Cardiovascular disorders, also known as cardiovascular diseases (CVDs), refer to a group of conditions that affect the heart and blood vessels. These disorders can range from mild to severe and can have a significant impact on an individual's health and quality of life. Here is a detailed description of some common cardiovascular disorders: Coronary Artery Disease (CAD): CAD is the most prevalent cardiovascular disorder and occurs when the blood vessels that supply the heart muscle with oxygen and nutrients become narrowed or blocked. This narrowing is usually caused by the buildup of plaque consisting of cholesterol, fat, and other substances. CAD can lead to chest pain (angina), heart attack (myocardial infarction), or heart failure if the blood flow to the heart is severely restricted. Hypertension (High Blood Pressure): Hypertension is a chronic condition characterized by elevated blood pressure levels. It puts additional strain on the heart and blood vessels, increasing the risk of heart disease, stroke, and other complications. Hypertension often has no noticeable symptoms, which is why it is often referred to as the "silent killer." Lifestyle modifications, such as a healthy diet, regular exercise, and medication, are commonly used to manage hypertension. Heart Failure: Heart failure occurs when the heart is unable to pump blood efficiently to meet the body's needs. It can result from various underlying conditions, including CAD, high blood pressure, heart valve disorders, or previous heart attacks. Symptoms of heart failure may include fatigue, shortness of breath, fluid retention (edema), and reduced exercise tolerance. Treatment options include medications, lifestyle changes, and in severe cases, surgical interventions such as heart transplantation. Arrhythmias: Arrhythmias are abnormal heart rhythms that can occur due to disruptions in the electrical signals that coordinate the heartbeat. This can cause the heart to beat too fast (tachycardia), too slow (bradycardia), or irregularly. Common types of arrhythmias include atrial fibrillation, atrial flutter, and ventricular tachycardia. Some arrhythmias may not require treatment, while others may be managed with medications, electrical cardioversion, or other procedures. Stroke: Although not exclusively a cardiovascular disorder, strokes often occur due to problems with blood vessels supplying the brain. Ischemic strokes are the most common type and are caused by blockages in the arteries leading to the brain. Hemorrhagic strokes occur when a blood vessel in the brain ruptures. Strokes can lead to long-term disability or even death, emphasizing the importance of recognizing and managing risk factors such as hypertension, smoking, and high cholesterol. Peripheral Artery Disease (PAD): PAD occurs when the blood vessels outside the heart, usually those supplying the legs and arms, become narrowed or blocked. This can result in reduced blood flow, causing pain, numbness, or weakness in

1. Cardiovascular
System
Pathophysiology
Casandra Mucilli MSN RN CCRN

2. Functions of the Cardiovascular
System
 Transport blood throughout the body
 Delivers oxygen and nutrients to the
tissues
 Carries waste products from cellular
metabolism to the kidneys and other
excretory organs
 Circulates electrolytes and hormones
 Transports various immune substances that
contribute to the body’s defense
mechanisms
 Helps to regulate temperature

3. Functions of the Heart
 Pumps oxygenated blood throughout the body
 Pumps deoxygenated blood through the lungs for
gas exchange

4. The Heart Layers

5. Structures of the Heart

6. What is needed for O2 delivery
to tissues?
 Pulmonary –
 both ventilation and perfusion needed for gas exchange
(if either is inadequate, there is a V/Q mismatch)
 Cardiovascular –
 Adequate Hgb, volume, and cardiac output (heart rate
X stroke volume)
 Tissue oxygenation –
 Need above plus normal capillary flow, acid-base,
electrolytes, temperature

8. The Cardiac Cycle
 Systole (“Lub”) Ventricular contraction
 Diastole (“Dub”): Ventricular relaxation/filling

9. Cardiac Output
 Amount of blood the heart pumps each
minute
 Determined by
 CO = SV x HR
• Stroke volume: the amount of blood
pumped with each beat
• Heart rate: the number of times the
heart beats each minute

11. Factors Determining the Stroke Volume
 Preload
 Volume of blood in RV during diastole
 Afterload
 The pressure the LV must generate to pump the blood out
through the aorta
 Contractility
 The ability of the heart muscle to contract

13. Medical Terminology:
Hemodynamics
 Hemo: means “blood”
 Dynamic: refers to the relation between motion
and forces
 Describes the physical principles governing pressure,
flow, and resistance as they relate to the cardiovascular
system
Hemodynamic means relating to the flow of blood within the
organs and tissues of the body.

14. Composition of the Arterial System
 Arteries
 Thick-walled vessels with large amounts of
elastic fibers
 Stretch during cardiac systole and recoil
during diastole
 Arterioles
 Serve as resistance vessels for the circulatory
system
 Act as control valves through which blood is
released as it moves into the capillaries

15. Effects of Peripheral Resistance and
the Regulation of Blood Flow
BP= CO x SVR
Blood pressure = cardiac output × systemic
vascular resistance
 SVR is regulated by the baroreceptor reflex in order
to maintain pressure and perfusion.
 Vasodilation vs vasoconstriction

16. Local Control of Blood Flow
 Autoregulation of blood flow is mediated by changes
in blood vessel tone due to changes in flow through the
vessel or by local tissue factors.
 Lack of oxygen
 Accumulation of tissue metabolites
 Endothelial Control
 Hyperemia
 Long-term regulation of blood flow
 Collateral circulation
• Anastomotic channels

17. Humoral Control of Vascular Function
 Vasodilator and vasoconstrictor substances in the
blood
 Norepinephrine
 Epinephrine
 Angiotensin II
 Histamine
 Serotonin
 Bradykinin
 Prostaglandins

18. Structure and Function of the
Microcirculation
 Arterioles
 Capillaries
 Microscopic vessels that connect the arterial and
venous segments
 Capillary pores
 Fluids, electrolytes, gases, and small and large
molecular weight substances move across the
endothelium by diffusion, filtration, and
pinocytosis.
 Venules

19. Function of the Microcirculation
 Nutrient flow
versus nonnutrient
flow
 Capillary—
interstitial fluid
exchange
 Controlled by the
hydrostatic and
osmotic pressures

21. Lymphatic System

22. Lymphatic System
 Vacuum cleaner of the interstitial spaces.
 Lymph is derived from interstitial fluids.
 Plasma proteins and other osmotically active particles
 Filters the fluid at the lymph nodes and removes foreign particles
such as bacteria
 Returns approximately 150cc/hour to vascular system via
lymphatic duct and thoracic duct
 Disruptions or disease can cause local or systemic edema

23. Edema
 Definition
 Excess interstitial fluid in the tissues
 Causes
 Imbalance of any of the factors that control movement
of water between the vascular compartment and the
tissue spaces
 Disproportionate increase in capillary fluid pressure or
permeability, decreased capillary colloidal osmotic
pressure, or impaired lymph flow

24. Edema

25. Autonomic Control Centers for Cardiac
Function and Blood Pressure
 Located bilaterally in the medulla oblongata
 The medullary cardiovascular neurons are grouped into
three distinct pools that lead to sympathetic innervation
of the heart and blood vessels and parasympathetic
innervation of the heart.
 Vasomotor center: contains the first two, controlling
sympathetic-mediated acceleration of heart rate and blood
vessel tone
 Cardioinhibitory center: contains the third, which controls
parasympathetic-mediated slowing of heart rate

26. Activity- NO notes!
 10 minute activity
1. Write or draw out the path of blood through
the heart lungs and body without using your
notes
2. What is the formula for Cardiac output
3. What are factors determine the workload of
the heart (Stroke volume)

27. What is the difference between a
Myocardial Infarction and a
Cardiac Arrest?

28. Alterations of
Cardiovascular
Function

29. Diseases of the Arterial System
 Dyslipidemia
 Primary dyslipidemia
 Familial hypercholesterolemia
 Secondary dyslipidemia
 Atherosclerosis
 Disorders of Systemic Arterial Blood Flow
 Vasculitis
 Arterial disease of the extremities
 Arterial aneurysms

30. Dyslipidemia
 indicator of coronary risk
 Abnormal concentrations of serum lipoproteins
 Dietary fat packaged into chylomicrons for absorption in
the small intestine
 Increased LDL: play a role in endothelial injury, inflammation, and
immune responses that are important in atherogenesis
 Low levels of HDL: are responsible for “reverse cholesterol
transport,” which returns excess cholesterol from the tissues to the
liver
 Elevated serum VLDL (triglycerides)
 Increased lipoprotein

31. Hypercholesterolemia
 A form of hyperlipidemia, high blood lipids, and
hyperlipoproteinemia
 Serum cholesterol levels
 240 mg/dL or greater
 Levels that could contribute to a heart attack, stroke, or other
cardiovascular event associated with atherosclerosis
 Primary hypercholesterolemia: elevated cholesterol levels
that develop independent of other health problems or
lifestyle behaviors.
 Secondary hypercholesterolemia is associated with other
health problems and behaviors.

32. Arteriosclerosis
 Chronic disease of the arterial system
Abnormal thickening and hardening of
the vessel walls
Smooth muscle cells and collagen
fibers migrate to the tunica intima

33. Atherosclerosis
 Form of arteriosclerosis
 Thickening and hardening caused by the accumulation of
lipid-laden macrophages in the arterial wall
 Plaque development
Types of lesions associated with atherosclerosis
 Fatty streaks
 Fibrous atheromatous plaque
 Complicated lesion

34. Arteriosclerosis

35.  Lumen
 No occlusion
• Asymptomatic
 50 % occlusion
• Some symptoms
 90 % occlusion
• Symptomatic
• Need intervention
 Medication
 Stent
 Surgery

36. Major Risk Factors for Atherosclerosis
 Hypercholesterolemia
 Cigarette smoking
 Hypertension
 Family history of premature CHD in a first-degree relative
 Age (men ≥45 years; women ≥55 years)
 HDL cholesterol <40 mg/dL
 CRP levels
 Homocysteine levels

37. Atherosclerosis
Clinical Manifestations
 Narrowing of the vessel and production of ischemia
 Sudden vessel obstruction due to plaque hemorrhage or rupture
 Thrombosis and formation of emboli resulting from damage to
the vessel endothelium
 Aneurysm formation due to weakening of the vessel wall
Major Complications
 Ischemic heart disease
 Stroke
 Peripheral vascular disease

38. Arterial Disease of the Extremities
 Atherosclerotic occlusive disease
 Sudden event that interrupts arterial flow to the affected
tissues or organ
 Thromboangiitis obliterans
 Inflammatory arterial disorder that causes thrombus
formation
 Raynaud disease and phenomenon
 Intense vasospasm of the arteries and arterioles in the
fingers and, less often, the toes

39. Thromboangiitis Obliterans
(Buerger disease)
 Occurs mainly in young men who smoke.
 Inflammatory disease of the peripheral arteries
resulting in the formation of non-atherosclerotic
lesions.
 Digital, tibial, plantar, ulnar, and palmar arteries
 Obliterates the small- and medium-sized arteries.
 Causes pain, tenderness, and hair loss in the affected
area
 Symptoms are caused by slow, sluggish blood flow
 Can often lead to gangrenous lesions

40. Raynaud Phenomenon and
Raynaud Disease
 Episodic vasospasm in arteries and arterioles of the
fingers, less commonly the toes
 Raynaud disease is a primary vasospastic disorder of
unknown origin
 Raynaud phenomenon is secondary to other systemic
diseases or conditions
 Collagen vascular disease (scleroderma), smoking,
pulmonary hypertension, myxedema, and
environmental factors (cold and prolonged exposure
to vibrating machinery)

41. Atherosclerotic Occlusive Disease
(Peripheral Artery Disease)
 Atherosclerotic disease of the arteries that perfuse the
limbs
 Affects 12 million people
 Risk factors the same as atherosclerotic disease
 Especially prevalent in individuals with diabetes
 Often asymptomatic
 Intermittent claudication – obstruction of arterial blood
flow in the ileo-femoral vessels resulting in pain with
ambulation

42. Vascular Obstruction
Acute Arterial Obstruction
• Skin is pale
• Pain increases with
walking and decreases
with rest (intermittent
claudication)
• No pulses
• Paresthesia
• Paralysis
Deep Venous Thrombosis
• Skin is red
• Pain (tender, sore) with
standing or dorsiflexion of
foot
• Pulses present
• Sensation intact
• Able to move limb

43. Embolism and Thrombus

44. Example of embolism

45. Diseases of the Arteries
 Aneurysm
 Local dilation or outpouching of a
vessel wall or cardiac chamber
 True aneurysms
• Fusiform aneurysms
• Circumferential aneurysms
 False aneurysms
• Saccular aneurysms
 Dissecting aneurysm (Aortic
Dissection)*

47. AAA
 Large abdominal
aortic aneurysms
you can sometimes
see pulsating over
the periumbilical
area, and hear a
systolic bruit over
the aorta

48. Aortic Dissection
 Dissecting aneurysm (Aortic
Dissection)
 Acute, life-threatening condition
 Involves hemorrhage into the
vessel wall with longitudinal
tearing (dissection) of the vessel
wall to form a blood-filled
channel
 Evidenced by acute severe back
pain on patient with a known
aneurysm

49. Blood pressure control
 Very important to keep BP under control
for patients with large aneurysms
 Other signs and symptoms of rupture
 Severe back or abdominal pain
 Hypotension
 Tachycardia
 Sweating
 Loss of conciousness

50. Diseases of the Veins
 Varicose veins
 Vein in which blood has
pooled
 Distended, tortuous, and
palpable veins
 Causes
• Trauma or gradual venous
distention, rendering
valves incompetent

51. Venous Insufficiency
 Deep vein thrombosis
(DVT)
 Causes deformity of the
valve leaflets
 Valvular incompetence
 Loss of unidirectional
blood flow
 Combination of both
conditions
 Stasis dermatitis
 Venous ulcers

52. Diseases of the Veins
 Deep venous thrombosis
(DVT)
 Obstruction of venous flow
leading to increased venous
pressure
 Risk factors
• Venous endothelial damage
• Hypercoagulable states
• immobility

53. Hypertension
 Sustained condition of elevation of the
blood pressure within the arterial circuit
 Risk factors
 Age
 Gender and race
 Family history and genetics
 Dietary factors
 Tobacco
 Alcohol consumption
 Obesity

54. Hypertension
Secondary hypertension
 Caused by a systemic disease process that
raises peripheral vascular resistance or
cardiac output
 Primary hyperaldosteronism
 Cushing disease or syndrome
 Pheochromocytoma
 Oral contraceptive drugs
Isolated systolic hypertension
 Elevations of systolic pressure are caused by
increases in cardiac output, total peripheral
vascular resistance, or both

55. Biggest risk of severe
hypertension is stroke!

56. Hypertension in Pregnancy
 Preeclampsia—eclampsia
 Chronic hypertension
 Chronic hypertension with superimposed
preeclampsia
 Gestational hypertension

57. Orthostatic (postural)
hypotension
 Decrease in both systolic and diastolic blood
pressure upon standing
 “Sustained reduction in systolic pressure of at
least 20 mmHg or more or diastolic blood
pressure of 10 mm Hg within 3 minutes of
standing or head-up tilt on a tilt table to at least
60 degrees”
 Acute orthostatic hypotension
 Chronic orthostatic hypotension – can be
common in the elderly

58. Types of Pericardial Disorders
 Pericarditis
 An acute inflammatory process of the pericardium
 Can be acute, chronic, or constrictive
 Constrictive Pericarditis
 Calcified scar tissue develops between the visceral and
parietal layers of the serous pericardium.
 Cardiac output and cardiac reserve become fixed.

59. Types of Pericardial Disorders
 Pericardial Effusion
 The accumulation of fluid in the pericardial
cavity
 Pericardial effusion can lead to a condition
called cardiac tamponade

60. Types of Pericardial Disorders
 Cardiac Tamponade- medical emergency
 Slow or rapid compression of the heart due to
accumulation of fluid, pus, or blood in the
pericardial sac
 Obstructs blood flow into the ventricles and
reduces cardiac output drastically
 Must be treated or can result in cardiogenic
shock or cardiac arrest

61. Cardiac Tamponade
signs and symptoms
Beck’s Triad
 Hypotension with
narrowing pulse pressure
• i.e. 100/70 becomes 80/70
 Jugular vein distension
 Muffled heart sounds

62. Example of Cardiac tamponade treatment
 Pericardiocentesis

63. Infective Endocarditis
 Inflammation of the
endocardium
 Pathogenesis
 Endocardial damage
 Bloodborne microorganism
adherence
 Formation of bulky, friable
vegetations and destruction
of underlying cardiac tissues
 Systemic manifestations

64. Infective Endocarditis
 Clinical manifestations
 Fever
 New or changed cardiac murmur
 Petechial lesions of the skin, conjunctiva, and oral mucosa
 Osler nodes: painful erythematous nodules on the pads of
the fingers and toes
 Janeway lesions: nonpainful hemorrhagic lesions on the
palms and soles
 Weight loss, back pain, night sweats, heart failure, emboli
 Treatment
 Antibiotics
 Antimicrobial therapy is generally administered for
several weeks.
 Surgery to repair or replace the valve, as prescribed

65. Coronary Artery Disease
 #1 cause of death in America
 Can not be cured but can be treated

66. It’s all about supply and demand

67. Coronary Artery Disease
 Impaired coronary blood flow that may cause:
 Angina
 Myocardial infarction or heart attack
 Cardiac arrhythmias
 Conduction defects
 Heart failure
 Sudden death
 Most common cause is atherosclerosis
Copyright © 2019, Elsevier Inc. All rights reserved.

68. Coronary Artery Disease-
Risk Factors
Modifiable risk factors
 Dyslipidemia
 Hypertension
 Cigarette smoking
 Diabetes and insulin resistance
 Obesity and/or sedentary lifestyle
Nontraditional risk factors
 Chronic kidney disease
 Medications
 Microbiome
 Air pollution and ionizing
radiation
Copyright © 2019, Elsevier Inc. All rights reserved.
Non-Modifiable risk factors
 Age
 Sex
 Family history

69. Classification of Coronary Heart Disease
 Chronic Ischemic Heart Disease
 Chronic stable angina, silent myocardial
ischemia, and variant or vasospastic angina
 Acute Coronary Syndromes (ACS)
 Represent the spectrum of ischemic coronary
disease ranging from unstable angina
through myocardial infarction

71. Pain From Angina

73. Stable Angina
 Classic sign of CAD
 Pain is predictable
• i.e. following
emotional
excitement, cold
exposure or after
eating large meals
 Pain is relieved by
rest or nitrates

75. Unstable Angina
 Chest pain at rest,
unpredictable, may be
relieved with nitroglycerin
 No elevation in cardiac
enzymes (negative troponins)
 ST depression or T wave
inversion on EKG
 Likely to progress into an MI

77. NSTEMI
 Non-ST elevated Myocardial Infarction
 Elevated troponins
 Severe unrelieved chest pain

78. STEMI
 Medical emergency
 ST elevated Myocardial infarction
 Elevated troponins
 Severe unrelieved chest pain
 Total occlusion

79. Manifestations of STEMI
 Abrupt onset
 Severe and crushing pain, usually substernal,
radiating to the left arm, neck, or jaw
 Gastrointestinal complaints (nausea and vomiting)
 Complaints of fatigue and weakness
 Tachycardia, anxiety, restlessness, feelings of
impending doom
 Pale, cool, and moist skin
 Require immediate intervention!!!!

80. Treatment of STEMI
STEMI is a medical
emergency
Reperfusion therapy
 cath lab to get clot
removed/stent placed
 Clot buster medication
with fibrinolytics
Time is muscle!

82. Factors Determining the
Extent of an Infarct
 Location and extent of occlusion
 Amount of heart tissue supplied by the vessel
 Duration of the occlusion
 Metabolic needs of the affected tissue
 Extent of collateral circulation
 Heart rate, blood pressure, and cardiac rhythm

83. LAD artery
 Largest artery that supplies the heart muscle is
the left anterior descending
 An infarct in this artery is known as the “widow
maker” because most people do not even make
it to the hospital

85. Medical Management Following
Infarct- NSTEMI or STEMI
 Thrombolytic therapy
 Revascularization interventions
 Coronary artery bypass grafting (CABG)
 Percutaneous coronary intervention (PCI)
 Atherectomy
 Cardiac rehabilitation programs

86. After an MI, the patient is
at risk for dysrhythmias

87. Populations Affected by Silent Myocardial
Ischemia
 Persons who are asymptomatic without other
evidence of CAD
 Persons who have had a myocardial infarct and
continue to have episodes of silent ischemia
 Persons with angina who also have episodes of silent
ischemia

88. Nonpharmacologic Treatment of
Angina
 Smoking cessation in persons who
smoke
 Stress reduction
 Regular exercise program
 Limiting dietary intake of cholesterol and
saturated fats
 Weight reduction if obesity is present
 Avoidance of cold or other stresses that
produce vasoconstriction

89. Antiplatelet and Anticoagulant Therapy
 Aspirin
 The preferred antiplatelet agent for preventing platelet
aggregation in persons with CAD
 Inhibits synthesis of prostaglandin, thromboxane A2
 Ticlopidine and clopidogrel [Plavix]
 May be used when aspirin is contraindicated
 Irreversibly inhibits the binding of ADP to its receptor
on the platelets; no effect on prostaglandin synthesis
 Platelet Receptor Antagonists
 Target a single step in the aggregation process
 Block the receptor involved in the final common
pathway for platelet adhesion, activation, and
aggregation
 Treat acute coronary syndrome

90. Summary of CAD

91. Myocardial Diseases
 Myocarditis
 Inflammation of the heart muscle and conduction
system without evidence of myocardial infarction

92. Primary and Secondary Cardiomyopathy
 Primary
 Genetic
• Hypertrophic
• Arrhythmogenic right
ventricular
• Left ventricular noncompaction
cardiomyopathy
• Inherited conduction system
disorders
• Ion channelopathies
 Mixed cardiomyopathy
• Dilated cardiomyopathy
• Restrictive cardiomyopathy
 Secondary
 Acquired
cardiomyopathies
• Myocarditis
 Peripartum
cardiomyopathy
 Stress cardiomyopathy
 Alcoholic cardiomyopathy

93. Types of Cardiomyopathies
 Dilated
 Hypertrophic
 Restrictive
 Arrhythmogenic right ventricular
 Peripartum

97. Treatment of Cardiomyopathy
 Treatment depends on the type
 Medication
 Implanted pacemakers
 Defibrillators
 Ventricular assist devices
 Ablation
 The goal of treatment is often symptom relief,
and some patients may eventually require a
heart transplant.

98. Acute Rheumatic Fever and
Rheumatic Heart Disease
 Rheumatic fever is a diffuse,
inflammatory disease caused by a
delayed immune response to infection
by the group A beta-hemolytic
streptococci
 Clinical manifestations
 Carditis: murmur
 Polyarthritis: large joints mainly affected
 Subcutaneous nodules
 Chorea: sudden, aimless, irregular,
involuntary movements
 Erythema marginatum: truncal rash
 Treatment: 10-day regimen of
antibiotics, NSAIDs, may need
antibiotics for 5 years
 If left untreated, rheumatic fever causes
rheumatic heart disease
Copyright © 2019, Elsevier Inc. All rights reserved.
101

99. Valve Disorders result in murmurs
 Mitral Valve
Disorders
 Mitral valve stenosis
 Mitral valve
regurgitation
 Mitral valve prolapse
 Aortic Valve
Disorders
 Aortic valve stenosis
 Aortic valve
regurgitation

100. Heart failure

101. Heart Failure
 A pathophysiologic condition in which the heart
is unable to generate adequate cardiac output,
resulting in an inadequate perfusion of tissues
or an increased diastolic filling pressure of the
left ventricle, or both
 The heart is unable to supply the metabolism
with adequate circulatory volume and pressure
 Risk factors include ischemic heart disease and
hypertension.
Copyright © 2019, Elsevier Inc. All rights reserved.

102. Types of Heart Failure
• Left heart failure
 Systolic heart failure
• ↓ cardiac output to perfuse tissues
 Diastolic heart failure (40% - 50%, > women)
• Pulmonary congestion despite normal SV and
CO
• Right heart failure
 Most commonly caused by a diffuse hypoxic
pulmonary disease

103. Heart Failure
Characteristics Left Heart Failure Right Heart Failure
Edema Pulmonary Peripheral
Clinical
manifestations
Dyspnea, orthopnea,
cough of frothy
sputum
Jugular venous
distension and
hepatosplenomegaly
Pathophysiologic
processes
Inability of the heart to
generate adequate
cardiac output to
perfuse vital tissues
Inability of the heart to
provide adequate
blood flow into the
pulmonary circulation
at a normal central
venous pressure

104. Right sided heart failure is usually related to a
pulmonary problem

105. Left sided heart failure
effects the Lungs
Left ventricle is no longer pumping enough
blood throughout the body
This makes blood back up and accumulate
in the pulmonary veins, leading to
pulmonary symptoms
This causes shortness of breath and
pulmonary edema

106. Systolic versus Diastolic HF
Systolic:
-dilated
ventricles
-Problem
ejecting blood
Diastolic:
-hypertrophied
ventricles or septum
-problem filling with
blood

107. Systolic and Diastolic Dysfunction

108. Heart failure treatment
Depends on type of heart failure. May include
 treat blood pressure/heart rate control with
medication
 Fluid restrictions or diuretics
 Revascularization (angioplasty, CABG)
 Valve repair
 ICD (Implantable cardioverter defibrillator)

109. What factor of ventricular
function would diuretics impact?

111. Heart failure is classified based on
symptoms and functional status

112. Chronic versus Acute Heart Failure
Chronic—
 long-term condition
characterized by
decreased cardiac
function
 Volume overload
 Venous congestion
become more
prominent in both
pulmonary and
systemic circulations
Acute—
 represents a gradual or
rapid change in heart
failure signs and
symptoms, indicating
need for urgent therapy
 Pulmonary congestion
due to elevated left
ventricular filling
pressures, with or
without a low cardiac
output

113. Cardiovascular disorders-
Pediatric considerations

114. Signs and Symptoms of Childhood
Congenital Heart Disease
 Symptoms associated with altered heart action
 Heart failure
 Pulmonary vascular disorders
 Difficulty in supplying the peripheral tissues with
oxygen and other nutrients

115. Fetal Blood Flow
 Parallel rather than in series
 The right ventricle delivering most of its
output to the placenta for oxygen uptake
 The left ventricle pumping blood to the
heart, brain, and primarily upper body
 Umbilical vein and two umbilical arteries
 Foramen ovale
 Ductus arteriosus

116. Cyanosis and Shunting
 Defects that increase resistance to aortic outflow increase
left-to-right shunting.
 Defects that obstruct pulmonary outflow increase right-
to-left shunting.
 Crying, defecating, or stress of feeding may increase
pulmonary vascular resistance and cause an increase in
right-to-left shunting.
 Resulting cyanosis

117. Types of Congenital Heart Defects
 Patent ductus arteriosus
 Atrial septal defects
 Ventricular septal defects
 Endocardial cushion defects
 Pulmonary stenosis
 Tetralogy of Fallot
 Transposition of the great vessels
 Coarctation of the aorta
 Kawasaki disease

118. Types of Congenital Heart Defects

119. Kawasaki Disease
 Acute febrile illness
 Affects the skin, brain, eyes,
joints, liver, lymph nodes, and
heart
 Vasculitis in the small vessels
and progresses to involve
some of the larger arteries
 Immunologic in origin
 fever, conjunctivitis, rash,
involvement of the oral
mucosa, redness and swelling
of the hands and feet, and
enlarged cervical lymph nodes

120. Causes of Heart Failure in Children
 Inability of heart to maintain the cardiac output
required to sustain metabolic demands
 Structural (congenital) heart defects
 Surgical correction of heart defects may cause
heart failure

121. Aging Process and Cardiac Function
 Increased vascular stiffness
 Reduced responsiveness to beta adrenergic
stimulation that limits the heart’s capacity to
maximally increase heart rate and contractility
 Left ventricular hypertrophy
 Heart compliance decreases

122. Cardiac Conduction

123. Electrocardiogram

124. Dysrhythmias
 Disorders of formation or conduction (or
both) of electrical impulses within heart
 Can cause disturbances of
 Rate
 Rhythm
 Both rate, rhythm
 Potentially can alter blood flow, cause
hemodynamic changes
 Diagnosed by analysis of electrographic
waveform

125. 12 lead EKG

126. Normal Sinus Rhythm (NSR)
o Lead II best for rhythm analysis
o Heart Rate – 60 to 100/min
o Rhythm – regular
o QRS for every P wave (1:1)
o PR interval - .12 sec to .20 sec (3-5 small boxes on EKG
paper)
o QRS – no greater than .12 sec (starting and ending on
baseline)

127. Sinus Bradycardia
Less than 60 bpm
Causes:
 Hypoxemia - > in peds or unstable adults
 Increased ICP (trauma, stroke)
 Hypothermia
 Cardiac meds - Beta Blockers, Digoxin
 Conduction Defects
Treatment (if symptomatic)
 Atropine 0.5 mg IV – 1.0 mg IV
 Pacemaker – temporary, transvenous, permanent

128. Sinus Tachycardia
 Heart rate over 100, narrow complex QRS
 Sinus tachycardia - look for cause – pain, fever,
hypotension, hypoxemia
 Others: atrial tachycardia (PAT), rapid atrial fibrillation (AF),
atrial flutter, etc.
Treatment
 Treat cause
 Adenosine
 Beta blockers, calcium channel blockers
 Synchronized cardioversion if patient is unstable

129. Supraventricular Tachycardia (SVT)
 HR over 150, no discernable P waves
 Treatment
 Treat the cause
 Adenosine
 Beta blockers
 Synchronized cardioversion

130. Premature Atrial Complexes

131. Atrial Fibrillation
 Can cause CHF – due to loss of “atrial kick”
– up to 30% of cardiac output is due to
atrial contraction
 Can cause emboli – due to mural thrombi
– Stroke; H.F.; increased risk of death

132. Atrial Flutter
• Usually regular rhythm between QRS complexes
• No discernable P waves
• “sawtooth” wave appearance
• Treated like A fib

133. Heart Blocks

134. Premature Ventricular Contractions
 Indicate ventricular irritability – Can deteriorate into
Ventricular tachycardia so treated in an unstable heart
Causes of irritable myocardium:
 May be caused by hypoxemia or hypokalemia, especially with
diuretics
 Anti-arrhythmics like amiodarone and multiple others

135. Ventricular Tachycardia
With a pulse
 Amiodarone or Lidocaine
 Synchronized cardioversion
Pulseless
 Treated like ventricular fibrillation
 DEFIBRILLATE!
 CPR
 Epinephrine, Amiodarone, Vasopressin, maybe CaCl

136. Ventricular Fibrillation
Treatment
 Call for help
 Start CPR
 Defibrillate ASAP
 Epinephrine
 Amiodarone Vasopressin

137. Vfib can be coarse or fine
 Coarse VFib
 Fine VFib

138. Asystole
Treatment
 CPR
 Epinephrine
 Underlying cause

139. Pacemakers

140. ATRIAL & VENTRICULAR
PACING

141. AV PACING

142. Complications of Pacemaker Use
 Infection
 Bleeding or hematoma formation
 Dislocation of lead
 Skeletal muscle or phrenic nerve stimulation
 Cardiac tamponade
 Pacemaker malfunction

143. Cardioversion and Defibrillation
 Treat tachydysrhythmias by delivering electrical
current that depolarizes critical mass of myocardial
ceils
 When cells repolarize, sinus node usually able to recapture
role as heart pacemaker
 In cardioversion, current delivery synchronized with
patient’s ECG (they have to have an R wave)
 In defibrillation, current delivery is unsynchronized

144. QUESTIONS?

145. References
 All content based on slides provided by Lippincott
 Norris, T. L. (2019). Porth’s Essentials of Pathophysiology. (5th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins. ISBN-13: 978-1975107192
 Rebar, C.R., et al (Eds.) Pathophysiology made incredibly easy. (6th
ed.). Philadelphia, PA: Wolters Kluwer. ISBN: 1-4963-9824-6
 American Heart Association at heart.org