ve re s igns of CHF
  103. 103. THE END!

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