1. The Incredible Heart APL3 Who sketched this?

2. Blood supply to the Heart Supplied to the heart muscle (myocardium) by the coronary arteries Supplied to the heart muscle (myocardium) by the coronary arteries First 2 branches off the Aorta First 2 branches off the Aorta Supply Myocardium with constant supply of blood. Supply Myocardium with constant supply of blood. –Poorest: ventricular contraction –Best: ventricular relaxation

3. Diagrams of Coronary vessels

4. Blocked Coronary Arteries (CAD) Angina Pectoris: Angina Pectoris: Blockage of blood flow to the heart Blockage of blood flow to the heart Ischemia & pain Ischemia & pain TX: Nitroglycerine TX: Nitroglycerine Sublingual, taken when pain occurs Sublingual, taken when pain occurs Taken 3x every 5 min Taken 3x every 5 min

5. Myocardial Infarction (heart attack) Mortality: 500K – 700K per year in US Mortality: 500K – 700K per year in US Cause:Complete obstruction of coronary artery leading to the heart Cause:Complete obstruction of coronary artery leading to the heart Result: death of heart tissue Result: death of heart tissue Signs & Symptoms Signs & Symptoms Persistent chest pain Persistent chest pain Tightness in chest Tightness in chest Difficulty breathing Difficulty breathing Jaw, neck, shoulder pain (referred pain) Jaw, neck, shoulder pain (referred pain) Sweating Sweating

6. More MI 50% of MI deaths occur prehospital 50% of MI deaths occur prehospital TX: immediately take aspirin and get to hospital TX: immediately take aspirin and get to hospital Sex: Age 40-70 M Sex: Age 40-70 M After age 70: male/female comparable After age 70: male/female comparable Mortality rates are declining over last several years Mortality rates are declining over last several years WHY?? WHY??

7. Hypertension “High Blood Pressure” “High Blood Pressure” Systolic BP: Amount of pressure in the aorta during ventricular contraction Systolic BP: Amount of pressure in the aorta during ventricular contraction Diastolic BP: amount of pressure in the aorta during “rest” or atrial contraction. Diastolic BP: amount of pressure in the aorta during “rest” or atrial contraction. Normal was 120/80 mm/Hg. Now changed to 115/75 mm/Hg. Normal was 120/80 mm/Hg. Now changed to 115/75 mm/Hg. Puts added stress on heart and vessels Puts added stress on heart and vessels

8. Thrombus Ex: Coronary Thrombosis (blood clot) Ex: Coronary Thrombosis (blood clot) Build-up of plaque(atherosclerosis can narrow arteries for blood flow and clot forms or Build-up of plaque(atherosclerosis can narrow arteries for blood flow and clot forms or Rupture of plaque Rupture of plaque

11. Embolus Ex: Pulmonary Embolism Ex: Pulmonary Embolism Obstruction caused from “floating” clot or bubble of gas Obstruction caused from “floating” clot or bubble of gas “Floating” clot gets stuck and blocks all blood flow. “Floating” clot gets stuck and blocks all blood flow.

13. Congestive Heart Failure (CHF) Fx as a pump is impaired due to: Fx as a pump is impaired due to: A. Diseases that weaken heart A. Diseases that weaken heart B. diseases causing stiffening of heart B. diseases causing stiffening of heart C. diseases that increase oxygen demand C. diseases that increase oxygen demand

14. Cerebral Vascular Accident (CVA/Stroke) Lack of blood supply to the brain that can result in a decrease in neurological/physical fx, caused by bleeding into the brain, or formation of a bloodclot that blocks an artery to the brain Lack of blood supply to the brain that can result in a decrease in neurological/physical fx, caused by bleeding into the brain, or formation of a bloodclot that blocks an artery to the brain

15. Aneurysm An aneurysm (or aneurism) is a localized, blood-filled dilation (balloon-like bulge) of a blood vessel caused by disease or weakening of the vessel wall. Aneurysms most commonly occur in arteries at the base of the brain (the circle of Willis) and in the aorta (the main artery coming out of the heart), a so-called aortic aneurysm. The bulge in a blood vessel can burst and lead to death at any time. The larger an aneurysm becomes, the more likely it is to burst. An aneurysm (or aneurism) is a localized, blood-filled dilation (balloon-like bulge) of a blood vessel caused by disease or weakening of the vessel wall. Aneurysms most commonly occur in arteries at the base of the brain (the circle of Willis) and in the aorta (the main artery coming out of the heart), a so-called aortic aneurysm. The bulge in a blood vessel can burst and lead to death at any time. The larger an aneurysm becomes, the more likely it is to burst.arteries circle of Willisaortaheartaortic aneurysmarteries circle of Willisaortaheartaortic aneurysm

16. Quick Quiz- 10 points 1. Why can the same coronary artery be of a different level of importance from one person to another? 1. Why can the same coronary artery be of a different level of importance from one person to another? 2. List 2 important interventions for someone who is suspected of having a myocardial infarction 3. Explain the connection between a thrombus and atherosclerosis 3. Explain the connection between a thrombus and atherosclerosis

17. Questions cont. 4. Describe what CHF is and what treatments are usually done for it 4. Describe what CHF is and what treatments are usually done for it 5. List 3 things that you would have a person suspected of having a CVA do. Why would you do this? 5. List 3 things that you would have a person suspected of having a CVA do. Why would you do this?