copyright © 2015 cengage learning ®. chapter 8 cardiovascular system diseases and disorders
TRANSCRIPT
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Chapter 8
Cardiovascular System Diseases and Disorders
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Anatomy and Physiology
• Cardiovascular system– Heart, arteries, and veins with blood
• Heart– Size of man’s fist– Located slightly left of the middle of the chest– Composed of cardiac muscle, 4 chambers, 4
valves
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The Heart
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Anatomy and Physiology
• Heart:
– Wall of heart has three layers
• Epicardium
• Myocardium
• Endocardium
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Common Signs and Symptoms
– Chest pain
– Shortness of breath
– Tachycardia
– Cardiac palpitations
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Diagnostic Tests
• Noninvasive procedures:
– Auscultation– Doppler– Arterial blood pressure– Electrocardiogram– Echocardiography– PET scan
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Diagnostic Tests
• Cardiac catheterization– Invasive procedure to determine oxygen
content and blood pressure
• X-rays– To determine normal function of heart and
vessels
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Diagnostic Tests
• Common X-rays:– Angiocardiography– Angiography– Venogram
• Blood tests– Enzymes
• Creatine phosphokinase (CPK)• Lactate dehydrogenase (LDH)
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Diseases of the Cardiovascular System
• Cardiovascular disease
– CVD
– Leading cause of death in the United States
– High blood pressure is common cause
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Diseases of Arteries
• Hypertension
– Indicator of development of cerebrovascular, cardiovascular, and kidney disease
– Chronic disease
– Leading cause of stroke and heart failure
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Diseases of Arteries• Hypertension
– Normal blood pressure• 120/80
– Top number (systolic)• Measures highest pressure in artery when ventricles
contract
– Bottom number (diastolic)• Measures pressure in artery when ventricles relax
– High blood pressure• Greater than 140/90
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Diseases of Arteries• Hypertension
– Primary• Idiopathic with gradual onset• Also known as essential hypertension
– Risk factors:• Heredity• Diet• Age• Obesity• Smoking• Stress
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Diseases of Arteries
• Hypertension
– Treatment:• Antihypertensive medications• Lifestyle changes• Low-salt diet• Stress-reducing exercise• Smoking cessation• Diuretics
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Diseases of Arteries
• Arteriosclerosis and atherosclerosis
– Loss of elasticity and thickening of artery wall
– Also known as hardening of arteries
– Plaque• Deposits of fatty or lipid material in wall of artery
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Diseases of Arteries
• Atherosclerosis
– Major areas affected:
• Coronary arteries
• Cerebral arteries
• Aorta
• Peripheral arteries
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Diseases of Arteries
• Atherosclerosis– Risk factors:
•Noncontrollable factors
– Heredity– Age– Sex– Diabetes
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Diseases of Arteries
• Atherosclerosis– Risk factors:
•Controllable factors– Diet– Sedentary lifestyle– Cigarette smoking– Stress– Hypertension
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Diseases of Arteries
• Atherosclerosis
– Diagnosis by blood pressure, arteriograms, X-rays, and Doppler
– Symptomatic treatment:• Bypass surgery of occluded arteries and plaque
removal
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Diseases of Arteries
• Peripheral vascular disease (PVD)
– Caused by atherosclerotic plaque in arteries supplying blood to legs
– Intermittent claudication• Muscle cramps relieved with rest and increased with
activity
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Diseases of Arteries
• Peripheral vascular disease (PVD)
– Treatment:• Endarterectomy
– If necrosis occurs, amputation or resection may be necessary
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Diseases of Arteries• Aneurysm
– Weakening in wall of artery leading to bulge or rupture
– Usually asymptomatic and discovered accidentally
– Aorta• Most common location
– Treatment:• Repairing aneurysm before rupture through resection
and grafting
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Types of Aneurysms
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Diseases of Arteries
• Coronary artery disease
– Narrowing of arteries that supply blood to myocardium
– Single leading cause of death in United States
– Commonly due to atherosclerosis
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Diseases of Arteries
• Coronary artery disease
– Progressive narrowing of vessels may lead to ischemia of heart muscle and symptoms
– Scar tissue replaces muscle
– Occlusion may progress slowly or suddenly as result of thrombus or embolus
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Diseases of Arteries
• Coronary artery disease
– Myocardial infarction• Death of heart muscle
– Diagnosis by history, electrocardiogram (ECG), and angiograms
– Treatment:• Aimed at increasing blood flow or decreasing oxygen
needs
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Diseases of Arteries• Coronary artery disease
– Treatment:• Angina treated with vasodilators
• Angioplasty
• Coronary artery bypass graft (CABG)
• Reduction of atherosclerotic risk factors– Diet– Exercise– Smoking
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CABG
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Diseases of the Heart• Angina pectoris
– Chest pain
– Lack of oxygen to heart
– Sign of impending myocardial infarction
– Treatment:• Decrease workload of heart• Use nitroglycerin
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Diseases of the Heart
• Myocardial infarction
– Heart attack
– Occurs when heart does not get enough oxygen
– Symptoms:• Severe chest pain with diaphoresis and nausea• Referred pain to neck, arm, and jaw with discomfort
similar to bad or unrelieved indigestion
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Diseases of the Heart
• Myocardial infarction– Treatment:
• Give immediate attention to prevent shock
• Relieve respiratory distress
• Decrease workload
• If cardiac arrest, cardiopulmonary resuscitation (CPR) must be performed
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Diseases of the Heart
• Myocardial infarction– Treatment:
• Oxygen and pain medication
• Medications to treat arrhythmias
• Clot-busting medications
• Education on prevention by lifestyle changes– Smoking cessation– Diet– Exercise
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Diseases of the Heart• Hypertensive heart disease
– Result of long-term hypertension
– Causes:• Disease or disorder causing chronic elevation in
blood pressure
– Treatment:• Treat cause of hypertension• Can only be controlled
– No cure
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Diseases of the Heart
• Rheumatic heart disease– Autoimmune disorder caused by streptococcal
throat infection
– All layers of heart and valves can be affected
– Treatment:• Prevention/treatment of streptococcal infections• Rest during acute stage• Valve replacement to correct deformity
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Diseases of the Heart
• Congestive heart failure (CHF)
– Heart fails to pump adequate blood supply
– Develops slowly and increases workload of heart
– Symptoms:• Gradual increase in dyspnea• Tachycardia• Tachypnea
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Diseases of the Heart
• CHF
– Symptoms:
• Neck vein distention
• Edema in ankles and lower legs
• Right-sided leads to congestion of liver and spleen
• Left-sided leads to congestion of lungs
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Diseases of the Heart
• CHF
– Diagnosis by history and physical, chest X-ray, and ECG
– Treatment:• Decrease workload• Diuretics• Salt and fluid restrictions• Medications to strengthen and slow heart
– E.g., digitalis
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Diseases of the Heart
• Cardiomyopathy
– Disease of heart muscle
– Characterized by dilated, enlarged, thin, flabby heart muscle
– No cure
– Leads to CHF, myocardial infarction, and death
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Diseases of the Heart• Carditis
– Inflammation of heart• E.g., pericarditis, myocarditis, endocarditis
– Often secondary to respiratory, urinary tract, or skin infection
– Treatment:• Rest• Antibiotics• Analgesics• Antipyretics
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Diseases of the Heart
• Valvular heart disease
– Malfunction of heart valves
– Murmurs or abnormal heart sound
– Causes:• Congenital abnormalities or malformations• Rheumatic fever• Endocarditis
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Diseases of the Heart• Arrhythmias
– Abnormal heart rhythm– Sinus rhythm is normal heart rhythm
• 60 to 100 beats per minute
– Flutter• Unusually fast heart rate
– Fibrillation• Wild and uncoordinated
– Heart block• Interruption in conduction system
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Diseases of the Heart
• Arrhythmias
– Divided into first-, second-, or third-degree
– Premature or early contractions (PVCs) may affect atria or ventricles
– Treatment:• Unnecessary if asymptomatic
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Diseases of the Veins
• Phlebitis
– Inflammation of superficial veins
– Symptoms:• Pain• Swelling• Red, cord-like hardening along vein toward heart
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Diseases of the Veins
• Phlebitis– Treatment:
• Analgesics
• Warm compresses
• Elevation of area above heart level
• Elastic stockings
• Exercise
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Diseases of the Veins
• Thrombophlebitis– Clotting in vessels of legs, thighs, and pelvis
– Asymptomatic until embolization occurs
– Risk factors:• Immobility• Dehydration• Varicose veins• Leg/pelvic surgery, obesity, pregnancy
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Phlebitis and Thrombus
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Diseases of the Veins
• Deep vein thrombosis (DVT)
– Treatment:
• Reduce clot
• Prevent embolization
• Use anticoagulants
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Diseases of the Veins
• Varicose veins
– Dilated, tortuous, and elongated veins in legs
– Causes:• Prolonged sitting or standing• Pregnancy• Obesity
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Diseases of the Veins
• Varicose veins– Symptoms:
• Leg fatigue and cramps• Thickening veins• Edema• Fluid
– Treatment:• Elevate legs• Walk• Use support or elastic hose• Strip vein
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Trauma
• Hemorrhage– Abnormal loss of blood
– May be acute or chronic
– Exsanguination• Loss of circulating blood
– Internal bleeding can lead to anemia or shock due to blood loss
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Trauma
• Hemorrhage
– Low-pressure vessels lead to petechiae or ecchymosis of purpura
– High-pressure vessels lead to squirting of bright red blood
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Trauma
• Shock– Extremely low blood pressure that leads to
decreased tissue perfusion
– Types:• Cardiogenic• Septic• Hypovolemic• Neurogenic• Anaphylactic
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Trauma
• Shock– Symptoms:
• Facial pallor• Cool and clammy skin• Cyanosis• Tachycardia• Tachypnea• Altered mental status• Syncope• Unconsciousness• Oliguria or anuria
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Trauma
• Shock
– Treatment:
•Rest in supine position•Move to warm, quiet environment•Elevate feet and legs above heart
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Rare Diseases
• Malignant hypertension• Cor pulmonale• Raynaud’s disease• Buerger’s disease• Polyarteritis nodosa
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Effects of Aging
• Decreased contractility of heart muscle
• Decreased elasticity of vessels
• Thickening of valves– Becoming sclerotic