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Left- Versus Right-Side Heart Failure Right-sided disease – tends to result in a buildup of blood flowing into the right side of the heart. This build-up results in edema of the ankles, distention of the neck veins, and enlargement of the spleen because of congestion in the veins that cannot empty properly into the heart. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Left-sided failure – leads to a build-up of fluid in the lungs or pulmonary edema, which causes shortness of breath. Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-13: (a) Left-sided congestive heart failure. (b) Right-sided congestive heart failure. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Normal ventricular wall Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypertrophied ventricular wall. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congenital Heart Disease Most congenital abnormalities are in the septum that separates the right and left side of the heart. An opening in this septum allows a mixing of deoxygenated and oxygenated blood, which causes the heart to overwork in an attempt to compensate for lower oxygen levels. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view an animation on the topic of congenital heart disease. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Septal Defects Failure of the Foramen Ovale to Close – Least serious, but most common defect Atrial Septal Defect Ventral Septal Defect – May lead to left ventricular failure – Cyanosis may develop if deoxygenated blood from the right side of the heart enters the general circulation Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-14: Effect of septal defects (a) Normal shunt - no cyanosis. (b) Increased pressure in right ventricle. ( c ) shunt reversal - cyanosis develops. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Tetralogy of Fallot Pulmonary stenosis – “Blue baby” cyanosis, because of poorly oxygenated blood. – The union of oxygen with hemoglobin gives normal arterial blood its bright, scarlet red color. Large ventricular septal defect Ventricular hypertrophy Misplaced aorta – Secondary polycythemia, dyspnea after any exertion – Clubbed fingers Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-15: Tetralogy of Fallot (top) compared to normal anatomy (bottom). Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Treatment – Tetralogy of Fallot Surgical repair of the problem consists of patching the ventricular septal defect Opening the narrowed passageway from the right ventricle and the narrowed pulmonary valve Closing any abnormal connection made between the aorta and the pulmonary artery Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patent Ductus Arteriosus (PDA) The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery and the aorta, shunting blood from the nonfunctional fetal lungs. Soon after birth, it normally closes, but if it remains open or patent, blood intended for the body flows from the aorta to the lungs overloading the pulmonary artery. This blood is oxygenated so there is no cyanosis. There is long-term danger of heart failure and infection at the site of the lesion. The ductus may be closed surgically by dividing the connection between the pulmonary artery and the aorta. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-16: Patent ductus arteriosis. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta A narrowing, or stricture, of the artery that provides blood to the entire body. The stricture, possibly near the ductus arteriosus, occurs beyond the branching of blood vessels to the head and arms, so the blood supply to the upper part of the body is adequate. Less blood, however, flows through the constricted area to the abdomen and legs. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta (continued) Blood pressure is significantly reduced in the legs, but is high in the arms. Many collateral blood vessels develop to compensate for this poor blood supply. The coarctation can be corrected surgically by cutting out (excising) the narrow segment and resectioning the aorta together. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Heart Valve Disorders Stenosis: opening too small for sufficient blood flow Insufficiency: opening too large Heart murmur: characteristic sounds that indicate the nature of the defect Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-17: Effect of mitral valve stenosis on the heart. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Mitral Stenosis Cusps that form the valve become rigid and fuse together A deep funnel shaped valve is formed Increased resistance of blood flow from the left atrium to the left ventricle Often follows rheumatic fever Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Complications of Valvular Stenosis Tendency for thrombus to form Clotting elements form over the malfunctioning valve Distention of veins delivering blood through the heart Edema, poor circulation, cyanosis, heart failure Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Mitral Insufficiency Blood leaks back through the mitral valve each time the ventricle contracts As the left ventricle pumps blood out of the heart and into the aorta, some blood leaks back into the atrium, increasing the pressure and volume there This backflow, in turn, increases blood pressure in the vessels leading from the lungs to the heart, resulting in lung congestion. This occurrence is exacerbated if the cusps become hardened, sclerotic, and retract. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Mitral Insufficiency (continued) Another cause for leakage is the failure of specialized muscles in the ventricle, called papillary muscles, to contract. These muscles are attached to the underside of the cusps by means of small cords (chorda tendinae) that normally prevent the cusps from flipping up into the atria when the ventricles contract. If the papillary muscles fail to contract, the cusps open upward toward the atria under the force of expelled ventricular blood. This failure is commonly referred to as mitral valve prolapse (MVP). Most individuals with MVP are asymptomatic and lead fairly normal lives. Those who have moderate or more severe cases of MVP take antibiotics like amoxicillin as a prophylaxis measure. If the case worsens, then a valve reconstruction or replacement may be in order. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aortic Stenosis Narrowing of the valve leading into the aorta, occurs more often in men than in women and most frequently in men over 50 years old. It may result from rheumatic fever but not as frequently as does mitral stenosis. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aortic Stenosis (continued) Sometimes it is a congenital defect or it may occur with hardening of the arteries; the cusps become rigid and adhere together. Masses of hard, calcified material are deposited, giving a warty appearance to the valve. Because the left ventricle of the heart must pump through this valve into the aorta, this chamber hypertrophies greatly through overwork. An inadequate amount of blood may be pumped into the aorta to meet the requirements of the body. An insufficient blood supply to the brain can cause syncope (fainting). This valve defect, like others, can be corrected surgically. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aortic Insufficiency The valve does not close properly. Each time the left ventricle relaxes, blood flows back in from the aorta. This condition can result from inflammation within the heart, endocarditis, or a dilated aorta, in which the ring around the valve is too large. Backflow of blood causes the ventricle to dilate, become exhausted, and eventually fail. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Rheumatic Heart Disease Rheumatic fever is an autoimmune disease. – Results from a reaction between streptococcal antigens and the patient’s own antibodies against them – There seems to be an attraction of the antigen-antibody complex for the mitral valve. The aortic semilunar valve is also affected at times Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Rheumatic Heart Disease The valves become inflamed as a result of the infection, and clotting elements are deposited by blood flowing over the valves. Small nodular structures called vegetations form along the edge of the cusps. The normally delicate cusps thicken and adhere to each other. Later, fibrous tissue develops, which has a tendency to contract. If the adhesions of the cusps seriously narrow the valve opening, the mitral valve becomes stenotic. An inadequate amount of blood flows from the left atrium to the left ventricle. Stasis, or slowed blood flow, frequently causes thrombus formation. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Rheumatic Heart Disease (continued) It is possible for the cusps to retract to the extent that they fail to meet, and the valve cannot close. The mitral valve is then insufficient, or incompetent. There is a backflow of blood, regurgitation, from the left ventricle into the left atrium, when the ventricle contracts. Fortunately, rheumatic fever is not as common today as it once was. This is because of the widespread use of antibiotics in treating streptococcal infections (e.g., penicillin). Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Infectious Endocarditis Inflammation of the endocardium caused by a strain of Streptococcus Organisms enter the blood stream from various routes Friable nodules form on the endocardium – Risk for emboli to vital organs Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-18: Infections resulting in bacterial endocaritis. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-19: Bacterial endocarditis. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-20:Thrombus formation in an atherosclerotic vessel. Depicted are the initial clot formation (a) and the varying degrees of occlusion (b). Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Thrombosis Formation of clots in areas of turbulence and slow blood flow (diseased valve) Thrombus breaks free and forms an embolus – Emboli may be septic or contain pyogenic bacteria. – Emboli may be fatal. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aneurysm A weakening in the wall of a blood vessel can cause localized dilation Most commonly occur in the abdominal aorta or brain and result primarily from arteriosclerosis Aneurysms can also develop in arteries other than the aorta. The danger of an aneurysm is its tendency to increase in size and rupture, resulting in hemorrhage, possibly in a vital organ such as the heart, brain, or abdomen. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Aneurysm (continued) Aneurysms usually produce no symptoms and are detected by an x-ray or routine physical exam. Ultrasound techniques can diagnose and measure aneurysms. A computed tomography or CT scan is accurate in determining the shape and size of an aneurysm. Early detection prevents rupture. Surgical procedures have been very successful in repairing blood vessels affected by aneurysm formation. The diseased area of the vessel is removed and replaced with an artificial graft or segment of another blood vessel. This procedure reduces the risk of hemorrhage and thrombus formation. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Raynaud’s Disease A condition in which small arteries or arterioles in the fingers and toes constrict. Symptoms are spasms including numbness, discoloration of the local skin of the fingers and toes, and pain. Spasms come and go and are most commonly triggered by cold. As vessels constrict, blood flow temporarily decreases causing the fingers and toes to turn white. As the episode resolves, the affected areas may turn pink or bluish in color. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Raynaud’s Disease (continued) Raynaud’s disease can usually be controlled by protection from cold. Smoking should be avoided as it constricts blood vessels regardless of environmental conditions. Relaxation techniques can help reduce stress, which may bring about an attack. Cigarette smoking must stop to ensure best results. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-21: Raynaud’s disease. (Courtesy of Jason L. Smith, M.D.) Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Phlebitis An inflammation of a vein, usually in the leg Veins are both superficial and deep. It is only when the deep veins are affected that the condition is considered potentially serious. Several factors may cause phlebitis: injury, general infection, poor circulation, and obesity, to name a few. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Phlebitis (continued) The greatest danger in the deep veins is thrombus formation, and the condition is then called thrombophlebitis. – Edema develops once a vein becomes occluded as fluid tends to leak out of the vessel. – The blood cannot return properly to the heart, the veins become congested with blood, and fluid seeps out into the tissues. – It is important that the clot does not become dislodged and travel as an embolism. Anticoagulants, e.g. aspirin, may be administered to prevent further clot formation, and antibiotics are administered to prevent infection. Surgery is sometimes required to remove the thrombus. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Varicose Veins Develop in the superficial veins of the leg Veins become swollen, painful, and appear knotty under the skin. The condition is caused by stagnation of blood in the veins that can result from several factors – Incompetent valves (pooling of blood) – Pregnancy, tumor Treatment: elastic hose, ligation, compression sclerotherapy Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-22: Thrombophlebitis (Courtesy of Jason L. Smith, M.D.) Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-23: Development of varicose veins Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-24: Spider veins (Courtesy of Jason L. Smith, M.D.) Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hemorrhoids Varicose veins of the rectum Cause pain, itching, and bleeding Can develop from pressure on the veins – Straining due to constipation, pressure on the veins from a pregnant uterus, or a tumor may promote their development Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Esophageal Varices Varicose veins of the esophagus frequently accompany cirrhosis of the liver. They result from pressure that develops within the veins as they try to empty. Because of blocked blood vessels within the damaged liver, there is a backup of blood and general congestion. A fatal hemorrhage from these varices can occur. Treatment: endoscopic sclerotherapy – In this procedure, a retractable needle is guided into the esophagus by means of a fiberoptic endoscope. The gastroenterologist punctures the varicosities and injects a caustic sclerosis (hardening) solution to occlude the swollen veins. This prevents engorgement, rupture, and hemorrhage, or stops a hemorrhage that has already begun. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypertension or “High Blood Pressure” A condition of abnormally high blood pressure in the arteries Primary – unknown causes – Aggravated by obesity, lack of exercise, and excessive alcohol and salt intake Secondary – due to brain tumors, kidney disease, endocrine disorder Hypertension may have a gradual onset and continue for a long time, or it may be malignant, with sudden onset and rapid progression resulting in death if not treated immediately. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Table 7-4: Risk of Stroke and Heart Disease Increase with Increasing Blood Pressure Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Control Mechanisms – Blood Pressure Adjustments of blood pressure are governed by changes in kidney function and nervous system. – Sympathetic nervous system – Kidneys – Parasympathetic nervous system Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Control Mechanism Sympathetic Nervous System – Constricts Arteries – Greater force through less space or constricted arteries – Fluid is added to the system, the blood pressure increases until arteries dilate or expand, and the kidneys are able to excrete the excess fluid. – During the “fight or flight” response, the sympathetic nervous system temporarily increases blood pressure. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Control Mechanisms – Kidney Decrease in blood volume by secreting a substance called renin Renin activates angiotensin, arteries constrict, and increase blood pressure. Angiotensin also triggers the release of aldosterone, which causes the kidneys to retain salt (sodium) and water, thus expanding blood volume and further increasing blood pressure. Vasoconstriction of blood vessels due to high blood pressure causes increased renin, angiotensin, and aldosterone secretion. If this cycle is not broken, blood pressure continues to increase. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Control Mechanisms – Parasympathetic Nervous System Works antagonistically to the sympathetic nervous system and decreases blood pressure Reduces blood pressure by reducing blood volume via a capillary shift mechanism Blood volume is high, the pressure in the arteries is higher than that of the tissue outside The high blood pressure forces the fluid through the walls of the capillaries into the tissue spaces, thus reducing blood volume and pressure. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypertensive Heart Disease This condition is caused by long-standing high blood pressure or hypertension. The heart naturally pumps against resistance of the narrowing blood vessels farther from the heart. – In the hypertensive heart, it struggles to enlarge as it tries to meet the demands of the body by pumping harder to force the blood through abnormally narrowed blood vessels. – The left ventricle that does most of the work finally enlarges or dilates, becomes exhausted, and eventually fails to pump blood adequately. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Hypertension and Kidney Disease Hypertension can contribute to kidney disease, and kidney disease can contribute to hypertension. Decreased function of the kidneys leads to water and salt retention, causing increased blood volume and elevated blood pressure levels. Long-standing hypertension causes arteriosclerosis of the renal artery, which reduces blood flow to the kidneys and damages them. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. High Blood Pressure and Morbidity Increases the risk of heart disease, kidney disease, and stroke. Increased blood pressure damages all arteries of the body, including the coronary arteries. Damaged arteries become sclerotic (hardened) and weak. Thrombi form in weakened vessels leading to ischemia and necrosis with loss of function in vital organs. Left ventricular hypertrophy Angina pectoris Stroke and damage to vital organs Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshots to view videos on the topic of vital signs. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view a video on the topic of vital signs. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Insert T 07-03 Table of blood pressure ranges Table 7-3: Blood Pressure Guidelines. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Treatment of Hypertension A combination of medication, diet changes, and exercise is the ideal method for controlling high blood pressure. Because there are usually no symptoms of high blood pressure, treatments that make people feel bad or interfere with lifestyle are avoided. Overweight individuals are advised to reduce their weight. Changes in diet for those who have diabetes and high cholesterol levels are important for overall cardiovascular health. Cutting down on salt and alcohol intake may make drug therapy for high blood pressure unnecessary. Moderate exercise can help control weight and improve circulation. Treatment of secondary hypertension depends on the underlying cause. For example, treatment of kidney disease, when recognized, can help normalize and lower blood pressure. If the blood vessels are examined and found to be partially occluded using angiography (dye flow), then angioplasty is called upon subsequently. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Abnormalities in Heart Conduction Heart block Atrial fibrillation and atrial flutter Ventricular fibrillation Cardiac arrhythmia or dysrhythmia Beats may be skipped or come prematurely; these beats are called premature ventricular contractions (PVCs). Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Heart Block Heart block can result from scar tissue interfering with the conduction bundle May be necessary to implant an electric pacemaker if the block is complete Graded – First degree – Second degree – Third degree Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Atrial Fibrillation and Atrial Flutter The impulse for contraction spreads over the atria and the ventricle in an uncoordinated fashion. Atrial fibrillation and atrial flutter are very fast impulses. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ventricular Fibrillation Potentially fatal A series of uncoordinated impulses spreads over the ventricles, causing them to twitch or quiver rather than contract. The ventricle does not carry out effective coordinated contractions. Because no blood is pumped from the heart, ventricular fibrillation is a form of cardiac arrest. Immediate attempts at resuscitation must be made or death will result. Permanent damage to other organs, particularly the brain, results when blood supply to them is compromised. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Dysrhythmia Heart beat rhythm may become irregular and is known as cardiac arrhythmia or dysrhythmia. – Beats may be skipped – Or come prematurely – premature ventricular contractions (PVCs). – Additional irregularities include significant increases in heart rate, called tachycardia, or abnormally slow rate, called bradycardia – Medications typically control the irregularities. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view an animation showing dysrhythmias. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Shock A life-threatening condition in which blood pressure is too low to sustain life Hypovolemic (hemorrhagic) shock results from fluid volume loss after severe hemorrhage or loss of plasma in burn patients. Treatment includes administration of plasma or whole blood. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Shock (continued) Neurogenic shock is due to generalized vasodilation, resulting from decreased vasomotor tone. The reduced blood pressure causes poor venous return to the heart and, hence, poor cardiac output. The decreased vasomotor tone may be due to spinal anesthesia, spinal cord injury, or certain drugs. Anaphylactic shock accompanies a severe antigenantibody reaction, such as occurs in an incompatible blood transfusion. Cardiogenic shock is the result of extensive myocardial infarction. It is often fatal, but there are drugs to combat it. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view an animation showing hypovolemic shock. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshots to view animations showing shock. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Return to Directory Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 7-25: Various types of shock Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnostic Procedures Auscultation ECG electrical recording Echocardiography Color Doppler echocardiography Exercise tolerance test Cardiac catheterization X-rays of the heart and great vessels, coronary arteriography Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.