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Human Diseases A Systemic Approach Sixth Edition Mary Lou Mulvihill Mark Zelman Paul Holdaway Elaine Tompary Jill Raymond Chapter 7 Diseases of the Cardiovascular 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. Chapter 7 Diseases of the Cardiovascular System Multimedia Asset Directory Slide 4 Slide 6 Slide 13 Slide 21 Slide 22 Slide 24 Slide 26 Slide 34 Slide 35 Slide 36 Slide 37 The Heart The Cardiovascular System Chambers of the Heart Atrial Blood Flow Atrial Contraction Systole and Diastole Ventricular Contraction Aneurysm Congestive Heart Failure Acute Myocardial Infarction Heart Attacks Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Slide 38 Slide 39 Slide 55 Slide 59 Slide 70 Slide 76 Slide 125 Slide 126 Slide 134 Slide 137 Slide 138 Electrocardiogram Arrhythmia Coronary Artery Disease Angina Coronary Heart Disease Congenital Heart Disease Vital Signs Vital Signs (Continued) Dysrhythmias Hypovolemic Shock Shock Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Organs of the Cardiovascular System Blood vessels – Arteries – Veins – Capillaries 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. Click on the screenshot to view an animation showing the heart. 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. Cardiovascular (CV) System Also called circulatory system Maintains the distribution of blood throughout the body Is composed of: – Heart – Blood vessels – Arteries – Capillaries – 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. Click on the screenshot to view an animation showing the cardiovascular system. 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. Circulatory System Composed of Two Parts Pulmonary circulation – Between heart and lungs – Transports deoxygenated blood to the lungs to get oxygen – Then back to the heart Systemic circulation – Carries oxygenated blood away from the heart to tissues and cells – Then back to the heart – All the body cells receive blood and oxygen. 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 Muscular pump Made up of cardiac muscle fibers Could be called a muscle instead of an organ Has 4 chambers or cavities Beats an average of 60 – 100 beats a minute (bpm), or about 100,000 times a day Each time the muscle contracts, blood is ejected, pushed throughout the body within blood vessels Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e Located in the mediastinum, in center of chest cavity More to the left side of the mediastinum Is about the size of a fist Is shaped like an upside-down pear The tip of the heart at the lower edge is called the apex The sternum is located directly in front of the heart Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Heart Layers Endocardium Myocardium Epicardium Inner layer Thick, muscular, Outer layer of heart Lines the heart middle layer of heart Visceral pericardium, Contraction of this inner layer of the muscular layer pericardium (pleural develops the pressure sac) required to pump Fluid between the 2 blood through the layers of the sac blood vessels reduces friction as the heart beats chambers Smooth, thin layer that reduces friction as the blood passes through the heart chambers 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 7-1: Heart covering and layers of 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. Heart Chambers Divided into 4 chambers or cavities – 2 atria (upper chambers) – 2 ventricles (lower chambers) These are divided into right and left sides by walls called the interatrial septum and the interventricular septum. 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 Chambers (continued) The atria are receiving chambers of the heart. – Blood returning to the heart in veins collects in the atria. The ventricles are pumping chambers. – They have a much thicker myocardium. – Contraction of the ventricles ejects blood out of the heart and into the great arteries. 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 chambers of the human heart. 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. Heart Valves 4 valves: tricuspid, pulmonary, mitral, aortic Act as restraining gates to control the direction of blood flow Situated at the entrances and exits to the ventricles When properly functioning, valves allow blood to flow only in the forward direction by blocking it from returning to the previous chamber 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 7-2: Heart valves in closed position viewed from the top. 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. Tricuspid Valve Is an atrioventricular valve – It controls the opening between the right atrium and right ventricle – Once the blood enters the right ventricle, it cannot back up into the atrium again. – The prefix tri-, meaning three, indicates that this valve has 3 leaflets or cusps. 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. Pulmonary Valve Semilunar valve Semi means half Lunar means moon Semilunar means this valve looks like a half moon Located between right ventricle and pulmonary artery Allows blood to flow from right ventricle into 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. Mitral Valve Also called bicuspid valve – 2 cusps Blood flows through this atrioventricular valve to the left ventricle Cannot back up into left atrium 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 Valve Blood leaves left ventricle through this semilunar valve between the left ventricle and into 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. Normal Flow of Blood through the Heart 1. 2. 3. Deoxygenated blood from all the tissues, except lung, enters a relaxed right atrium via two large veins called the superior vena cava and inferior vena cava. The right atrium contracts and blood flows through the tricuspid valve into the relaxed right ventricle. The right ventricle then contracts and blood is pumped through the pulmonary valve into the pulmonary artery, which carries it to the lungs. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e 4. 5. 6. The left atrium receives blood that has been oxygenated by the lungs. This blood enters the relaxed left atrium from the four pulmonary veins. The left atrium contracts and blood flows through the mitral valve into the relaxed left ventricle. When the left ventricle contracts, the blood is pumped through the aortic valve and into the aorta, the largest artery in the body. The aorta carries blood to all parts of the body except the lungs. Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Click on the screenshot to view an animation on atrial blood flow. 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 an animation on atrial contraction. 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. Heart Chambers Alternate between relaxing in order to fill and contracting to push blood forward Relaxation phase is diastole. Contraction phase is systole. 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 systole and diastole. 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. Conduction System of the Heart Autonomic nervous system controls the heart rate No voluntary control over our heart Special tissue conducts electrical impulses that stimulate different chambers to contract in correct 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. Click on the screenshot to view an animation on ventricular contraction. 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. The path that the impulses travel is as follows: 1. The sinoatrial (SA) node, or pacemaker, is where the electrical impulse begins. From the sinoatrial node a wave of electricity travels through the atria, causing them to contract, or go into systole. 2. Next, the atrioventricular node is stimulated. 3. This node transfers the stimulation wave to the bundle of His. Mulvihill, Zelman, Holdaway, Tompary, and Raymond Human Diseases: A Systemic Approach, 6e 4. The electrical signal next travels down the bundle branches within the interventricular septum. 5. Finally, the Purkinje’s fibers out in the ventricular myocardium are stimulated which results in ventricular systole. Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Three Types of Blood Vessels Arteries: large, thick-walled vessels that carry blood away from the heart Veins: carry blood back to the heart Capillaries: connecting units between the arteries and veins. They are very thin and carry oxygen-rich blood from the arteries to the body cells. 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 7-3: Coronary arteries and major blood vessels. 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. Blood Pressure A measurement of the force exerted by blood against the walls of a vessel During ventricular systole, blood is under a lot of pressure from ventricular contraction. – Gives highest pressure – systolic During ventricular diastole, blood isn’t being pushed from the heart at all. – Blood pressure drops to lowest point – diastolic Both numbers are required to see full range. 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 7-4: Venous return to the heart and blood flow to the lungs. 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 7-5: Return of oxygenated blood to heart and entry into aorta (red=oxygenated blood, blue=deoxygenated 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. Figure 7-7: The blood flow through 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. Click on the image to view an animation on heart conditions: aneurysm. 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 image to view an animation on congestive heart failure (CHF). 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 an animation on heart conditions: acute myocardial infarction. 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 heart attacks. 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 electrocardiogram. 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 an animation on arrhythmia. 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 7-6: Conducting system of 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. Major Diseases within the Cardiovascular System Congenital heart disease which affects the infant or child Inflammatory heart disease, especially of an infectious nature, but also the peripheral or metabolic forms. Ischemic vascular disease as found in blood clots or occlusion of vessels Hypertension related disease involving high blood pressure or hypertensive heart or lung Metabolic diseases, associated with diet, diabetes, and kidney-related problems 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 of the Heart and the Influence of the Autonomic Nervous System The cardiac muscle can contract continuously and rhythmically without nerve stimulation The sinoatrial node, the pacemaker of the heart, initiates the heartbeat. The impulse for contraction spreads over the atria and the ventricles via the (AV) – bundle of His. The impulse terminates in the Purkinje’s fibers, which further branch through the ventricles 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. Autonomic Influence Parasympathetic: vagus nerve secretes acetylcholine, slows the heart Sympathetic: stimulates the release of epinephrine into the bloodstream – Speeds up the heart during periods of stress and physical activity when the body needs greater blood flow 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. Structure of Blood Vessels The walls of arteries are thick and strong with considerable elastic tissue and are lined with endothelium, which comprises the intima. Arterioles are not only smaller in diameter but their walls are thin, consisting mostly of smooth muscle fibers arranged circularly; arterioles are also lined with endothelium. Capillaries are minute vessels about 1/2 to 1 mm long with a lumen as wide as a red blood cell. Their walls consist of a layer of endothelium. 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. Structure of Blood Vessels (continued) Capillaries, the thinnest-walled vessels, allow for the exchange of oxygen and carbon dioxide between the blood and tissues. Nutrients and waste products of cellular metabolism are also exchanged through capillary walls by diffusion. Veins have walls that are much thinner than their companion arteries, but the lumen is considerably larger. Veins tend to collapse when empty. 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. Arteriosclerosis Arteriosclerosis is caused by several conditions in which the wall of an artery becomes thicker and less elastic. The most common of these diseases is atherosclerosis, in which fatty material accumulates under the inner lining or intima of the arterial wall, forming an atheroma. 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 7-8: An atherosclerotic 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. Figure 7-9: Blood vessels: (a) Normal artery. (b) Constriction. ( c ) Arteriosclerosis and atherosclerosis. 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. Atherosclerosis Begins with inflammatory processes such as a slight tear in the artery wall. Monocytes or white blood cells then accumulate under the inner lining or intima of the arterial wall forming an atheroma. These white blood cells, in turn, transform into cells that accumulate fat. Fatty deposits, called plaques, narrow the lumen of the blood vessels and, in some instances, completely occlude it. Plaque may also consist of complex carbohydrates, blood and blood products, fibrous tissue, and calcium deposits. The aorta and its branches can be affected as well as smaller coronary and cerebral arteries. Occlusion of these vessels interferes with blood flow to the heart muscle, causing a myocardial infarction, and to the brain, causing a stroke or cerebral vascular accident (CVA). Lack of blood to any organ is called ischemia and causes tissue damage. 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. The Cause of Atherosclerosis Not completely known But it does have a hereditary basis Atherosclerosis is a common complication of diabetes, also a disease with a hereditary tendency. A low-cholesterol diet and regular exercise should reduce the risk of developing atherosclerosis. 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. Arteriosclerosis Arteriosclerosis is caused by several conditions in which the wall of an artery becomes thicker and less elastic. The most common underlying cause of this condition is atherosclerosis as previously described. With time, calcium may accumulate and the vessel is less resilient or flexible and therefore is unable to rebound with the pressurized blood rushing through it during the contraction phases of the heart. Arteriosclerosis is the resultant (due to atherosclerosis) basis of hypertension or high 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. Table 7-1: Risk Factors for Heart Disease 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. Coronary Artery Disease The heart muscle itself receives a fraction (about 5%) of the large volume of blood flowing through the atria and the ventricles. Coronary circulation supplies the heart with oxygen-rich blood and returns oxygen-depleted blood to the right atrium. Vessels can become occluded (blocked). Narrowing of the lumen is due to that same condition termed atherosclerosis. Ischemia is a deficiency of blood supply (and therefore oxygen supply) to an area or organ. Continued ischemia to the heart muscle results in a heart attack. When an area of the myocardium is suddenly deprived of blood due to occlusion of the coronary artery, that tissue dies and the dead muscle is called an infarct. This situation is a true heart attack or myocardial infarction (MI). 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 7-10: Blockage of coronary arteries. 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 a video on the topic of coronary artery 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. Angina pectoris Temporary chest pain or sensation of chest pressure that is caused by transient oxygen insufficiency Pressure and pain below the breastbone, may radiate to the neck, jaw, and arms. Feeling of tightness and suffocation Triggered by physical activity, heavy meals, exposure to cold, or emotional stress, it lasts no more than a few minutes, and subsides with rest. Medication such as nitroglycerin (a pill under the tongue) is administered to dilate coronary arteries, permitting adequate blood flow. 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. Chronic Unstable Angina Recurring attacks of angina is called chronic unstable angina. Control of exercise and physical activity is necessary for all cases of angina. Severe chest pains generally accompany an MI, but the pain may be referred to the neck or left arm, and the person may feel nauseous, and have symptoms confused with heartburn sensations. Additional symptoms are restlessness, cold sweats, vomiting, lightheadedness, and clammy skin. 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 7-2: Signs and Symptoms of Heartburn and Heart Attack 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 a video on the topic of angina. 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 7-11: Outcome of myocardial infarction. 40% of 1 week survivors have late complications resulting in death. Ten year survival is about 25%. 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. Prognosis Depends on many factors – The speed with which medical attention is given is very important. Thus, cardiopulmonary resuscitation (CPR) can be of great assistance while waiting for an emergency care unit to arrive. – If one is alone or awaiting emergency care it is suggested that coughing helps create pressure to assist the heart. Women need to take special precautions following an MI, because within one year 38% will die, compared to 25% of deaths in men 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. Diagnosis and Severity of MI Size of occlusion and distance from its origin impacts the extent of heart damage The diagnosis and severity of an MI is also indicated by the type and level of certain enzymes found in the blood. These enzymes, which are additional factors, relate closely to the prognosis. If a collateral circulation has been established, that is, if blood vessels from the surrounding area have channeled into the damaged tissue, recovery will be faster and better. 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 7-12: Serum enzyme level patterns used to diagnose myocardial infarction. AST=aspartate aminotransferase, CPK=creatine phosphokinase, and LDH=lactate dehydrogenase. 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. Myocardial Repair Scar tissue – Limited function – Potential site for clot formation Controlled exercise to maintain circulation Strength may be limited 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. Risks for Coronary Artery Disease Obesity Hypertension Smoking Sedentary lifestyle High-cholesterol diet 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 Heart Disease Severe damage to heart muscle after a heart attack has been greatly reduced by early administration of thrombolytic (blood clotdissolving) drugs. TPA (tissue plasminogen activator), preferably used within 3 hours of the attack, applied in about 20% of the cases, and streptokinase are commonly used. Other anticoagulants, aspirin (81 mg), and Coumadin are used depending on the person having had an MI or bypass surgery, age, or health status. 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 Heart Disease (continued) During coronary bypass surgery, a portion of the patient’s vein, usually the saphenous vein, is used to reroute blood around the occlusion. When obstruction to blood flow is less severe, angioplasty may be performed. Inserting a balloon-tipped catheter, usually from the femoral artery, and guiding it up to the heart into a narrowed coronary artery, in order to dilate it, the balloon expands and opens up the vessel. This process is called percutaneous transluminal coronary angioplasty (PTCA). 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. Cor Pulmonale A serious heart condition in which the right side of the heart fails as a result of long-standing chronic lung disease As respiratory failure develops, pressure in the blood vessels to the lung increases, a condition termed pulmonary hypertension. This hypertension overworks the right ventricle, which pumps blood into the pulmonary artery, causing dilation and hypertrophy of the right ventricle. Treatment is aimed at relieving the causative lung disease by administration of bronchodilator medication (e.g., Albuterol) and the use of a ventilator. 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. Congestive Heart Failure Progressive heart condition in which the quantity of blood pumped by the heart is insufficient to meet the needs of the body. Coronary heart disease impairs blood flow to the heart and can cause a heart attack, as previously described, that permanently damages the heart. An infection of the heart caused by viruses, bacteria, and other microorganisms may damage the heart muscle and heart valves to cause heart failure. Heart valve disorders and hypertension increase the size of the heart muscle and cause it to work harder initially. Over time, the enlarged heart weakens and fails to pump adequately. The heart’s conduction system may fail, resulting in slow, fast, or irregular heartbeats that cannot pump blood effectively. 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 a video on the topic of coronary 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.
