1. Cardiovascular Diseases & Disorders
Anatomy & Physiology

2. 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

3. 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.

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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)

13. 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

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

15. 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.

16. 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

17. 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)

18. 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

19. 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

20. Common Blood Vessel Disorders
Figure 15.5

21. 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

22. 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 .

23. 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

24. Varicose veins

25. 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

26. 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

28. 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.

29. 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

30. 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

31. 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

32. 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

33. 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.

34. 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