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1. Disorders of Cardiac Function

2. Definition and Functions of the
Pericardium
 Definition
 A double-layered serous membrane
 Functions
 Isolates the heart from other thoracic
structures
 Maintains its position in the thorax
 Prevents it from overfilling
 Contributes to coupling the distensibility
between the two ventricles during
diastole; they both fill equally

3. Types of Pericardial Disorders
 Pericardial effusion
 The accumulation of fluid in the pericardial cavity
 Cardiac tamponade
 Slow or rapid compression of the heart due to
accumulation of fluid, pus, or blood in pericardial
sac
 Pericarditis
 An acute inflammatory process of the
pericardium
 Can be acute, chronic or constrictive

4. Coronary Heart Disease
 Impaired coronary blood flow that may
cause:
 Angina
 Myocardial infarction or heart attack
 Cardiac arrhythmias
 Conduction defects
 Heart failure
 Sudden death

5. The Evaluation of Coronary Blood
Flow and Myocardial Perfusion
 ECG
 Echocardiogram
 M-mode, two-dimensional, Doppler, and
esophageal
 Exercise stress testing
 Motorized treadmill and bicycle ergometer
 Nuclear cardiovascular imaging methods
 Myocardial perfusion imaging, infarct imaging,
radionuclide angiocardiography, and positron
emission tomography

6. Types of Artherosclerotic
Lesions
 Fixed or stable plaque
 Obstructs blood flow
 Implicated in stable angina
 Unstable or vulnerable plaque
 Can rupture and cause platelet adhesion
and thrombus formation.
 Implicated in unstable angina and
myocardial infarction

7. Major Determinants of Plaque
Vulnerability to Rupture
 The size of the lipid-rich core and the
stability and thickness of its fibrous cap
 The presence of inflammation with plaque
degradation
 The lack of smooth muscle cells with
impaired healing and plaque stabilization
 Plaques with a thin fibrous cap overlaying a
large lipid core are at high risk for rupture

8. Antiplatelet and Anticoagulant
Therapy
 Aspirin
 The preferred antiplatelet agent for preventing
platelet aggregation in persons with CHD
 Inhibits synthesis of prostaglandin, thromboxane
A2
 Ticlopidine and clopidogrel
 May be used when aspirin is contraindicated
 Irreversibly inhibits the binding of ADP to its
receptor on the platelets; no effect on
prostaglandin synthesis

9. Antiplatelet and Anticoagulant
Therapy (cont.)
 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

10. Classification of Coronary
Heart Disease
 Chronic ischemic heart disease
 Chronic stable angina, silent myocardial
ischemia, and variant or vasospastic
angina
 Acute coronary syndromes
 Represent the spectrum of ischemic
coronary disease ranging from unstable
angina through myocardial infarction

11. Types of Angina
 Chronic stable angina
 Associated with a fixed coronary
obstruction that produces a disparity
between coronary blood flow and
metabolic demands of the myocardium
 Stable angina
 The initial manifestation of ischemic heart
disease in approximately half of persons
with CHD

12. Populations Affected by Silent
Myocardial Ischemia
 Persons who are asymptomatic
without other evidence of CHD
 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

13. Non-pharmacologic 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

14. Determinants of ACS Status
 Persons with an ACS are routinely
classified as low risk or high risk for
infarction based on:
 Presenting characteristics
 ECG variables
 Serum cardiac markers
 The timing of presentation

15. Causes of Unstable Angina
 Atherosclerotic plaque disruption
 Platelet aggregation
 Secondary hemostasis

16. Characteristics of Pain Associated with
Unstable Angina
 The pain has a more persistent and severe course
and is characterized by at least one of three
features:
1. It occurs at rest (or with minimal exertion) usually
lasting more than 20 minutes (if not interrupted by
nitroglycerin)
2. It is severe and described as frank pain and of new
onset
3. It occurs with a pattern that is more severe,
prolonged, or frequent than previously experienced

17. Basis for Diagnosis of
Unstable Angina
 Pain severity and presenting
symptoms
 Hemodynamic stability
 ECG findings
 Serum cardiac markers

18. Manifestations of ST-segment
Elevation AMI
 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 doom
 Pale, cool, and moist skin

19. 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

20. Involvement of Heart Muscle in an
Infarct
 Transmural infarcts
 Involve the full thickness of the
ventricular wall
 Occur when there is obstruction of a
single artery
 Subendocardial infarcts
 Involve the inner one third to one half of
the ventricular wall
 Occur more frequently in the presence of
severely narrowed but still patent arteries

21. Medical Management
Following Infarct
 Thrombolytic therapy
 Revascularization interventions
 Coronary artery bypass grafting (CABG)
 Percutaneous coronary intervention (PCI)
 Atherectomy
 Cardiac rehabilitation programs

22. Myocardial Diseases
 Myocarditis
 Inflammation of the heart muscle and conduction
system without evidence of myocardial infarction
 Primary cardiomyopathies
 Heart muscle diseases of unknown origin
 Secondary cardiomyopathies
 Conditions in which the cardiac abnormality
results from another cardiovascular disease,
such as myocardial infarction

23. Types of Cardiomyopathies
 Dilated
 Hypertrophic
 Restrictive
 Arrhythmogenic Right Ventricular
 Peripartum

24. Predisposing Factors for
Endocarditis
 A damaged endocardial surface
 A portal of entry by which the organism gains
access to the circulatory system
 The presence of valvular disease, prosthetic
heart valves, or congenital heart defects
provides an environment conducive to bacterial
growth
 In persons with preexisting valvular or
endocardial defects, simple gum massage or an
innocuous oral lesion may afford the pathogenic
bacteria access to the bloodstream

25. Manifestations of Rheumatic
Fever
 Acute stage
 History of an initiating streptococcal infection
 Involves mesenchymal connective tissue of the
heart, blood vessels, joints, and subcutaneous
tissues
 Recurrent phase
 Extension of the cardiac effects of the disease
 Chronic phase
 Permanent deformity of the heart valves

26. Function and Disorders of the
Heart Valves
 Function: Promote directional flow of
blood through the chambers of the
heart
 Dysfunction results in disorders:
 Congenital defects
 Trauma
 Ischemic damage
 Degenerative changes
 Inflammation

27. Disruptions Occurring with
Valvular Heart Disease
 Narrowing of the valve opening so it
does not open properly
 Stenosis
 Distortion of the valve so it does not
close properly
 Incompetent or regurgitant valve:
permits backward flow to occur when the
valve should be closed

28. Valve Disorders
 Mitral valve Disorders
 Mitral valve stenosis
 Mitral valve regurgitation
 Mitral valve prolapse
 Aortic Valve Disorders
 Aortic valve stenosis
 Aortic Valve Regurgitation

29. Factors Affecting Postnatal
Pulmonary Vascular Development
 Prematurity
 Alveolar hypoxia
 Lung disease
 Congenital heart defects

30. 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

31. 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