1. PHARMACY TECHNICIAN
CHAPTER TWENTY SIX

2. The heart. 2

3. Anatomy of the Heart
Composed of four chambers: two upper and two lower
Atria—top two chambers
Ventricles—bottom two chambers
Septum—divides heart into right and left sides 3

4. Valves of the Heart
Tricuspid valve—located between the right atrium and the right ventricle
Pulmonary valve—located between the right ventricle and the pulmonary artery
Mitral or bicuspid valve—located between the left atrium and the left ventricle
Aortic valve—located between the left ventricle and the aorta 4

5. Layers of the Heart
Pericardium—fluid-filled sac that surrounds and protects the heart
Permits free movement of the heart during contraction
Endocardium—innermost wall layer; covers the inside surface of the heart
Myocardium—surrounds heart and causes chamber contractions 5

6. Function of the Heart
Provides oxygenated blood throughout the body by a pumping mechanism
Oxygenated blood deposits materials necessary for growth and nourishment
Receives from tissues the waste products resulting from metabolism 6

7. Hypertension Sustained elevation of systemic arterial blood pressure
Symptoms include:
Severe headache
Chest pain
Irregular heartbeat
Fatigue
Pharmaceutical treatment includes diuretics, vasodilators, ACE inhibitors, beta blockers, and calcium channel blockers 7

8. Congestive Heart Failure
Heart pumps out less blood than it receives
Results in weakened and enlarged heart
Symptoms of CHF include:
Upright posture or leaning forward
Anxiety and restlessness
Cyanotic and clammy skin
Persistent cough
Rapid breathing
Fast heart rate
Edema of the lower limbs
Pharmaceutical treatment includes cardiac glycosides, diuretics, vasodilators, ACE inhibitors, beta-adrenergic blockers, and phosphodiesterase inhibitors 8

9. Coronary Artery Disease
Occurs when there is insufficient blood flow to the heart
Can lead to:
Angina
Heart attack
Arrythmias
Stroke
Pulmonary embolism
Heart failure
Pharmaceutical treatment includes platelet aggregation inhibitors, anticoagulants, tissue plasminogen activators, and thrombin inhibitors 9

10. Cardiovascular Pharmaceuticals
Antiarrhythmic drugs—restore normal rhythm patterns but do not cure the cause of the irregular heartbeat
Cardiac glycosides—used to increase the force of myocardial contraction, without causing an increase in the consumption of oxygen
Diuretics—used to eliminate excess sodium and water via the urinary tract
Vasodilators—allow more blood to exit the heart, preventing or mitigating congestion; lower blood pressure 10

11. Cardiovascular Pharmaceuticals (cont.)
Angiotensin-converting enzyme inhibitors (ACE inhibitors)—lower high blood pressure; thought to reshape the heart; prevent the body from producing natural vasodilators
Angiotensin II receptor blockers—similar to ACE inhibitors; block the body’s natural vasodilators
Beta-adrenergic blockers—used to block cells from receiving natural vasoconstrictors
Antiadrenergic agents—interfere with the manufacture of vasoconstrictors at nerve endings
Platelet aggregation inhibitors—reduce the ability of the blood to coagulate 11

12. Cardiovascular Pharmaceuticals (cont.)
Anticoagulants—prevent clots from forming or existing clots from getting bigger
Tissue plasminogen activators—break down blood clots by reversing the clotting order and interfering with the synthesis of various clotting factors
Thrombin inhibitors—inactivate bound thrombin by binding to the enzyme and blocking its interaction with its substrates of fibrin
Antihyperlipidemics—help prevent the progression of coronary artery disease by lowering plasma lipid levels 12

13. Anticoagulants Do not thin out the blood Prevent clots from forming
Prevent existing clots from getting bigger
Cannot dissolve existing blood clots 13

14. Warfarin Oral drug of choice
Works by preventing the synthesis of clotting factors II, VII, IX, and X
Used in the long-term prevention or management of venous thromboembolic disorders, including:
Deep vein thrombosis
Pulmonary embolism
Clotting associated with atrial fibrillation and prosthetic heart valves
Vitamin K may be used as an antidote when too much warfarin has been given 14

15. Heparin Parenterally administered drug of choice
Works by inactivating clotting factors IX, X, XI, and XII
Used prophylactically to:
Prevent and treat deep vein thrombosis
Prevent and treat pulmonary embolism
Treat thrombophlebitis
Prevent clotting during cardiac and vascular surgery
The only antidote for heparin overdose is protamine sulfate 15

16. Cholesterol and Triglycerides
HDL—high-density lipoproteins or “good” cholesterol
LDL—low-density lipoproteins or “bad” cholesterol
Triglycerides—a form of energy stored in adipose and muscle tissues
Often measured to depict fat ingestion and metabolism
Can be used to assess CAD risk factors

17. Lymphatic System
Complex system of lymph organs, nodes, ducts, tissues, vessels, and capillaries
Transports lymph fluid to the circulatory system
Cardiovascular and lymphatic systems work in tandem
Joined by a capillary system through which lymph and blood move

18. Lymphatic System (cont.)
Lymphatic system supports the immune system by:
Filtering out organisms that cause disease
Producing specific white blood cells
Manufacturing antibodies
Distributing fluids and nutrients throughout the body
Draining excess fluids and protein so that tissues do not swell or become inflamed