Cardiology Chapter 5

Cardiology The medical specialty that studies the anatomy and physiology of the cardiovascular system and uses diagnostic tests, medical and surgical procedures, and drugs to treat cardiovascular diseases.

Figure 5-1 Cardiovascular system.

The Cardiovascular System A continuous, circular body system which includes: the heart blood vessels Moves blood throughout the body which transports: Oxygen carbon dioxide Nutrients wastes in the blood

Anatomy of the Cardiovascular System Heart A muscular organ that contracts at least once every second to pump blood through the body Has an extensive electrical system that initiates and coordinates its contractions

Figure 5-2 Surface of the heart. 5-1

Anatomy of the Cardiovascular System Heart Chambers four chambers: Each small upper chamber is an atrium. Each large lower chamber is a ventricle. The septum, a central wall, divides the heart into right and left sides. The inferior tip of the heart is the apex (comes to a point).

Figure 5-3 Chambers and valves of the heart.

Anatomy of the Cardiovascular System Heart Muscle - Myocardium Composed of cardiac muscle Responds to electrical impulses generated by a node within the heart itself Contracts in a coordinated way to pump blood Thickest on the left side of the heart

Anatomy of the Cardiovascular System Thoracic Cavity Contains the lungs and the mediastinum, an irregularly shaped central area between the lungs Mediastinum: contains the heart and parts of the great vessels (aorta, superior vena cava, inferior vena cava, pulmonary arteries, and veins), as well as the thymus, trachea, and the esophagus.

Anatomy of the Cardiovascular System Blood Vessels Vascular channels through which blood circulates in the body Have a central opening or lumen through which the blood flows Lined with endothelium, a smooth inner layer that promotes the flow of blood

Anatomy of the Cardiovascular System There are three kinds of blood vessels in the body, each performing a different function: Arteries-carry oxygenated blood Capillaries-exchange O2 & CO2 Vein-carry deoxygenated blood

Anatomy of the Cardiovascular System Arteries Large blood vessels that branch into smaller arteries called arterioles. All share important characteristics and functions: Carry blood away from the heart to the body or lungs Carry bright red blood that has a high level of oxygen (exception: pulmonary arteries) Most lie deep beneath the skin All have smooth muscle in their walls

Figure 5-7 Vasoconstriction and vasodilation.

Anatomy of the Cardiovascular System Capillaries Smallest blood vessels in the body The lumen of a capillary is so small that blood cells must pass through in single file. Veins Capillaries merge to form small veins known as venules, which then combine to form a large vein.

Figure 5-8 Valves in a vein. 5-1

Anatomy of the Cardiovascular System Aorta Largest artery in the body Receives oxygenated blood from the left ventricle of the heart Veins Superior and Inferior Vena Cava

Figure 5-11 Circulation of the blood.

Figure 5-12 Conduction system of the heart. 5-2

Physiology of a Heartbeat Two Heartbeat Phases Systole (contraction) Diastole (resting period between contractions) Normal sinus rhythm (NSR)

Diseases Myocardium Cardiomegaly- enlargement of the heart r/t CHF Cardiomyopathy- any disease that affects the heart muscle. Congestive heart failure (CHF)- inability for the heart to pump enough blood. Right and left side CHF In the early stages heart will enlarge to compensate Jugular distention Peripheral edema Myocardial infarction (MI)- AKA heart attack Death of myocardial cells due to severe ischemia

Figure 5-14 Peripheral edema.

Diseases Heart Valves and Layers of the Heart Murmur- abnormal heart sound caused by turbulence as blood moves through the heart valves Pericarditis peri- = around card/i- = heart -itis = infection of; inflammation of Rheumatic heart disease Autoimmune response to a streptococcal infection, such as strep throat. Occurs most often in children Often will attack mitral and aortic valves Tetralogy of Fallot- Congenital abnormalities Four defects with the heart

Diseases Arrhythmia- any irregular rate or rhythm of the heart Conduction System Arrhythmia- any irregular rate or rhythm of the heart Bradycardia Fibrillation- quivering Flutter-heart beats fast (>250 BPM)

Diseases Arrhythmia 5-3 Conduction System Tachycardia tachy- = fast card/i- = heart -ia = condition; state; thing Asystole- complete absence of a heartbeat

Diseases Blood Vessels Aneurysm- area of dilation and weakness in the wall of the artery Arteriosclerosis- hardening of the artery Cholestrol- HDL- good cholesterol-you want elevated levels LDL- bad cholesterol- you want low levels Coronary artery disease (CAD) Hypertension (HTN) Hypotension

Figure 5-17 Aneurysm.

Figure 5-17 (cont.) Aneurysm.

Figure 5-19 Severe atherosclerotic plaque in an artery.

Diseases Blood Vessels Peripheral vascular disease (PVD) Phlebitis Any disease of the arteries of the extremities Phlebitis Inflammation of a vein, usually with infection Varicose veins Damaged valves in a vein that allow blood to flow backward and collect in the previous section Caused by injury, long periods of sitting with legs crossed, occupations that require constant standing.

Figure 5-20 Severe varicose veins in the leg.

Laboratory and Diagnostic Procedures Diagnostic Heart Procedures Cardiac catheterization Cardiac exercise stress test Electrocardiography (ECG, EKG) Holter monitor Pharmacologic stress test Telemetry

Figure 5-21 Treadmill exercise stress test.

Figure 5-22 Electrocardiography.

Figure 5-24 Echocardiogram.

Figure 5-25 Doppler ultrasonography.

Medical and Surgical Procedures Medical Procedures Auscultation Cardiopulmonary resuscitation (CPR) Cardioversion Vital signs

Medical and Surgical Procedures Aneurysmectomy Cardiopulmonary bypass

Medical and Surgical Procedures Carotid endarterectomy Coronary artery bypass graft (CABG) Heart transplantation Pacemaker insertion Percutaneous transluminal coronary angioplasty (PTCA) Pericardiocentesis

Figure 5-31 Pacemaker.

Figure 5-33 Stent.

Abbreviations AAA abdominal aortic aneurysm ACE angiotensin-converting enzyme ACS acute coronary syndrome AED automatic external defibrillator AI aortic insufficiency AICD automatic implantable cardioverter-defibrillator AMI acute myocardial infarction AS aortic stenosis ASD atrial septal defect ASHD arteriosclerotic heart disease AV atrioventricular BP blood pressure LVH left ventricular hypertrophy MI myocardial infarction mm Hg millimeters of mercury MVP mitral valve prolapse NSR normal sinus rhythm P pulse (rate) PAC premature atrial contraction PAD peripheral artery disease PCI percutaneous coronary intervention PDA patent ductus arteriosus

Abbreviations BPM, bpm beats per minute CABG coronary artery bypass graft (pronounced “cabbage”) CAD coronary artery disease CCU coronary care unit CHF congestive heart failure CK-MB creatine kinase-MB CPK-MB creatine phosphokinase- MB CPR cardiopulmonary resuscitation CRP C-reactive protein CV cardiovascular PVC premature ventricular contraction PVD peripheral vascular disease RA right atrium RBBB right bundle branch block RV right ventricle S1 first heart sound S2 second heart sound S3 third heart sound S4 fourth heart sound

Abbreviations ECG electrocardiography EKG electrocardiography HDL high-density lipoprotein HTN hypertension JVD jugular venous distention LA left atrium LBBB left bundle branch block LDL low-density lipoprotein LV left ventricle LVAD left ventricular assist device SA sinoatrial SVT supraventricular tachycardia TPR temperature, pulse, and respiration V-fib ventricular fibrillation (slang) VLDL very low-density lipoprotein VSD ventricular septal defect V-tach ventricular tachycardia (slang)