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Chapter_01228129.pptx
1.
Chapter 12 Cardiovascular System
Disorders Copyright © 2019 by Elsevier Inc. All rights reserved.
2.
Review of the
Cardiovascular System Copyright © 2019 by Elsevier Inc. All rights reserved. 2
3.
Circulatory System The
circulatory system is composed of: Vessels Fluid Pump Blood flows from systemic to pulmonary to systemic circulation. Copyright © 2019 by Elsevier Inc. All rights reserved. 3
4.
Heart: Anatomy Located
in the mediastinum Located in the pericardial sac Parietal pericardium Epicardium (visceral pericardium) Pericardial cavity Myocardium Endocardium Heart valves Atrioventricular valves Semilunar valves Septum Copyright © 2019 by Elsevier Inc. All rights reserved. 4
5.
Heart: Conduction System
Conduction pathway Sinoatrial (SA) node • Pacemaker • Sinus rhythm Atrioventricular (AV) node Located in floor of the right atrium AV bundle (Bundle of His) Right and left branches Purkinje fibers Terminal fibers Copyright © 2019 by Elsevier Inc. All rights reserved. 5
6.
Heart: Conduction System
(Cont.) Electrocardiogram (ECG) P wave • Depolarization of atria QRS wave • Depolarization of ventricles T wave • Repolarization of ventricles Copyright © 2019 by Elsevier Inc. All rights reserved. 6
7.
Cardiac Conduction System Copyright
© 2019 by Elsevier Inc. All rights reserved. 7
8.
Control of the
Heart Cardiac control center in medulla oblongata Controls rate and force of contraction Located in the medulla Baroreceptors Detect changes in blood pressure Located in the aorta and internal carotid arteries Sympathetic stimulation (cardiac accelerator nerve) Increases heart rate (tachycardia) Parasympathetic stimulation (cranial nerve [CN] X; vagus nerve) Decreases heart rate (bradycardia) Copyright © 2019 by Elsevier Inc. All rights reserved. 8
9.
Factors that Increase
Heart Rate Increased thyroid hormones or epinephrine Elevated body temperature, infection Example: Fever Increased environmental temperature Especially in high humidity Exertion or exercise Smoking Stress response Pregnancy Pain Copyright © 2019 by Elsevier Inc. All rights reserved. 9
10.
Coronary Circulation Right
and left coronary arteries Branch of aorta immediately distal to the aortic valve Part of the systemic circulation Left coronary artery divides into: Left anterior descending or interventricular artery Left circumflex artery Copyright © 2019 by Elsevier Inc. All rights reserved. 10
11.
Coronary Circulation (Cont.)
Right coronary artery branches Right marginal artery Posterior interventricular artery Many small branches extend from these arteries to supply the myocardium and endocardium. Collateral circulation is extremely limited. Copyright © 2019 by Elsevier Inc. All rights reserved. 11
12.
Coronary Arteries Copyright ©
2019 by Elsevier Inc. All rights reserved. 12
13.
Cardiac Cycle Diastole
Relaxation of myocardium required for filling chambers Systole Contraction of myocardium provides increase in pressure to eject blood. Cycle begins with Atria relaxed, filling with blood AV valves open blood flows into ventricles atria contract, remaining blood forced into ventricles atria relax ventricles contract AV valves close semilunar valves open blood into aorta and pulmonary artery ventricles relax Copyright © 2019 by Elsevier Inc. All rights reserved. 13
14.
Heart Sounds “Lubb-dub”
“Lubb”—closure of AV valves “Dub”—closure of semilunar valves Murmurs Caused by incompetent valves Pulse Indicates heart rate Pulse deficit Difference in rate between apical and radial pulses Copyright © 2019 by Elsevier Inc. All rights reserved. 14
15.
Pulse Points Copyright ©
2019 by Elsevier Inc. All rights reserved. 15
16.
Cardiac Cycle Copyright ©
2019 by Elsevier Inc. All rights reserved. 16
17.
Cardiac Function Cardiac
output (CO) Blood ejected by a ventricle in 1 minute CO = SV HR (heart rate) Stroke volume (SV) Volume of blood pumped out of ventricle— contraction Preload Amount of blood delivered to heart by venous return Afterload Force required to eject blood from ventricles • Determined by peripheral resistance in arteries Copyright © 2019 by Elsevier Inc. All rights reserved. 17
18.
Blood Pressure Systolic
pressure Exerted when blood is ejected from ventricles (high) Diastolic pressure Sustained pressure when ventricles relax (lower) Blood pressure (BP) is altered by cardiac output, blood volume, and peripheral resistance to blood flow. Copyright © 2019 by Elsevier Inc. All rights reserved. 18
19.
Blood Pressure (Cont.)
Changes in blood pressure Sympathetic branch of ANS • Increased output → vasoconstriction and increased BP • Decreased output → vasodilation and decreased BP BP is directly proportional to blood volume. Hormones • Antidiuretic hormone (↑ BP); aldosterone (↑ blood volume, ↑ BP); renin-angiotensin-aldosterone (vasoconstriction; ↑ BP) Copyright © 2019 by Elsevier Inc. All rights reserved. 19
20.
Blood Pressure (Cont.) Copyright
© 2019 by Elsevier Inc. All rights reserved. 20
21.
Heart Disorders Copyright ©
2019 by Elsevier Inc. All rights reserved. 21
22.
Diagnostic Tests for Cardiovascular
Function Electrocardiography Useful in the initial diagnosis and monitoring of dysrhythmias, myocardial infarction, infection, pericarditis Auscultation Determination of valvular abnormalities or abnormal shunts of blood that cause murmurs Detected by listening through a stethoscope Echocardiography Used to record heart valve movements, blood flow, and cardiac output Exercise stress tests Used to assess general cardiovascular function Copyright © 2019 by Elsevier Inc. All rights reserved. 22
23.
Diagnostic Tests for Cardiovascular
Function (Cont.) Chest x-ray films Used to show shape and size of the heart • Nuclear imaging • Tomographic studies Cardiac catheterization Measures pressure and assesses valve and heart function • Determines central venous pressure and pulmonary capillary wedge pressure Angiography Visualization of blood flow in the coronary arteries Copyright © 2019 by Elsevier Inc. All rights reserved. 23
24.
Coronary Angiography Copyright ©
2019 by Elsevier Inc. All rights reserved. 24
25.
Diagnostic Tests for Cardiovascular
Function (Cont.) Doppler studies Assess blood flow in peripheral vessels Record sounds of blood flow or obstruction Blood tests Assess levels of serum triglycerides, cholesterol, sodium, potassium, calcium, other electrolytes Arterial blood gas determination Checks the current oxygen level and acid-base balance Copyright © 2019 by Elsevier Inc. All rights reserved. 25
26.
General Treatment Measures
for Cardiac Disorders Dietary modifications To decrease total fat intake General weight reduction Reduce salt intake Regular exercise program Increases high-density lipoprotein levels Lowers serum lipid levels Reduces stress levels Cessation of smoking Decreases risk of coronary disease Copyright © 2019 by Elsevier Inc. All rights reserved. 26
27.
General Treatment Measures
for Cardiac Disorders: Drug Therapy Vasodilators Reduction of peripheral resistance Beta blockers Treatment of hypertension and dysrhythmias Reduction of angina attacks Calcium channel blockers Decrease cardiac contractility Antihypertensives and vasodilators Prophylactic against angina Copyright © 2019 by Elsevier Inc. All rights reserved. 27
28.
General Treatment Measures
for Cardiac Disorders: Drug Therapy (Cont.) Digoxin Treatment for heart failure Antidysrhythmic drug for atrial dysrhythmias Antihypertensive drugs Used to lower blood pressure Adrenergic blocking drugs Act on SNS centrally or on the periphery Angiotensin-converting enzyme (ACE) inhibitors Block conversion of angiotensin I to angiotensin II Copyright © 2019 by Elsevier Inc. All rights reserved. 28
29.
General Treatment Measures
for Cardiac Disorders: Drug Therapy (Cont.) Diuretics Remove excess sodium and/or water. Treat high BP and congestive heart failure. Anticoagulants Reduce risk of blood clot formation Cholesterol-lowering drugs Reduce low-density lipoprotein and cholesterol levels Copyright © 2019 by Elsevier Inc. All rights reserved. 29
30.
Selected Cardiovascular Drugs Copyright
© 2019 by Elsevier Inc. All rights reserved. 30
31.
Coronary Artery Disease
(CAD) or Ischemic Heart Disease (IHD) or Acute Coronary Syndrome Copyright © 2019 by Elsevier Inc. All rights reserved. 31
32.
Arteriosclerosis and Atherosclerosis
Arteriosclerosis General term for all types of arterial changes • Degenerative changes in small arteries and arterioles • Loss of elasticity • Lumen gradually narrows and may become obstructed • Cause of increased BP Atherosclerosis Presence of atheromas in large arteries • Plaques consisting of lipids, calcium, and possible clots • Related to diet, exercise, and stress Copyright © 2019 by Elsevier Inc. All rights reserved. 32
33.
Normal (Top) Versus Atherosclerotic
Aorta (Bottom) Copyright © 2019 by Elsevier Inc. All rights reserved. 33
34.
Lipid Transport Lipids
are transported in combination with proteins. Low-density lipoprotein (LDL) Transports cholesterol from liver to cells Major factor contributing to atheroma formation High-density lipoprotein (HDL) Transports cholesterol away from the peripheral cells to liver—“good” lipoprotein Catabolism in liver and excretion Copyright © 2019 by Elsevier Inc. All rights reserved. 34
35.
Lipoproteins Composition and Transport Copyright
© 2019 by Elsevier Inc. All rights reserved. 35
36.
Risk Factors for
Atherosclerosis Nonmodifiable Age Gender Genetic or familial factors Modifiable Obesity Sedentary lifestyle Cigarette smoking Diabetes mellitus Poorly controlled hypertension Combination of oral contraceptives and smoking Copyright © 2019 by Elsevier Inc. All rights reserved. 36
37.
Progression of Artherosclerosis Copyright
© 2019 by Elsevier Inc. All rights reserved. 37
38.
Diagnostic Tests Serum
lipid levels LDL, HDL Exercise stress testing Screening for arterial obstruction Nuclear medicine studies Determine the degree of tissue perfusion Copyright © 2019 by Elsevier Inc. All rights reserved. 38
39.
Consequences of Atherosclerosis Copyright
© 2019 by Elsevier Inc. All rights reserved. 39
40.
Treatment Weight loss
Increase exercise Dietary modification Reduction of sodium intake Control hypertension Control of primary disorder Cessation of smoking Antilipidemic drugs Surgical intervention coronary artery bypass grafting Copyright © 2019 by Elsevier Inc. All rights reserved. 40
41.
Coronary Artery Bypass Copyright
© 2019 by Elsevier Inc. All rights reserved. 41
42.
Angina Pectoris Occurs
when there is a deficit of oxygen to meet myocardial needs Chest pain may occur in different patterns. Classic or exertional angina Variant angina • Vasospasm occurs at rest. Unstable angina • Prolonged pain at rest—may precede myocardial infarction Copyright © 2019 by Elsevier Inc. All rights reserved. 42
43.
Angina Pectoris (Cont.)
Recurrent, intermittent brief episodes of substernal chest pain Triggered by physical or emotional stress Attacks vary in severity and duration but become more frequent and longer as disease progresses. Relieved by rest and administration of coronary vasodilators Example: nitroglycerin • Primarily acts by reducing systemic resistance, decreasing the demand for oxygen Copyright © 2019 by Elsevier Inc. All rights reserved. 43
44.
Signs and Symptoms
Pallor Diaphoresis (excessive sweating) Nausea Chest pain Copyright © 2019 by Elsevier Inc. All rights reserved. 44
45.
Angina: Imbalance of
Oxygen Supply and Demand Copyright © 2019 by Elsevier Inc. All rights reserved. 45
46.
Emergency Treatment for
Angina Rest, stop activity Patient seated in upright position Administration of nitroglycerin—sublingual Check pulse and respiration. Administer oxygen, if necessary. Patient known to have angina Second dose of nitroglycerin Patient without history of angina Emergency medical aid Copyright © 2019 by Elsevier Inc. All rights reserved. 46
47.
Myocardial Infarction Occurs
when coronary artery is totally obstructed Atherosclerosis is most common cause. Thrombus from atheroma may obstruct artery. Vasospasm is caused in a small percentage. Size and location of the infarct determine the damage. Copyright © 2019 by Elsevier Inc. All rights reserved. 47
48.
Warning Signs of
Heart Attack Feeling of pressure, heaviness, or burning in chest—especially with increased activity Sudden shortness of breath, weakness, fatigue Nausea, indigestion Anxiety and fear Pain may occur and, if present, is usually Substernal Crushing Radiating Copyright © 2019 by Elsevier Inc. All rights reserved. 48
49.
Myocardial Infarction (MI) Copyright
© 2019 by Elsevier Inc. All rights reserved. 49
50.
Acute Myocardial Infarct Copyright
© 2019 by Elsevier Inc. All rights reserved. 50
51.
Diagnostic Tests Changes
in ECG Serum enzyme and isoenzyme levels Serum levels of myosin and cardiac troponin are elevated Leukocytosis, elevated CRP and ESR common Arterial blood gas measurements may be altered in severe cases. Pulmonary artery pressure measurements helpful Copyright © 2019 by Elsevier Inc. All rights reserved. 51
52.
Serum Enzyme Levels Copyright
© 2019 by Elsevier Inc. All rights reserved. 52
53.
Complications Sudden death
Cardiogenic shock Congestive heart failure Rupture of necrotic heart tissue/cardiac tamponade Thromboembolism causing cerebrovascular accident (CVA; with left ventricular MI) Copyright © 2019 by Elsevier Inc. All rights reserved. 53
54.
Treatment Reduce cardiac
demand Oxygen therapy Analgesics Anticoagulants Thrombolytic agents may be used. Tissue plasminogen activator Medication to treat: Dysrhythmias, hypertension, congestive heart failure Cardiac rehabilitation begins immediately. Copyright © 2019 by Elsevier Inc. All rights reserved. 54
55.
Cardiac Dysrhythmias (Arrhythmias)
Deviations from normal cardiac rate or rhythm Caused by electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity Electrocardiography—for monitoring the conduction system • Detects abnormalities Reduction of the efficiency of the heart’s pumping cycle Many types of abnormal conduction patterns exist. Copyright © 2019 by Elsevier Inc. All rights reserved. 55
56.
Treatment Determine cause
That is, drugs Change of drug dose might eliminate dysrhythmia Antiarrhythmic drugs Beta-adrenergic blockers Calcium channel blockers Digoxin Pacemaker Copyright © 2019 by Elsevier Inc. All rights reserved. 56
57.
Permanent Pacemaker Copyright ©
2019 by Elsevier Inc. All rights reserved. 57
58.
Sinus Node Abnormalities
SA node Pacemaker of the heart; rate can be altered. Bradycardia Regular but slow heart rate Tachycardia Regular rapid heart rate Sick sinus syndrome Marked by altering bradycardia and tachycardia • Often requires mechanical pacemaker Copyright © 2019 by Elsevier Inc. All rights reserved. 58
59.
ECG Strip Chart
Recordings Copyright © 2019 by Elsevier Inc. All rights reserved. 59
60.
Atrial Conduction Abnormalities
Premature atrial contractions or beats (PACs, PABs) Extra contraction or ectopic beats • Irritable atrial muscle cells outside conduction pathway Atrial flutter Atrial heart rate of 160 to 350 beats/min • AV node delays conduction—ventricular rate slower Atrial fibrillation Rate over 350 beats/min • Causes pooling of blood in the atria • Thrombus formation is a risk. Copyright © 2019 by Elsevier Inc. All rights reserved. 60
61.
Atrioventricular Node Abnormalities
Heart blocks Conduction excessively delayed or stopped at AV node or Bundle of His First-degree block Conduction delay between atrial and ventricular contractions Second-degree block Every second to third atrial beat dropped at AV node Third-degree block No transmission from atria to ventricles Copyright © 2019 by Elsevier Inc. All rights reserved. 61
62.
Ventricular Conduction Abnormalities
Bundle branch block Interference with conduction in one of the bundle branches Ventricular tachycardia Likely to reduce cardiac output as reduced diastole occurs Ventricular fibrillation Muscle fibers contract independently and rapidly Cardiac standstill occurs if not treated immediately! Premature ventricular contractions (PVCs) Additional beats from ventricular muscle cell or ectopic pacemaker; may lead to ventricular fibrillation Copyright © 2019 by Elsevier Inc. All rights reserved. 62
63.
Cardiac Dysrhythmias Copyright ©
2019 by Elsevier Inc. All rights reserved. 63
64.
Treatment of Cardiac
Dysrhythmias Cause needs to be determined and treated. Antidysrhythmic drugs are effective in many cases. SA nodal problems or total heart block require pacemaker. Defibrillator may be implanted for conversion of ventricular fibrillation. Copyright © 2019 by Elsevier Inc. All rights reserved. 64
65.
Cardiac Arrest Cessation
of all heart activity No conduction of impulses Flat ECG Many reasons Excessive vagal nerve stimulation Potassium imbalance Cardiogenic shock Drug toxicity Insufficient oxygen Respiratory arrest Blow to heart Copyright © 2019 by Elsevier Inc. All rights reserved. 65
66.
Congestive Heart Failure
Heart is unable to pump out sufficient blood to meet metabolic demands of the body. Usually a complication of another cardiopulmonary condition May involve a combination of factors Various compensation mechanisms maintain cardiac output Some of these often aggravate the condition. Copyright © 2019 by Elsevier Inc. All rights reserved. 66
67.
Congestive Heart Failure
(Cont.) When heart cannot maintain pumping capability Cardiac output or stroke volume decreases • Less blood reaches the various organs. • Decreased cell function • Fatigue and lethargy • Mild acidosis develops. Backup and congestion develop as coronary demands for oxygen and glucose are not met. • Output from ventricle is less than the inflow of blood. • Congestion in venous circulation draining into the affected side of the heart Copyright © 2019 by Elsevier Inc. All rights reserved. 67
68.
Course of Congestive
Heart Failure Copyright © 2019 by Elsevier Inc. All rights reserved. 68
69.
Effects of Congestive
Heart Failure Left-sided congestive heart failure Copyright © 2019 by Elsevier Inc. All rights reserved. 69
70.
Effects of Congestive
Heart Failure (Cont.) Right-sided congestive heart failure Copyright © 2019 by Elsevier Inc. All rights reserved. 70
71.
Signs and Symptoms
Forward effects (similar with failure on either side) Decreased blood supply to tissues, general hypoxia Fatigue and weakness Dyspnea and shortness of breath Compensation mechanisms Tachycardia Cutaneous and visceral vasoconstriction Daytime oliguria Copyright © 2019 by Elsevier Inc. All rights reserved. 71
72.
Signs and Symptoms
(Cont.) Backup effects of left-sided failure Related to pulmonary congestion Dyspnea and orthopnea • Develop as fluid accumulates in the lungs Cough • Associated with fluid irritating the respiratory passages Paroxysmal nocturnal dyspnea • Indicates the presence of acute pulmonary edema • Usually develops during sleep • Excess fluid in lungs frequently leads to infections such as pneumonia. Copyright © 2019 by Elsevier Inc. All rights reserved. 72
73.
Signs and Symptoms
(Cont.) Signs of right-sided failure and systemic backup Dependent edema in feet, legs, or buttocks Increased pressure in jugular veins leads to distention. Hepatomegaly and splenomegaly • Digestive disturbances Ascites • Complication when fluid accumulates in peritoneal cavity • Marked abdominal distention Acute right-sided failure • Flushed face, distended neck veins, headache, visual disturbances Copyright © 2019 by Elsevier Inc. All rights reserved. 73
74.
Congestive Heart Failure
(CHF) Copyright © 2019 by Elsevier Inc. All rights reserved. 74
75.
Young Children with
CHF Often secondary to congenital heart disease Feeding difficulties often first sign Failure to gain weight or meet developmental guidelines Short sleep periods Tripod position to play Cough, rapid grunting respirations, flared nostrils, wheezing Radiographs show cardiomegaly. Arterial blood gases used to measure hypoxia Copyright © 2019 by Elsevier Inc. All rights reserved. 75
76.
Congenital Heart Defects
Cardiac anomalies Structural defects in the heart that develop during the first 8 weeks of embryonic life Congenital heart disease Valvular defects Septal defects Detected by the presence of heart murmurs If untreated, child may develop heart failure. May be cyanotic or acyanotic, depending on direction of shunting. Copyright © 2019 by Elsevier Inc. All rights reserved. 76
77.
Signs and Symptoms
Large defects Pallor Tachycardia • Occurs with very rapid sleeping pulse and frequent pulse deficit Dyspnea on exertion Squatting position—toddlers and older children • Appears to modify blood flow, more comfortable Clubbed fingers Intolerance for exercise and exposure to cold weather Delayed growth and development Copyright © 2019 by Elsevier Inc. All rights reserved. 77
78.
Diagnostic Tests Severe
defects are often diagnosed at birth. Others may not be detected for some time. Examination techniques Radiography Diagnostic imaging Cardiac catheterization Echocardiography Electrocardiography Surgical repair Copyright © 2019 by Elsevier Inc. All rights reserved. 78
79.
Ventricular Septal Defect
VSD is the most common congenital heart defect. Opening in the interventricular septum May vary in size and location Untreated VSD Pressure usually higher in left ventricle Shunt from left → right Acyanotic condition unless respiratory condition increases pressure in right ventricle Copyright © 2019 by Elsevier Inc. All rights reserved. 79
80.
Treatment Treatment usually
involves both surgical and medical procedures. Surgical Open heart surgery Catheter procedure Hybrid procedure Medical used to: Increase strength of contractions Decrease amount of fluid in circulation Keep a regular heartbeat Copyright © 2019 by Elsevier Inc. All rights reserved. 80
81.
Valvular Defects Usually
affect aortic and pulmonary valves May be classified as stenosis or valvular incompetence Failure of valve to close completely Blood regurgitates or leaks backward Mitral valve prolapse Abnormally enlarged and floppy valve leaflets Surgical replacement Mechanical or animal (porcine) tissue Copyright © 2019 by Elsevier Inc. All rights reserved. 81
82.
Effects of Heart
Valve Defects Copyright © 2019 by Elsevier Inc. All rights reserved. 82
83.
Mitral Valve Replacement Copyright
© 2019 by Elsevier Inc. All rights reserved. 83
84.
Tetralogy of Fallot
Most common cyanotic (R → L shunt) congenital heart condition Cyanosis occurs because shunt bypasses the pulmonary circulation. Alters pressures in heart and alters blood flow Includes four abnormalities Involves heart as well as joints VSD Dextroposition of the aorta Right ventricular hypertrophy Copyright © 2019 by Elsevier Inc. All rights reserved. 84
85.
Congenital Heart Defects Copyright
© 2019 by Elsevier Inc. All rights reserved. 85
86.
Congenital Heart Defects
(Cont.) Copyright © 2019 by Elsevier Inc. All rights reserved. 86
87.
Inflammation and Infection
of the Heart Copyright © 2019 by Elsevier Inc. All rights reserved. 87
88.
Rheumatic Fever and
Rheumatic Heart Disease Rheumatic fever Acute systemic inflammatory condition • May result from an abnormal immune reaction • Can occur a few weeks after an untreated infection (usually group A -hemolytic Streptococcus) Involves heart as well as joints Usually occurs in children ages 5 to 15 years Long-term effects • Rheumatic heart disease • May be complicated by infective endocarditis and heart failure in older adults Copyright © 2019 by Elsevier Inc. All rights reserved. 88
89.
Rheumatic Fever and
Rheumatic Heart Disease (Cont.) Acute stage—inflammation of the heart Pericarditis Myocarditis Endocarditis and incompetent heart valves Other sites of inflammation Large joints Erythema marginatum Nontender subcutaneous nodules Involuntary jerky movement of the face, arms, legs Copyright © 2019 by Elsevier Inc. All rights reserved. 89
90.
Signs and Symptoms
Low-grade fever Leukocytosis Malaise Anorexia, and fatigue Tachycardia Heart murmurs Epistaxis and abdominal pain may be present. Copyright © 2019 by Elsevier Inc. All rights reserved. 90
91.
Acute Rheumatic Mitral
Valvulitis Copyright © 2019 by Elsevier Inc. All rights reserved. 91
92.
Mitral Valve Stenosis Copyright
© 2019 by Elsevier Inc. All rights reserved. 92
93.
Signs and Symptoms
Low-grade fever Leukocytosis Malaise Anorexia Fatigue Tachycardia Copyright © 2019 by Elsevier Inc. All rights reserved. 93
94.
Diagnostic Tests Elevated
serum antibody levels Heart function test Electrocardiography ASO titer Copyright © 2019 by Elsevier Inc. All rights reserved. 94
95.
Treatment Prophylactic antibacterial
agents Antiinflammatory agents Copyright © 2019 by Elsevier Inc. All rights reserved. 95
96.
Development of Rheumatic
Fever and Rheumatic Heart Disease Copyright © 2019 by Elsevier Inc. All rights reserved. 96
97.
Infective Endocarditis Subacute
Streptococcus viridans Acute Staphylococcus aureus Basic effects Same regardless of organism Factors that predispose to infection Presence of abnormal valves in heart Bacteremia Reduced host defenses Copyright © 2019 by Elsevier Inc. All rights reserved. 97
98.
Infective Endocarditis (Cont.)
Low-grade fever or fatigue Anorexia, splenomegaly, congestive heart failure in severe cases Acute endocarditis Sudden, marked onset—spiking fever, chills, drowsiness Subacute endocarditis Insidious onset—increasing fatigue, anorexia, cough, and dyspnea Blood culture to identify causative agent Antimicrobial drugs for several weeks, often IV Copyright © 2019 by Elsevier Inc. All rights reserved. 98
99.
Pericarditis Usually secondary
to another condition Classified by cause or type of exudate Acute pericarditis May involve simple inflammation of the pericardium May be secondary to: • Open heart surgery, myocardial infarction, rheumatic fever, systemic lupus erythematosus, cancer, renal failure, trauma, viral infection Effusion may develop • Large volume of fluid accumulates in pericardial sac • Leads to distended neck veins, faint heart sounds, pulsus paradoxus Copyright © 2019 by Elsevier Inc. All rights reserved. 99
100.
Effects of Pericardial
Effusion Copyright © 2019 by Elsevier Inc. All rights reserved. 100
101.
Pericarditis (Cont.) Chronic
pericarditis Results in formation of adhesions between the pericardial membranes Fibrous tissue often results from tuberculosis or radiation to the mediastinum. Limiting movement of the heart during diastole and systole → reduced cardiac output Inflammation or infection may develop from adjacent structures. Causes fatigue, weakness, abdominal discomfort • Caused by systemic venous congestion Copyright © 2019 by Elsevier Inc. All rights reserved. 101
102.
Vascular Disorders Copyright ©
2019 by Elsevier Inc. All rights reserved. 102
103.
Arterial Diseases—Hypertension High
blood pressure Common May occur in any age group More common in individuals of African ancestry Sometimes classified as systolic or diastolic Copyright © 2019 by Elsevier Inc. All rights reserved. 103
104.
Arterial Diseases—Hypertension (Cont.)
Primary Essential hypertension Blood pressure consistently above 140/90 mm Hg • May be adjusted for age Increase in arteriolar vasoconstriction Over long period of time—damage to arterial walls • Blood supply to involved area is reduced. • Ischemia and necrosis of tissues, with loss of function Copyright © 2019 by Elsevier Inc. All rights reserved. 104
105.
Arterial Diseases—Hypertension (Cont.)
Secondary hypertension Results from renal or endocrine disease, pheochromocytoma (benign tumor of the adrenal medulla) Underlying problem must be treated to reduce blood pressure. Malignant or resistant hypertension Uncontrollable, severe, and rapidly progressive form with many complications Diastolic pressure is extremely high. Copyright © 2019 by Elsevier Inc. All rights reserved. 105
106.
Development of Hypertension Copyright
© 2019 by Elsevier Inc. All rights reserved. 106
107.
Arterial Diseases—Hypertension (Cont.)
Areas most frequently damaged by hypertension Kidneys Heart Brain Retina Predisposing factors Incidence increases with age. Men affected more frequently and more severely Incidence in women increases after middle age. Genetic factors Sodium intake, excessive alcohol intake, obesity, smoking, prolonged or recurrent stress Copyright © 2019 by Elsevier Inc. All rights reserved. 107
108.
Effects of Uncontrolled
Hypertension Copyright © 2019 by Elsevier Inc. All rights reserved. 108
109.
Hypertension Frequently asymptomatic
in early stages Initial signs vague and nonspecific • Fatigue, malaise, sometimes morning occipital headache Essential hypertension treated in steps Lifestyle changes Reduction of sodium intake Weight reduction Reduction of stress Drugs • Diuretics, ACE inhibitors, drug combinations Copyright © 2019 by Elsevier Inc. All rights reserved. 109
110.
Peripheral Vascular Disease: Atherosclerosis
Disease in arteries outside the heart Increased incidence with diabetes Most common sites Abdominal aorta Carotid arteries Femoral and iliac arteries Diagnostic tests Blood flow assessed by Doppler studies and arteriography Plethysmography measures the size of limbs and blood volume in organs or tissues. Copyright © 2019 by Elsevier Inc. All rights reserved. 110
111.
Signs and Symptoms
Increasing fatigue and weakness in the legs Intermittent claudication (leg pain) Associated with exercise caused by muscle ischemia Sensory impairment Tingling, burning, numbness Peripheral pulses distal to occlusion become weak. Appearance of the skin • Marked pallor or cyanosis • Skin dry and hairless • Toenails thick and hard Copyright © 2019 by Elsevier Inc. All rights reserved. 111
112.
Treatment Maintain control
of blood glucose level Reduce body mass index Reduce serum cholesterol level Platelet inhibitors or anticoagulant medication Cessation of smoking Increase activity and exercise Maintain dependent position for legs Peripheral vasodilators Observe skin for breakdown and treat promptly. If gangrene develops, amputation is required Copyright © 2019 by Elsevier Inc. All rights reserved. 112
113.
Aortic Aneurysm Localized
dilation and weakening of arterial wall Develops from a defect in the medial layer Different shapes Saccular • Bulging wall on the side Fusiform • Circumferential dilation along a section of artery Dissecting aneurysm • Develops when there is a tear in the intima of the wall and blood continues to dissect or separate tissues Copyright © 2019 by Elsevier Inc. All rights reserved. 113
114.
Types of Aortic
Aneurysms Copyright © 2019 by Elsevier Inc. All rights reserved. 114
115.
Etiology Atherosclerosis Trauma
Syphilis and other infections Congenital defects Copyright © 2019 by Elsevier Inc. All rights reserved. 115
116.
Signs and Symptoms
Bruit (a blowing sound) may be heard on auscultation. Pulse may be felt on palpation of abdomen. Frequently asymptomatic until they become large or rupture. Rupture may lead to moderate bleeding but usually causes severe hemorrhage and death. Copyright © 2019 by Elsevier Inc. All rights reserved. 116
117.
Diagnostic Tests Radiography
Ultrasound CT scanning MRI Copyright © 2019 by Elsevier Inc. All rights reserved. 117
118.
Abdominal Aortogram Copyright ©
2019 by Elsevier Inc. All rights reserved. 118
119.
Treatment Maintain blood
pressure at normal level Prevent sudden elevations caused by exertion Prevent stress, coughing, constipation Surgical repair Copyright © 2019 by Elsevier Inc. All rights reserved. 119
120.
Venous Disorders Copyright ©
2019 by Elsevier Inc. All rights reserved. 120
121.
Varicose Veins Irregular,
dilated, tortuous areas of superficial veins Familial tendency Increased body mass index, parity, and weight lifting are risks In the legs May develop from defect or weakness in vein walls or valves Appear as irregular, purplish, bulging structures Treatment Keep legs elevated, support stockings Restricted clothing, crossing legs to be avoided Can be surgically removed Copyright © 2019 by Elsevier Inc. All rights reserved. 121
122.
Varicose Veins (Cont.) Copyright
© 2019 by Elsevier Inc. All rights reserved. 122
123.
Thrombophlebitis and Phlebothrombosis Thrombophlebitis
Thrombus development in inflamed vein (e.g., IV site) Phlebothrombosis Thrombus forms spontaneously without prior inflammation; attached loosely. Factors for thrombus development Stasis of blood or sluggish blood flow Endothelial injury Increased blood coagulability Copyright © 2019 by Elsevier Inc. All rights reserved. 123
124.
Thrombophlebitis and Phlebothrombosis (Cont.)
Signs and symptoms Often unnoticed Aching, burning, tenderness in affected legs Systemic signs—fever, malaise, leukocytosis Complication—pulmonary embolism Treatment Preventive measures • Exercise, elevating legs Anticoagulant therapy Surgical intervention Copyright © 2019 by Elsevier Inc. All rights reserved. 124
125.
Shock Hypovolemic shock
Loss of circulating blood volume Cardiogenic shock Inability of heart to maintain cardiac output to circulation Distributive, vasogenic, neurogenic, septic, anaphylactic shock Changes in peripheral resistance leading to pooling of blood in the periphery Copyright © 2019 by Elsevier Inc. All rights reserved. 125
126.
Types of Shock Copyright
© 2019 by Elsevier Inc. All rights reserved. 126
127.
Shock: Early Manifestations
Anxiety Tachycardia Pallor Light-headedness Syncope Sweating Oliguria Copyright © 2019 by Elsevier Inc. All rights reserved. 127
128.
Shock Compensation mechanisms
SNS and adrenal medulla stimulated—increase heart rate, force of contraction, systemic vasoconstriction. Renin secretion increases Increased ADH secretion Secretion of glucocorticoids Acidosis stimulates increased respiration. • With prolonged shock, cell metabolism is diminished, waste not removed—leads to lower pH Copyright © 2019 by Elsevier Inc. All rights reserved. 128
129.
Shock (Cont.) Complications
of shock Acute renal failure Shock lung, or adult respiratory distress syndrome Hepatic failure Paralytic ileus, stress or hemorrhagic ulcers Infection or septicemia Disseminated intravascular coagulation Depression of cardiac function Copyright © 2019 by Elsevier Inc. All rights reserved. 129
130.
Manifestations of Shock Copyright
© 2019 by Elsevier Inc. All rights reserved. 130
131.
General Effects of
Circulatory Shock Copyright © 2019 by Elsevier Inc. All rights reserved. 131
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