• CAD- CORONARY ARTERY DISEASE
• Coronary arteries supply O2 blood to the
• Coronary arteries can easily become clogged
and a blood clot forms.
• This is called coronary thrombosis- narrowing
of the lumen of the artery- lumen is the
opening in a tube
• If the lumen is narrowed because of fat
deposits it is called plaque
• This is called atherosclerosis
• If the blockage is big enough it can block the
whole artery and cause ischemia- this is a
deficiency of blood and O2 to the heart
muscle which causes a heart attack!
• CAD is the leading cause of death in the US!
if a lumen slowly narrows, some of the heart
cells die and are replaced by scar tissue. Dead
muscle tissue is called an infarct.
This is a true heart attack or myocardial
Signs and symptoms of a heart attack may be:
“feels like an elephant sitting on my chest.”
“feels like someone squeezing my chest.”
Referred pain to the neck or the left arm
Clammy, tired, nausea,sweating
• What should I do if someone is having a
• If conscious- give aspirin, if they have a script
of nitroglycerin(causes vasodilation), put it
under their tongue- you can give up to 3 every
• Call 911
• If not conscious start CPR
Why do people have CAD?
High blood pressure
Diet high in fat and salt- high in cholesterol
*One or more of these factors may put a
person at risk*
• How is this treated?
• Thrombolytic drugs- clot busters like:
• TPA (tissue plasminogen activator) and
streptokinase busts a clot once it has
happened. hospital wants thrombolytics
within 3 hours.
• Anticoagulants- aspirin thins the blood to
keep one from forming
• Oxygen and pain relievers- O2 to help get
oxygen to the dying portions of the heart
and pain meds to reduce stress on the heart
and use less O2.
Surgery- coronary artery bypass graft (CABG)
They take a vein from somewhere in the bodylike the saphenous from the leg, or mammary
vein from the chest and bypass the artery with
• Angina pectoris- this is temporary O2
insufficiency. They may have severe pain in
the chest. This is not a heart attack, but can
feel like one. These usually follow a big meal,
trying to exercise, exposure to cold or stress.
• Again nitroglycerin under the tongue can help
with pain because it dilates the arteries to let
blood through more easily
Hypertensive heart disease
• People who have had high blood pressure for
a long time overwork the heart because it has
to pump against resistance- like putting your
finger over the hose.
• The heart enlarges and the left ventricle has
to do most of the work to meet the demands
of the body.
• Finally the ventricle becomes exhausted and is
unable to pump and fails. Heart failure.
• Cor pulmonale- right side heart failure from
chronic lung disease. The lung blood vessels
are diseased and impairs the blood flow to the
lungs. This works the right side ventricle and
it becomes enlarged and eventually fails. right
ventricle pumps to lungs.
• Congestive heart failure- CHF
• Means the heart is pumping inadequately to
meet the needs of the body. This allows fluid
buildup in lungs and extremities.
• It can be right or left sided each have different
signs and symptoms
• Right side failure looks like:
• Edema in the ankles, distention of neck veins,
enlarged liver and spleen.
• Left side looks like:
• Shortness of breath due to fluid build up in
the lungs- pulmonary edema, wheezing
Congenital heart disease
• The foramen ovale is a small opening that babies
have before they are born and it is located in the
septum, or the middle wall that divides the right
and left side of the heart.
• Before the baby is breathing on it’s own, this
little hole allows the blood from the right side of
the heart to go directly to the left side without
having to go to the lungs.
• If it does not close after the baby is born, it can
cause some heart failure because the heart is
pumping too hard to get the blood into the aorta.
• Tetralogy of fallot- very serious defect- means
there are 4 abnormalities. These babies are blue,
Congenital heart disease
Tetrology of fallot- signs and symptoms
Child will be blue
Clubbed fingers and nails
Short of breath with any exertion- even crying
Child will squat after exercise for relief from
• What can they do for tetrology of fallot?
• Surgery on the narrow opening of blood flow
to the lungs.
• Sometimes these children do not live long
• There are 2 ways valves can fail:
• 1st: valve may be too small for blood flow
• 2nd: valve can be too large and floppy and
allows the back-flow of blood into the atria
called valvular insufficiency.
• Heart murmur is the sound that indicates the
defect- whoosh whoosh sound not lub dub
• Mitral stenosis- valve is too small and cusps
form on the valve flaps that are normally
flexible. Now they become rigid and fuse
together and it takes much pressure to get the
blood forced through the narrow opening.
• Sometimes a clot can form because the blood
pools for too long and can travel to the brain
vessels of the brain ect.
Signs and symptoms: neck veins distended
Edema in ankles
More common in women than men
• The valve stenosis that leads to the aorta,
happens more in men than women.
• Again the cusps become rigid and fuse
together look like warts on the valve because
calcified material are deposited on the valve.
The left ventricle has to work too hard to
pump the blood to the body
Signs and symptoms can be:
Short of breath
Rheumatic heart disease
• Heart disease that occurs from a strep
• When a person has an infection with
hemolytic strep, they have sore throat, or ear
infection, inflamed and painful joints, and
sometimes a rash.
• Usually this is an infection of children or
Rheumatic heart disease
• A few weeks after the infection, the body
develops a reaction between the strep
antigen and the body’s own antibodies against
them. This makes scarring on the mitral valve
and sometimes the semilunar valve.
• Rheumatic heart disease can be the
underlying cause for valve disease.
• Infectious endocarditis- the endocardium is
the inner lining of the chambers of the heart
and covers the valves. Endocarditis is an
inflammation of this lining caused by a strain
of strep. Organisms enter the blood stream
from an infected tooth, UTI, skin infection ect.
• If the person already has rheumatic fever
lesion on the heart, the infection will spread
to the heart.
Signs and symptoms:
Swelling in ankles
New heart murmur sounds like whooshwhoosh to even scrapping
• Treatment- antibiotics, surgery on the valves if
it is necessary.
• Anemia is an inadequate number of red blood
cells, hemoglobin or both.
• There are different kinds of anemia from
• Chronic blood loss anemia- too few RBCs
needs a transfusion- caused by slow bleeding
or inability to clot
• Iron deficiency anemia- not enough iron to
form hemoglobin. Diet is poor in green leafy
veggies, and may need an iron supplement
• Aplastic anemia- injury or destruction of red
bone marrow. This leads to poor formation of
red blood cells. Usually caused by
chemotherapy, radiation, or viruses.- this is
• Pernicious anemia- abnormally large erythrocytes(RBCs) and
not enough of them.
Patients do not absorb vitamin b12 in the digestion tract, and
need b12 injections
Signs and symptom of anemia:
Weakness short of breath
Restless leg syndrome
Increased susceptibility to infections
• Sickle cell anemia- chronic inherited anemia.
RBC are abnormally shaped. They look like
crescents and carry less O2. the sometimes
break easily, and cause clots
• Signs and symptoms of sickle cell:
• In babies you might see swollen hands and
• In a “crisis” the sickle cells can clog vessels in
joints chest, legs, and cause moderate to
• Some people only have a few crisis’ ever, and
some people can have dozens per year.