Cardiovascular Diseases & Disorders Anatomy & Physiology

Anemia Insufficient erythrocytes (red blood cells) or hemoglobin Types Hemorrhagic anemia – result of acute or chronic loss of blood Hemolytic anemia – prematurely ruptured erythrocytes Aplastic anemia – destruction or inhibition of red bone marrow Iron-deficiency anemia --Impaired iron absorption Pernicious anemia -- Deficiency of vitamin B12 Treatment is intramuscular injection of B12; application of Nascobal Symptoms Bloody stools Weakness, Tiredness, Fatigue Chest and abdominal pains Shortness of breath (in severe cases) An increased heart rate especially during exertion

Polycythemia Excess RBCs that increase blood viscosity Three main polycythemias are: Polycythemia vera: Generally result of bone marrow cancer Secondary polycythemia: Less oxygen available – normal at high altitudes Blood doping: Artificially induced Signs and symptoms Early: none Late: Headache , Dizziness, Itchiness, Redness of your skin, Shortness of breath, Breathing difficulty when you lie down, Chest pain, Fatigue Risk Factors Age. Polycythemia vera is more common in adults older than 60. It's rare in people younger than 20. Sex. Polycythemia vera affects men more often than it does women. Family history. In some cases, polycythemia vera appears to run in families, indicating that genetic factors other than JAK2 may contribute to the disease.

Sickle Cell Anemia Single base pair mutation results in a single amino acid change. Under low oxygen, Hgb becomes insoluble forming long polymers This leads to membrane changes (“sickling”) and blocking vessels OXY-STATE DEOXY-STATE

Transfusion in Sickle Cell (Controversy!) Used correctly, transfusion can prevent organ damage and save the lives of sickle cell disease patients. Used unwisely, transfusion therapy can result in serious complications.

The Leukemias—Pathophysiology Neoplastic disorders involving WBC 1 or more leukocyte types present as: Undifferentiated, immature, nonfunctional cells Multiply uncontrollably Lg quantities released into general circulation

Types of Leukemia Type Malignant Cells Acute lymphocytic leukemia (ALL) Lymphocytes Acute myelocytic leukemia (AML) Granulocytes (neutrophils, eosinophils, basophils) Chronic lymphocytic leukemia (CLL) B lymphocytes Chronic myelocytic leukemia (CML) Granulocytes

The Leukemias—Pathophysiology Cell growth in bone marrow suppresses production of normal cells Leads to: Anemia, thrombocytopenia, lack of normal functioning leukocytes Bone marrow presses on nerves = pain As progresses, increase # leukemic cells cause: Congestion and enlargement of lymphoid tissue Lymphademopathy Splenomegaly Hepatomegaly

The Leukemias-Treatment Prognosis related to: WBC count Proportion of immature cells at time of count Individuals with chronic may live 10 yrs. with treatment Chemo Less effective in adults with AML May have to be temp discontinued if blood cell count drops too low Thrombocytopenia, neutropenia Transfusion of platelets might be req Bone marrow transplant If chemo ineffective Must find suitable donor

Mononucleosis Mononucleosis (often called "mono") is an infection caused by the Epstein-Barr virus. Signs of mono include fever, sore throat, headaches, white patches on the back of your throat, swollen glands in your neck, feeling tired and not feeling hungry. Mono is not spread as easily as some other viruses, such as the common cold. The mono virus is found in saliva and mucus. Signs of mono usually develop 4 to 6 weeks after you're exposed to the virus. Generally, people only get mono once. It's most common among people 15 to 35 years old.

Thrombus & Embolus Blood clots are the clumps that result from coagulation of the blood (blood hardens to from liquid to solid). Thrombus: a blood clot that forms in a blood vessel or within the heart and remains there. Embolus: a thrombus that travels from the blood vessel or heart to another location in the body

Thrombocytopenia Any disorder in which there are not enough platelets. Platelets are cells in the blood that help blood to clot.    Three major causes of low platelets: Low production of platelets in the bone marrow Increased breakdown of platelets in the bloodstream (called intravascular) Increased breakdown of platelets in the spleen or liver (called extravascular) Symptoms    Bruising Nosebleeds or bleeding in the mouth Rash (pinpoint red spots)

Hemophilia rare, inherited bleeding disorder in which your blood doesn’t clot normally. Two main types: A – no clotting factor B – very little clotting factor Symptoms: Excessive bleeding externally & internally Treatments Replacement therapy—giving or replacing the clotting factor that’s too low or missing. Antifibrinolytic Medicines Desmopressin (DDAVP) stimulates the release of stored factor VIII and von Willebrand factor

Hemotoma localized collection of blood, usually clotted, in a tissue or organ. Treatment: RICE for 1st 24-36 hrs; gentle heat & massage after maybe

Septicemia Definition  Septicemia is the presence of bacteria in the blood (bacteremia) and is often associated with severe disease. Causes  Septicemia is a serious, life-threatening infection. It can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract.

Arrythmias An irregularity in heart rhythm Tachycardia – racing heart in the absence of exercise or anxiety Bradycardia – abnormally slow heartbeat Fibrillation – heart beat is sporatic, quivering pattern

Tachycardia Rapid heart beat initiated within the ventricles, characterized by 3 or more consecutive premature ventricular beats. Causes    Ventricular tachycardia is a potentially lethal disruption of normal heartbeat that may cause the heart to become unable to pump adequate blood through the body. The heart rate may be 160 to 240 (normal is 60 to 100 beats per minute). Healed heart attacks form scar tissue which can lead to ventricular tachycardia. This can occur days, months, or years after the heart attack. Ventricular tachycardia can also result from anti-arrhythmic medications (an undesired effect) or from altered blood chemistries (such as a low potassium level), pH (acid-base) changes, or insufficient oxygenation. Symptoms   Sensation of feeling the heart beat (palpitations) Light-headedness or dizziness Fainting Shortness of breath Chest discomfort (angina)

Bradycardia Brachycardia is a condition in which the heart beats at a rate that is below normal, below 65 beats per minute.  Brachycardia affects older patients and can be caused and linked by certain prescribed medications.  Treatment – Treatment for brachycardia or sinus brachycardia is quite simple.  Doctors might start a regiment of heart rate increasing drugs.  Doctors could also prescribe an artificial pacemaker. Signs and Symptoms – Fatigue Decreased exercise Irritability Hypertension

Heart palpitation Palpitations are heartbeat sensations that feel like your heart is pounding or racing. You may simply have an unpleasant awareness of your own heartbeat, or may feel skipped or stopped beats. Palpitations can be felt in your chest, throat, or neck. Heart palpitations can be caused by: Exercise Anxiety, stress, fear Fever Caffeine, nicotine, cocaine, diet pills Overactive thyroid Anemia Hyperventilation Low levels of oxygen in your blood Mitral valve prolapse, Heart disease You are more likely to have an abnormal heart rhythm if you have: Known heart disease Significant risk factors for heart disease An abnormal heart valve An electrolyte abnormality -- low potassium

Common Blood Vessel Disorders Figure 15.5

Atherosclerosis Characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the artery Hyperlipidemia – abnormally high blood lipid level Plaque – the buildup of substances

Arteriosclerosis Arteriosclerosis of the extremities is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. Symptoms include leg pain, numbness, cold legs or feet and muscle pain in the thighs, calves or feet .

Varicose veins Varicose veins (varicosities) are twisted, enlarged veins at the skin surface. The word comes from the Latin word varix, which means "twisted." You are at greater risk if you: Are older Have other family members with varicose veins Are overweight Stand for long periods of time To prevent varicose veins from getting worse: Exercise Lose weight Avoid tight clothing Elevate your legs Avoid long periods of standing

Varicose veins

Aneurysm An abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel. Some common locations for aneurysms include: Aorta (the major artery from the heart) Brain (cerebral aneurysm) Leg (popliteal artery aneurysm) Intestine (mesenteric artery aneurysm) Splenic artery aneurysm

Stroke Occurs when the blood supply to the brain is interrupted Thrombus – blood clot Embolus – free flowing clot Aneurysm – bulging or burst blood vessel Transient ischemic attack (TIA) – brief interruptions that cause temporary impairment

                                                                                                                                                

Hypertension Hypertension = high blood pressure. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as 2 numbers. For example, 140 over 90 (written as 140/90). The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140. The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90. Many factors can affect blood pressure, including how much water and salt you have in your body, the condition of your kidneys, nervous system, or blood vessels, and the levels of different body hormones.

Hypovolemic shock Emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. Causes -- Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Symptoms    Rapid pulse Rapid breathing Anxiety or agitation Cool, clammy skin Weakness Pale skin color (pallor) Sweating, moist skin Decreased or no urine output Low blood pressure

Congestive Heart Failure (CHF) Damaged or overworked heart muscle is unable to keep blood circulating normally Affects over 5 million Americans Damage to heart muscle may result from rheumatic fever, pneumonia, or heart attack, Lack of proper circulation may allow blood to accumulate in the vessels of the legs, ankles, or lungs Diuretics relieve fluid accumulation

Myocardial infarction (MI) heart attack – blood supplying the heart is disrupted Risk factors for heart attack and coronary artery disease include: Bad genes (hereditary factors) Being male Diabetes Getting older High blood pressure Smoking Too much fat in your diet Unhealthy cholesterol levels

Angina Pectoris Ischemia – reduction of the heart’s blood and oxygen supply The more serious the oxygen deprivation, the more severe the pain Nitroglycerin – drug used to dilate the veins Beta blockers control potential overactivity of the heart muscle

Mitral valve prolapse Mitral valve prolapse is a disorder in which, during the contraction phase of the heart, the mitral valve does not close properly. Some symptoms can include palpitations, chest pain, difficulty breathing after exertion, fatigue, cough, and shortness of breath while lying down.

Aspirin for Heart Disease? Research shows that 80 milligrams of aspirin every other day is beneficial to heart patients due to its blood thinning properties Some side effects of aspirin: gastrointestinal intolerance and a tendency for difficulty with blood clotting