121 Week 8 Circulatory System

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  • Angina can be caused by an insufficient supply of blood and oxygen to the heart muscle. The body responds to this oxygen deprivation with pain (many people refer to the pain as tightness or pressure) in the chest, arms, shoulders, neck and/or jaw. Some people also experience shortness of breath, fatigue, sweating, dizziness and/or vomiting. It is most frequently caused by narrowing of the coronary arteries. The narrowing is due to buildup of fatty deposits (plaque or atherosclerosis) within the artery walls.
  • A heart attack is a complete blockage of blood flow in a coronary artery. The blockage prevents oxygen-rich blood from reaching part of the heart muscle. Usually a blood clot or piece of plaque (fatty deposits called atherosclerosis) causes the blockage in the heart artery. When blood cannot reach this part of the heart muscle, the muscle may become permanently damaged. The faster you get to a hospital for treatment, the less damage to your heart. If you wait too long, the condition can be fatal. There are a variety of procedures that can treat and stabilize the lining of the coronary arteries. These procedures include: Acute Angioplasty ;Balloon Angioplasty ; Coronary Stenting ;Coronary Artery Bypass Surgery; Thrombolytic Therapy Medications There are several medications your doctor can prescribe if you are having a heart attack. Here are some possibilities: Anticoagulants (blood thinners) such as aspirin Nitroglycerin which dilate the blood vessels to increase blood flow Adrenergic Receptive Blockers (Beta blockers) help regulate the heart beat and decrease oxygen demand, lower B/P, protect against heart attack and heart failure Angiotensin Converting Enzyme (ACE) Inhibitors dilate blood vessels to increase blood flow, guard against arteriosclerosis (plaque in the arteries), help strengthen heart muscles, lower blood pressure (B/P) Calcium channel blockers decrease heart contractility and spasms, dilate arteries, help to treat high B/P and angina Statins lower cholesterol
  • The warning signs and symptoms of a heart attack are gender-specific, meaning men and women have very different feelings and experiences when a heart attack is occurring. Men typically experience the following common warning signs of a heart attack: Moderate to severe chest pain; Dizziness ; Shortness of breath ; Nausea ; Radiating pain in the arms and chest Women may have symptoms that differ from men. While chest pain is often a key warning sign of a heart attack, some women who have a heart attack do not experience chest pain. A woman's pain, may be in the back, arm, neck, shoulder, and/or throat. Also, women will typically have more "non-pain" symptoms than men. These include vomiting, nausea, fatigue and shortness of breath. It is also surprisingly common for people to experience no symptoms at all. This is especially true of diabetics and those over the age of 75.
  • Heart failure occurs when the heart loses its ability to pump enough blood through the body. This is not a sudden stopping; heart failure usually develops slowly. Nearly everyone loses some pumping capacity through aging, but the loss is significantly more with CHF. Severe heart failure can interfere with even simple activities and prove fatal. Congestion (build-up of fluids) is just one feature of the condition and does not occur in all patients. Systolic heart failure occurs then the heart’s ability to contract decreases. ( also known as left-sided heart failure) The heart can’t pump with enough force to push a sufficient amount of blood into the heart from the lungs may back up and cause fluid to leak into the lungs (pulmonary congestion). Diastolic heart failure occurs then the heart has a problem relaxing. (also known as right-sided failure) The heart cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This leads to fluid accumulation in the feet, ankles and legs. This condition is slightly more common among men than women and twice as common among African Americans than whites, mostly over 65 years of age. It causes 39,000 deaths a year and contributes to 225,000 deaths. Heart failure is closely associated with same risk factors as coronary artery disease (CAD): smoking, high cholesterol levels, hypertension, diabetes and obesity. Persons with diabetes have about 2-8 x greater risk of heart failure than those without diabetes .(the disease process also damages the heart muscle) The best known symptom is dyspnea, caused from excess fluid in the lungs. Fatigue occurs since the muscles and other tissues receive less oxygen and nutrition, which are carried by the blood. Edema may cause swelling of the feet, ankles, legs and abdomen. Persistent coughing that produces mucus or pink-tinged sputum with raspy breathing and wheezing are also common. The heart tried to compensate to cope with the effects of heart failure: Enlargement (dilatation) which allows more blood into the heart Thickening of muscle fibers (hypertrophy) to strengthen the heart muscle, which allows the heart to contract for forcefully and pump more blood and More frequent contraction, which increases circulation The heart can temporarily make up for the loses caused by failure, but cannot offset the lost ability to pump blood Diagnosis can be made by echocardiography, which can reveal the abnormal heart size, shape and movement Treatment may include diuretics to reduce the amount of fluid in the body, digitalis, which increases the force of the heart’s contractions and angiotensin converting enzyme (ACE) inhibitors (decreases the pressure inside the blood vessels; and nitrites (hydralazine) while it relaxes tension in blood vessels to improve blood flow.
  • Thromb/o means clot. Phlebitis is inflammation of a vein. Thrombophlebitis occurs when a blood clot causes inflammation in one or more of your veins, typically the legs, but it can affect the veins in the arms. The affected vein may be near the surface of the skin (superficial thrombophlebitis) or deep within (deep vein thrombosis or DVT) A clot in a deep vein increases your risk of serious health problems, including a dislodged clot traveling to your lungs and blocking an artery (pulmonary embolism). Thrombophlebitis is often caused by prolonged inactivity (sitting while traveling, or lengthy bedrest after surgery). This decreases the blood flow through your veins and may cause a clot to form. Paralysis, certain cancers, estrogen may also lead to thrombophlebitis. Signs and symptoms include warmth, tenderness and pain in the affected area with redness and swelling. When a superficial vein is affected, a red, hard, and tender cord may be present just under the skin. When a deep vein is affected, the leg may become swollen, tender and painful, mostly when standing or walking. You may have a fever. Some people with DVT may have no symptoms. Diagnosis may be done by ultrasound, venography (dye injected into large vein in foot or ankle; x-ray creates image of veins in legs and feel, so the physician can visualize a clot. Blood tests may also be ordered. Elevated levels of clot-dissolving substance called D dimmer can be elevated in other conditions, too. Complications of DVA may lead to pulmonary embolism (clot becomes dislodged and travel to lungs where it can block an artery) or heart attack or stroke (clot becomes dislodged and enter coronary artery or brain; these are less frequent complications. DVA may also damage the valves in the veins of the legs. Veins have valves to prevent blood from flowing back as it is gradually pushed uphill toward the heart. When the valves in the veins don’t work, you may develop varicose veins (ballooning of veins), swelling, skin discoloration called stasis pigmentation ( get picture) which may lead to skin ulcerations, or vein obstruction. Treatment may included medications (anticoagulants such as heparin and warfarin (Coumadin) for several months to prevent clots from growing; support stockings to prevent recurrent swelling; filter that may be inserted into the vena cava to prevent clots that break loose in leg veins from lodging in the lungs; and varicose vein stripping, which surgically remove varicose veins that cause pain or recurrent thrombophlebitis .
  • Reye’s syndrome is a rare disease, affecting approx. 1 in 1,000,000. 90% of cases affect children under age 15, but ages range from 4 days to 59 years. Reports of the syndrome appeared as early as 1929, but wasn’t until 1963 that symptoms first recognized as disease by R. Douglas Reye, M.D., an Australian pathologist; He suspected that drug or poison triggered disease’s development, but there was no proof in toxicology screenings and autopsies. By the 1980’s reports of the dangers of using salicylates (Pepto-Bismol, Excedrin, Anacin, Bufferin, Coricidin, Triaminic, Alka-seltzer, Aspergum, Dristan) were well known. FDA required aspirin manufacturers to add product warning labels. “Children and teenagers should not use this medicine for chicken pox or flu symptoms before a doctor is consulted about Reye’s syndrome, a rate but serious illness reported to be associated with aspirin”. Reye’s syndrome can occur several days (1-14) days after a viral infection and generally progresses through 2 stages. The first stage includes persistent or continuous vomiting, severe tiredness, belligerence, nausea and loss of energy. The second stage follows with personality stages, bizarre mental and physical behavior (confusion, restlessness and irrational behavior) and lethargy or inactivity of the senses to the point of comatose and convulsions. Vomiting does not occur in children under 2, usually they exhibit diarrhea and hyperventilation. Since Reye’s syndrome is a rare disease, physicians often misdiagnose it for encephalitis, meningitis, diabetes, poisoning, mental illness or drug abuse. Early diagnosis is vital since death is common and may occur in only a few days. There is a 90% chance of recovery for those diagnosed early . Stage 1-lethargy, vomiting, herpetic dysfunction Stage 2 – hyperventilation, delirium, hyperactive reflexes Stage 3- coma, rigidity Stage 4- deepening coma, large/fixed pupils, loss of cerebral functioning Stage 5- seizures, loss deep tendon reflexes, flaccidity, respiratory arrest
  • Before antibiotic medications became widely used, rheumatic fever was the single biggest causer of valve disease. It is a complication of untreated strep throat. Strep throat is caused by group A streptococcal infection. When they body senses strep infection, it sends antibodies to fight it. Sometimes these antibodies attack the tissues of your joints or heart instead. If the antibodies attack your heart, they can cause your heart valves to swell which can lead to scarring of the valve doors. Rheumatic fever can damage body tissues by causing them to swell, but the biggest damage it can do is to the heart by scarring the valves in the heart. The scarring can narrow the valve and make it harder for the valve to open properly or close completely. The heart has to work harder to pump blood to the rest of the body. Fewer than 0.3% of people that get strep throat also get rheumatic fever. It is most common in children age 5-15. Symptoms of rheumatic fever begin 1-6 weeks after the strep infection. They include: Fever Joint pain or swelling in joints Small bumps under skin over elbows or knees Raised, red rash on chest, back or stomach Stomach pain, anorexia Weakness, SOB, fatigue Rheumatic fever may be followed by chorea (jerky movements) see quicktime movie and symptoms characteristic of obsessive-compulsive disorder or tic disorder. Obsessive-compulsive disorder is a psychiatric disorder. Obsessions are unwanted ideas or impulses that repeatedly well up in the mid of the person. In response to their obsessions, most people resort to repetitive behaviors called compulsions. Rheumatic fever must be treated right away. Rheumatic fever can result from an untreated strep infection. The physician may recommend that you take antibiotic medications continuously for many years, or even the rest of your life. The physician may also prescribe anti-inflammatory medications to reduce the swelling in the body’s tissues, and diuretics. Surgery may be performed to repair or replace the damage to the valves Rheumatic fever may have caused the death of Wolfgang Amedias Mozart. Late in 1791, during a fever epidemic, Mozart suddenly developed a high fever, headache, sweats, and severe swelling and pain in his hands and feet. 2 weeks later Mozart’s entire body swelled and he developed nausea, vomiting, diarrhea and a persistent rash. 15 days after becoming ill, Mozart convulsed, went into a coma and died. Investigations revealed that Mozart had at least 2 bouts with rheumatic fever as a child. He had recurrent sore throats and tonsillitis which may indicate recurrent strep infection, which created a major predisposition to rheumatic fever since no antibiotics were used then. Also noted, Mozart had a sudden distaste for the singing of his pet canary. Irritability is a classic symptom of rheumatic fever.
  • If taken in large quantities, warfarin can cause severe and even fatal bleeding. When given as a medication however and monitored by blood tests, it can be quite safe. Clots in the legs or other parts of the body ("Deep Venous Thrombosis") which have the potential to break loose and go to the lungs ("Pulmonary Emboli"). Pulmonary emboli can be very dangerous. People with many types of artificial heart valves. Some people who have a specific type of irregular heart beat known as "Atrial Fibrillation". In this condition, clots can form in the left atrium, and then become dislodged and travel to other parts of the body. If they become lodged in an artery to the brain, they can cause a stroke. Some people who have had strokes or "Transient Ischemic Attacks" ("TIA's"). Some people who have had heart attacks. Some people with blocked arteries. After knee or hip surgery, generally for just a few weeks or months. Some people with certain types of abnormal clotting disorders The "Pro Time" (or "prothrombin time" or "PT") is the name of the test which is used to monitor the effects of warfarin. It measures the tendency of your blood to clot as compared with a normal ("control") sample. It is expressed as the number of seconds it takes for the blood to clot, and may be expressed as a ratio of the blood sample to the control. The "INR" (the "International Normalized Ratio") expresses the speed of blood clotting and corrects for any inconsistencies in the control samples. It is a more accurate expression of the action of warfarin and it is currently recommended that the "INR" be used as the number to adjust the dose of warfarin.
  • 121 Week 8 Circulatory System

    1. 1. Cardiovascular System
    2. 2. Objectives <ul><li>Identify anatomy and physiology of the cardiovascular system </li></ul><ul><li>Recognize common symptoms of the cardiovascular system </li></ul><ul><li>Recognize common laboratory and diagnostic tests for diseases of the cardiovascular system </li></ul><ul><li>Differentiate various diseases of the cardiovascular system Myocardial Infarction Congestive Heart Failure Thrombophlebitis Reye’s Syndrome Rheumatic Fever </li></ul>
    3. 3. Identify anatomy and physiology of the cardiovascular system
    4. 4. Recognize common symptoms of the cardiovascular system <ul><li>Fatigue </li></ul><ul><li>Dyspnea </li></ul><ul><li>Fever </li></ul><ul><li>Weakness </li></ul><ul><li>Tachycardia and palpitations </li></ul><ul><li>Pallor </li></ul><ul><li>Chest pain (angina) </li></ul><ul><li>Unusual sweating, especially at night </li></ul><ul><li>Edema </li></ul><ul><li>Nausea, vomiting or anorexia </li></ul><ul><li>Anxiety </li></ul><ul><li>Headache </li></ul><ul><li>Clubbing </li></ul>
    5. 5. Common laboratory and diagnostic tests <ul><li>Blood tests (serum enzymes, ESR) </li></ul><ul><li>Angiography/ arteriography </li></ul><ul><li>Electrocardiography </li></ul><ul><li>Chest x-ray </li></ul><ul><li>Cardiac catheterization </li></ul><ul><li>Blood pressure </li></ul><ul><li>Echocardiography </li></ul>
    6. 6. Cardiac catheterization <ul><li>Echocardiography </li></ul><ul><li>Angiography </li></ul>
    7. 7. Atherosclerosis <ul><li>controllable risk factors for atherosclerosis : </li></ul><ul><li>High blood cholesterol (especially LDL or &quot;bad&quot; cholesterol over 100 mg/dL) </li></ul><ul><li>Cigarette smoking and exposure to tobacco smoke </li></ul><ul><li>High blood pressure </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Obesity </li></ul><ul><li>Physical inactivity </li></ul>
    8. 8. Myocardial Infarction <ul><li>Life-threatening; occlusion of one or more coronary arteries </li></ul><ul><li>Predisposing factors heredity, obesity, aging, hypertension, cholesterol, smoking, diabetes, lifestyle </li></ul><ul><li>Unrelieved crushing chest pain </li></ul><ul><li>ECG, cardiac enzyme levels angiography, </li></ul><ul><li>CPR, hospitalization, bedrest </li></ul><ul><li>Prognosis is guarded </li></ul>
    9. 9. Heart attacks can have gender-specific symptoms
    10. 10. Congestive Heart Failure <ul><li>Impaired ability of the heart to pump blood </li></ul><ul><li>Inadequate pumping of either left or right ventricles </li></ul><ul><li>Signs/symptoms determined by which ventricles are affected </li></ul><ul><li>ECG, chest x-ray, elevated venous pressure; echocardiography, angiography </li></ul><ul><li>Tx includes diuretics, bedrest, vasodilators, digitalis, low-sodium diet </li></ul>
    11. 11. Thrombophlebitis <ul><li>Inflammation of vein with formation of a clot </li></ul><ul><li>Caused by trauma, reduced blood flow, infection, prolonged immobility </li></ul><ul><li>Dull ache and tightness at site; induration, redness, tenderness </li></ul><ul><li>Dx’d by phlebography, US </li></ul><ul><li>Tx depends if superficial or DVT </li></ul>
    12. 12. Reye’s Syndrome <ul><li>Disruption of urea cycle; accumulation of ammonia in blood, hypoglycemia, severe brain edema </li></ul><ul><li>Affects children under 15; follows URI; use of ASA </li></ul><ul><li>Signs/symptoms follow stages </li></ul><ul><li>Dx’d by lab tests: increase ammonia in blood, liver function studies, spinal fluid analysis </li></ul><ul><li>Tx to restore blood sugar levels, control cerebral edema, correct acid-base imbalances </li></ul><ul><li>Prognosis dependent on which stage dx’d; fatal </li></ul>
    13. 13. Rheumatic Fever <ul><li>Systemic inflammatory disease </li></ul><ul><li>Likely complication of strep A infection </li></ul><ul><li>Signs/symptoms: polyarthritis, carditis, fever, chorea, subQ nodules over body surfaces, erythemia </li></ul><ul><li>Dx’d by ASO (test for antibodies) increased WBC, elevated ESR, cardiac enzymes </li></ul><ul><li>Tx of strep infection </li></ul><ul><li>Can cause scarring and deformities of the valves </li></ul>
    14. 14. BLOOD THINNING WITH WARFARIN (COUMADIN) <ul><li>Drug used to “thin” blood </li></ul><ul><li>Warfarin still used as rat poison </li></ul><ul><li>Pro Time test essential </li></ul>

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