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Chapter 11
Cardiology
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Anatomy of The Heart
• Composed almost entirely of muscle
• Two different pumps:
– Pumps deoxygenated blood into the lungs to
gather oxygen
– Pumps oxygenated blood throughout the body
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• Pericardium
– Surrounds the heart like a sac
Layers:
– Epicardium – outer layer
– Myocardium – middle layer
– Endocardium – inner layer
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• Chambers: sections through which blood is
pumped
– Right atrium (upper chamber)
– Left atrium (upper chamber)
– Right ventricle (lower chamber)
– Left ventricle (lower chamber)
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• Valves: open and close to maintain blood flow through
the heart
– Tricuspid valve – between right atrium and right
ventricle
– Mitral valve – between left atrium and left ventricle
– Pulmonary valve – between the right ventricle and
pulmonary artery
– Aortic valve – between the left ventricle and the
aorta
• Leaflets: prevent backflow of blood during heartbeat
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• Arteries and Vessels
– Arteries: carry blood away from the heart
– Capillaries: feed tissues and collect waste
– Venules: gather blood from the capillaries
– Veins: carry blood back to the heart
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• Coronary arteries: carry blood to the heart’s muscle
tissue
– Aorta: the main arterial line
– Left coronary artery (LCA)
– Right coronary artery (RCA)
– Posterior descending artery (PDA)
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– Left anterior descending artery (LAD)
– Left circumflex artery (LCA)
– Lesser vessels:
• Diagonal branches D1, D2
• Obtuse marginal branches (OM1, OM2)
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Blood’s Path Through the Heart
Blood empties into vena cavae
– Superior vena cava: carries blood from upper body
to right atrium
– Inferior vena cava: carries blood from lower body to
right atrium
Blood in right atrium empties into right ventricle
Pumped by pulmonary artery to lungs
Through left atrium and left ventricle
Pumped into the aorta for circulation throughout the body
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• Cardiac Conduction
– Provides the electric stimulus necessary for heart to
beat
• Cardiac Cycle
– The sequence of events in one heartbeat
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– From the sinoatrial (SA) node, “the heart’s
natural pacemaker”
– To the AV node
– To the bundle of His
– To the left and right bundle branches
– To the Purkinje fibers
– To the ventricles and valves
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• Heart rates
– Normal heart rate: sinus rhythm
– Arrhythmia: absence of heart rhythm
– Dysrhythmia: abnormal heart rhythm
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• Abnormal heart rates and rhythms
– Bradycardia: slow heartbeat, less than 60 bpm
– Tachycardia: fast heart rate, greater than 100 bpm
– Atrial flutter: atrial rhythm is regular, but the rate is
abnormally fast
– Fibrillation: uncoordinated, irregular contraction of the
heart muscle
• Atrial fibrillation
• Ventricular fibrillation
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– Heart block: impaired conduction of the heart’s
electrical impulses
– Paroxysmal atrial tachycardia: a rapid heart rate that
starts and stops suddenly and unpredictably
– Premature atrial contraction: an extra heartbeat that
originates from the atria before it should
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• Blood Pressure
– Measures the force of blood against artery walls
– Sphygmomanometer: measures blood pressure
– Indicated in terms of millimeters of mercury (mmHg)
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Common Cardiac Diseases and
Treatments
• Signs of heart problems
– Cyanosis: bluish tinge
– Pallor: paleness
– Edema: swelling of tissues
– Diaphoresis: excessive sweating
– Angina (angina pectoris): severe chest pain
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• Hypertension
– Primary hypertension: no identifiable cause
– Secondary hypertension: another known cause
Treatment:
– Diuretics
– Beta-blockers
– ACE inhibitors
– Calcium-channel blockers
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• Coronary Artery Disease (CAD): narrowing arteries
hinder blood supply to heart
– Cause: plaques (atherosclerosis)
– Symptoms:
• Angina pectoris (severe chest pain)
• Dyspnea (shortness of breath)
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– Complications: PND, orthopnea
– Treatment:
• Nitrates and other drug therapies
• Angioplasty (PTCA)
• Atherectomy
• Coronary artery bypass graft (CABG)
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• Cardiomyopathy: impairment in structure and function
of the myocardium
– Dilated cardiomyopathy: enlargement of the heart
chambers
– Hypertrophic cardiomyopathy: overgrowth of heart
muscle
– Restrictive cardiomyopathy: ventricles stiffen and do
not fill normally
Treatment:
– Drug therapy
– Heart transplant
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• Valvular Heart Disease: the heart’s ability to pump blood is
impeded
– Treatment: not usually required
• Pericarditis: inflammation of the pericardium
– Treatment:
• Medications to reduce inflammation and pain
• Drainage of fluid
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Congenital Heart Disorders
• Atrial septal defect (ASD): “hole in the heart”, or in
atrial septum
– Treatment: hole usually closes on its own
• Ventricular septal defect (VSD): a hole in the
ventricular septum
– Treatment: hole usually closes on its own
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• Patent Ductus Arteriosus
– Ductus arteriosus remains open (patent) after birth
– Treatment: condition will resolve alone or with
corrective surgery
• Transposition of the Great Vessels
– Location of aorta and pulmonary artery (great
vessels) is switched
– Treatment: arterial switch operation
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• Tetralogy of Fallot
– Too little oxygen in the blood, leading to cyanosis
– Combination of four defects:
• VSD
• Pulmonary stenosis
• Displaced aorta
• Right ventricular hypertrophy
– Treatment: surgery to increase blood flow and
correct defects
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Diagnostic Studies and Procedures
• Blood Tests
– Cardiac risk factor testing: evaluate risk of heart
disease or stroke
• C-reactive protein (CRP)
• Homocysteine
• Lipoprotein (a) or Lp(a)
• Cholesterol particle test
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– Lipid profile (total cholesterol, HDL and LDL)
– Blood sugar (glucose)
– B-type natriuretic peptide (BNP)
– Cardiac enzyme studies
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• Electrocardiogram (EKG/ECG)
– Analyzes electrical activity of the heart
– Produces graphic tracing of waveforms on paper strip
– Deviation in shape or interval of waveforms indicates
possible problem.
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• Echocardiogram
– Uses ultrasound to examine heart anatomy
– Sound waves “echo” off cardiac structures
– Provides image of beating heart on a computer
screen.
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• Cardiac Stress Test: evaluates the heart when heart is
working
– Measured using Bruce protocol
– Expressed in metabolic equivalents (METS)
– Nuclear scan thallium
• Camera records thallium received by the heart
• Shows problems with blood flow and pumping
action
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• Cardiac Catheterization and Angiography
– Diagnose and treat heart disorders other than those
involving coronary arteries
– Radiopaque dye is inserted into coronary arteries to
view images of the blood vessels as the heart pumps
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• Multiple gated acquisition (MUGA) scan
– Determines if the left and right ventricles are
functioning properly
– Diagnoses abnormalities in the heart wall
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Insight
The Heart-Brain
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