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Blood pressure: 150/100, occasionally higher Elevated levels of cholesterol High LDL and Low HDL ECG: ST segment elevation Trop I and cardiac enzyme markers elevated Progressive breathlessness Orthopnea Ankle edema Respiratory rate: 25/min Pansystolic heart murmur Apex beat of heart at anterior axillary line Heart rate: 110 beats/ minute CXR: cardiomegaly and interstitial infiltrates Cardiac enzymes unremarkable Echocardiography: dilated heart w/ anterior and septal wall hypokinesis apical dilation Posterior wall contracting vigorously Mitral regurgitation Left atrial size normal HEART AS PUMP AND FUNCTION OF HEART VALVES -right heart: through lungs; left heart: peripheral organs -atrium: primer pump for ventricle that helps move blood to ventricle -ventricle: supply main pump force that propels blood in (1) right: pulmonary, (2) left: peripheral -cardiac rhythmicity: heart contraction; action potentials Path: extremities via vena cavas right atrium (tricuspid valve) right ventricle (pulmonary valve)lungs left atrium via pulmonary veins (mitral valve) left ventricle (aortic valve) left ventricle extremities via aorta -Sulci: contain coronary vessels, each sulcus marks external boundary between 2 chambers of heart RIGHT ATRIUM - Right and left are separated by interatrial septum; Fossa ovalis: remnant of foramen ovale, closes after birth Tricuspid valve: also calle right atrioventricular valve RIGHT VENTRICLE - Trabeculae carneae: bundles of cardiac muscles; convey part of conduction system of heart Interventricular septum: separates 2 ventricles LEFT ATRIUM - Bicuspid valve: left atrium to left ventricle MYOCARDIAL THICKNESS AND FUNCTION - Atria: thin-walled, deliver to ventricles under less pressure Ventricles: thick-walled because they deliver blood to greater distances Right ventricle: smaller workload because it only pumps blood to lungs at lower pressure and resistance to blood flow is small Left ventricle: THICKEST deliver to greater distances and to those with high resistance to bloodflow, so higher pressure. AUTORHYTHMIC FIBERS: THE CONDUCTION SYSTEM - Self-excitable Fibers repeatedly generate action potentials that trigger heart contractions - Sinoatrial node: located in right atrial wall, do not have stable resting potential so they repeatedly depolarize to threshold spontaneously (pacemaker potential). When threshold is reached, it triggers action potential atria contract - Action potential reaches AV node enter AV bundle where action potential can conduct from atria to ventricles Action potential enters right and left bundle branches Purkinje fibers conduct action potential at apex of heart to remainder of ventricular myocardium ventricles contract ACTION POTENTIAL AND CONTRACTION OF MUSCLE FIBERS 1. DEPOLARIZATION: contractile fibers have stable resting membrane potential. when fiber is brought to threshold, voltage gated Na channels open. Inflow of Na produces rapid depolarization 2. PLATEAU: period of maintained depolarization. Due to opening of voltage gated Ca channels. Increased Ca in cytosol trigger cytosol 3. REPOLARIZATION: recovery of resting potential. additional K channels open . outflow of K, restores resting potential ELECTROCARDIOGRAM (ECG) - - Amplifies heart signals producing 12 different tracings determines: abnormal conducting pathway, enlarged heart, regions of heart damaged, cause of chest pain - P WAVE: small upward deflection. represents atrial depolarization Large P: indicate enlargement of atrium - QRS COMPLEX: begins as a downward deflection, continues as a large, upright, triangular wave, and ends as a downward wave. Represents rapid ventricular depolarization Enlarged Q: myocardial infarction Enlarged R: enlarged ventricles - T WAVE: dome shaped, represents ventricular repolarization, smaller and wider that QRS because repolarization occurs more slowly Flat T: heart muscle receiving insufficient oxygen (coronary heart disease) Elevated T: hyperkalemia- high blood K+ level - Long P-Q interval: As the action potential is forced to detour around scar tissue caused by disorders such as coronary artery disease and rheumatic fever - Elevated S-T segment: acute myocardial infarction - Depressed S-T: heart receives insufficient oxygen - Long Q-T: myocardial damage, myocardial ischemia (decreased blood flow), conduction abnormalities SYSTOLE: contraction phase; high pressure DIASTOLE: relaxation phase; low pressure AUSCULTATION - Four heart sounds but in a normal heart only 1st and 2nd are heard. - - S1: LUBB sound, closure of AV valves soon after the ventricular systole begins - S2: DUPP sound, closure of SL valves at beginning of ventricular diastole Best heard at places slightly away from the valves because sound is carried by blood flow away HEART MURMUR: clicking, rushing, gurgling noise - STENOSIS: narrowing of valve opening CARDIAC OUTPUT - Volume of blood ejected from left ventricle (or RV) to aorta (or pulmonary trunk) each minute stroke volume (SV): volume of blood ejected by ventricle during each contraction Heart rate(HR): number of beats per minutes CO= SV * HR Typical: 75 b/min * 70 ml/ b= 5.25 L/min During intense: 150 b/ min, SV 130ml/b= 19.5 ml/min CARDIAC MUSCLE o o o Atria and Ventricular- contract like skeletal but longer Excitatory & conductive- conduct weakly because they contain 2 fibrils they exhibit either automatic rhythmical electrical discharge in the form of action potentials or conduction of the action potentials through the heart, providing an excitatory system that controls the rhythmical beating of the heart. Cardiac muscle as SYNCTIUM o ATRIAL SYNCTIUM- constitutes walls of 2 atria o VENTRICULAR SYNCTIUM- walls of 2 ventricles BLOOD PRESSURE - BP is highest in aorta Systolic pressure: highest, normal about 110 Diastolic pressue: low, 70 EDEMA - If filtration exceeds reabsorption Either excess filtration or inadequate reabsorption - Increased capillary blood pressure: more fluid filtered - Increased permeability of capillaries: raise interstitial fluid osmotic pressure by allowing some plasma proteins to escape - Decreased concentration of plasma protein: lowers blood colloid osmotic pressure PULSE - TACHYCARDIA: rapid resting heart or pulse rat >100 b/min BRADYCARDIA: slow resting heart <50 b/min HEART RATE: 60-100 NORMAL LDL AND HDL LDL: bad cholesterol LOW DENSITY LIPOPROTEINS - Collects in walls of blood vessels Cause atherosclerosis: hardening and narrowing of arteries Some WBC convert LDL to toxic oxidized form more WBC go here creates inflammation High levels increase heart disease Bloodclot resulting from high LDL can lead to heart attack HDL : good cholesterol HIGH DENSITY LIPOPROTEINS - Removes LDL from where it doesn’t belong High: 60 mg/dL, Low: 40 mg/dL TROP I AND ENZYME CARDIAC MARKERS - A person who had had a myocardial infarction would have an area of damaged heart muscle and so would have elevated cardiac troponin levels in the blood Trop I : cardiac regulatory proteins that regulate Ca mediated interaction between actin and myosin BREATHLESSNESS - - Heart Failure: The shortness of breath in heart failure is caused by the decreased ability of the heart to fill and empty, producing elevated pressures in the blood vessels around the lung. Common symptoms of heart failure are difficulty in breathing when lying down (this is a specific symptom of heart failure), necessity of propping up the head of the bed with many pillows, wakefulness at night with shortness of breath, cough at night or when lying down, shortness of breath with activity, swelling of ankles or legs, unusual fatigue with activity, and fluid weight gain. Normal respiratory rate: 12-20 per minutes ORTHOPNEA: shortness of breath while sitting CARDIOMEGALY: ENLARGED HEART MITRAL VALVE REGURGITATION: mitral valve does not close properly, leaking backwards from LV to LA HYPOKINESIS: decreased contraction