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the leading cause of death in the United States and is a major cause of disability Heart disease
The most common heart disease in the United States is coronary heart disease, which often appears as a heart attack.
About every 25 seconds, an American will have a coronary event, and about one every minute will die from one.
How many times can the healthcare provider (like Carilion Clinic) bill a dead ventricle? (AMI that dies in the ED.) Just once.
Blood is pumped under pressure to capillaries
Capillaries are the site of vascular exchange of nutrients, waste, gases..etc.
Capillaries are composed of just endothelial cells. (Capillary endothelium)
Where is blood?” In the vascular space as defined by the vascular endothelium
The capillary is the site of internal respiration.
Oxygen (O2) moves from Hemoglobin (Hb) to cells (mitochondria) by simple diffusion to be used to make ATP during cellular respiration (CR).
Carbon Dioxide (CO2) moves from cells to the blood to be transported back to the lungs. This is also part of internal respiration.
The lungs are the site of external respiration
Hb transporting O2 is normally about 99-98% saturated with O2.
Low O2 sats result in supplemental oxygen therapy to decrease cardiac workload trying to increase O2 sats
when CO2 concentrations go up the patient is in a respiratory acidosis.
Poor gas exchange means low O2 and increased CO2. Increased CO2 means more acid. This acid is from failed gas exchange
When perfusion fails (heart) then gas exchanges fail, then all capillaries go acid, (acidosis) cellular respirations stop (decrease), the system goes anaerobic
Acute myocardial infarction (AMI) occurs when a blood clot blocks a coronary artery
Tunica intima (Also called T. interna) inside of a blood vessel
Tunica media middle part of the blood vessel,The visceral muscle layer. (Smooth muscle)
Tunica externa outside layer of the blood vessel,The external boundary of connective tissue that defines the vessel.
Tunica media Controls vascular lumen diameter. Vasoconstricts to increase BP / Vasodilates to decrease BP. Controlled by SANS and PANS
Tunica intima The inside lining. Also called endothelium, squamous epithelium
Like floor tiles that form the inside lining of the blood vessel. Defines the vascular space Tunica intima
Arteriosclerosis Chronic abnormal formation of thick, hard plaques (less elastic) under the tunica intima of arteries.
Atherosclerosis A type of arteriosclerosis that involves the formation of an atheroma
the number one killers of Americans. CAD and AMI
The vascular space is defined by the tunica intima.
Whenever blood escapes the vascular space it will clot.
Anything that reduces blood flow decreases perfusion
Coronary artery disease (CAD) results from the formation of this plaque (atheroma)
The atheroma is located under the intima.
If it the endothelium covering the atheroma breaks (tears) then a clot forms.
Atheroma is A fatty deposit in (under) the intima (inner lining) of an artery, resulting from atherosclerosis
A varicose vein is a vein in which blood as pooled, become distended, and tortuous.
Varicose veins are a result when intravein valve fails
Aneurysm A localized dilation or out pouching of a vessel wall caused by a diseased or weakened vessel wall
Most aneurysms are located in the aorta
An aortic dissection occurs when (if) the aortic aneurysm splits the aortic wall and forms a extravascular pouch of blood between the tunica media and tunica externa.
Berry Aneurysm Most commonly found at arterial bifurcations, Most common type of cerebral aneurism, usually at the Circle of Willis.
Fusiform Aneurysm are lens shaped some are circular, some are saccular (one sided)
stents look like a mesh fence designed to keep a vessel open
Hemorrhagic stroke For some unk reason a blood vessel (an aneurism??) in the brain or sp. chord breaks and the patient bleeds into the tissue space
Thromboembolic stroke A blood clot that has formed in an artery or in the Left side heart breaks lose (becomes and embolism) and moves to the next capillary bed….Usually the brain. There is no bleed. These patients can be treated with lytic therapy if they arrive at ED early
lytic drugs digest a blood clot
lytic drugs need to be used within 180 minutes (3hrs)
Hypertension is defined as the consistent elevation of systemic arterial BP.
Primary Hypertension; Essential or idiopathic hypertension When hypertension occurs without evidence of other underlying disease.
Secondary hypertension is when hypertension occurs as a result of other underlying disease …Like kidney disease.
Sympathetic autonomic nervous system (SANS) uses catecholamines (Norepinephrine and Epinephrine) to increase heart rate & force of contractions
primary hypertension uses sympathetic autonomic nervous system to lower the BP
Natriuretic hormones (from brain, heart and kidney) influence vascular tone (similar to RAA). (Save more Na+ = more water saved = increased BP.)
Thicken arterial walls, decrease vascular space = increase BP
Inflammation plays an important role in the development of hypertension.
Endothelial injury causes the release of vasoactive cytokines that over time cause vascular thickening and vasoconstriction
Obesity causes increase SANS activity and an increase in the RAA system. These two systems are mediated by leptin
the RAAS increases BP by forcing the patient to keep Na+ and water
The renin-angiotensin system(RAS) or the renin-angiotensin-aldosterone system (RAAS) is a hormone system that regulates blood pressure and water (fluid) balance.
Angiotensin I is subsequently converted to angiotensin II by the enzyme angiotensin converting enzyme found in the lungs.
what carries out the conversion of angiotensinogen released by the liver to angiotensin I. Plasma renin 
Angiotensin II is a potent vaso-active peptide which causes blood vessels to constrict, resulting in increased blood pressure
Angiotensin II stimulates the secretion of the hormone aldosterone from the adrenal cortex
Aldosterone causes the tubules of the kidneys to increase the reabsorption of sodium and water into the blood, also cause the BP to go up
where NOR and EPI bond to myocardial cells Beta receptors
ACE-I block the RAAS which lets the BP adjust down and decrease stress (workload) on the myocardium
This type of hypertension is the result of CV disease including heart and vascular disease Complicated hypertension
Hypertension that develops very rapidly. Very damaging to cerebral circulation. Causes massive problems at capillaries Malignant hypertension
Severe hypertension that runs a rapid course and damages the inner linings of the blood vessels and the heart and spleen and kidneys and brain Malignant hypertension
These terms refer to a decrease in systolic and diastolic BP on standing. Orthostatic (postural) Hypotension
caused by a variety of factors that delay or depress the autonomic reflexes Acute orthostatic hypotension
hypotension typically secondary to a specific disease process. Chronic orthostatic
has no known cause. It may be the result of a generalized degeneration of CNS function. Idiopathic hypotension
Right Coronary passes under the R. atrium and progresses DOWN (in an inferior direction)
the Left Coronary artery passes under the left atrium and supplies the left vent
Decreased lumen diameter translates into less perfusion of cardiac tissue.
Rescue PTCA When the patient is taken to the cath lab after a lytic drug fails to open the occluded vessel.
Lytic drugs is a TPA = Tissue plasminogen activator
Lytic durgs are made up of a protein that are made using recombinant DNA. It is given IV. It’s job is to convert plasminogen (a blood plasma zymogen) into an active fibrin digester
the preferred method to open occluded coronary arteries in rural facilities where rescue PTCA and or heart surgery are not immediate options lytic drug
CABG = Coronary artery bypass grafting is a Heart surgery that uses non-diseases arteries to “bypass” the diseased artery
general group of fats that impacts cardiac health are the triglycerides and cholesterol.
triglycerides fatty food) (greasy food) (food with lard or oils) (the fat of bacon, beef, burgers, ice cream, sweet deserts
two generalized groups of triglycerides Saturated fats and unsaturated fats
saturated fats are bad fats
unsaturated fats are not as bad fats
saturated fats consist of From animals Lard (of ham or beef), Solids, Very sticky,Contribute to CV disease.
saturated fats are saturated with hydrogen
unsaturated fats are not saturated with hydrogen
unsaturated fats consist of From plants, Cooking Oils, Liquids, Not very sticky
Monounsaturated fats Liquid at room temp, Solids when chilled
Monounsaturated fats Known to lower LDLs, Known to raise HDLs
Polyunsaturated fats Always liquid, cost more money
EFAs = essential fatty acids = Those we need from diet
trans fats are From artificial sources (margarines, vegetable shortenings, butter fat
trans fat Raise LDL and lower HLD
trans fat raise blood sugar
Total cholesterol level Less than 200 mg/dL is Desirable
total cholesterol level of 200-239 mg/dl is borderline
total cholesterol lever of 240 mg/dl or higher is high
LDL cholesterol is bad cholesterol
LDL less than 100 mg/dl is optimal
LDL collects in the walls of blood vessels, causing the blockages of atherosclerosis.
Low HDL cholesterol is a heightened risk for heart disease
High HDL level is a optimal condition considered protective against heart disease
Dyslipidemia refers to abnormal concentrations of these serum lipoproteins as a result of genetics or poor diet
LDL is bad when it is above 160 mg/dl
HDL is bad when it is below 40 mg/ dl
statin drugs help lower LDL and raise HDL cholesterol
silent ischemia Ischemia that produces no angina (chest) pain. Asymptomatic ischemia. Patient may complain of being very tired, fatigued, dyspneic, often express a feeling of doom. Most often seen in women
mental-stress ischemia Usually silent, mental stresses (emotional upset) increase BP, myocardial oxygen demand, which results in ischemia
Stable angina usually occurs in a predictable fashion during or after physical exercise or emotional stress.
Prinzmetal angina Chest pain from ischemic myocardium that occurs unpredictably and often at rest
Myocardial ischemia is ischemic stress from a lack of perfusion
When an AMI is in progress the ECG can shows ST segment elevation (This is the best ECG variation to show AMI.
Hibernating myocardium is a Myocardium that survives because it adapts to ischemia.
Myocardial remodeling is a A process mediated by RAAS system that causes the contractile function to be lost a sites distant from the infarct. The ventricle builds scare tissue
Enzyme washout is Following myocardial cell death, intracellular enzymes washout of dead cells.
Myocardial stunning is Temporary loss of contractile function that may persist for a few hrs to days after perfusion has been restored.
Zone of ischemia is the Least amount of injury.
Zone of hypoxic injury is the Mid zone, more injury but not total dead cells.
Zone of infarction and necrosis are Dead myoctes. (Dead meat, won’t beat.)
Transmural infarct is the Death of myocardial tissue that extends from the endocardium to the epicardium as a result of a myocardial infarction.
Subendocardial infarct is Not transmural, Less extensive damage
The parietal pericardium is what We usually call this the pericardial sac.)
The pericardial sac space is Filled with pericardial fluid
pericardial fluid prevents friction as the heart contracts)
Endocardium is the The inside lining of the heart
Myocardium is the pumping muscle of the heart
Pericarditis The pericardial membranes become inflamed as the result of an infection, or trauma
Pericardial effusions is the accumulation of excess fluid in the pericardial sac. There is an excess of pericardial fluid. It occurs as a result of the inflammation. The excess fluid pressure causes the cardiac tamponade
Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up in the space between the myocardium
cardiac tamponade is caused by blood or fluid collects in the pericardium. This prevents the ventricles from expanding fully
Acute Pericarditis An inflammation of the pericardial membranes that enclose the heart that develops quickly.
Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue
Bacterial endocarditis causes causes the valves to have a roughened surface and as a result they do not close completely
the rough surface caused by bacterial endocarditis called a vegetation
Cardiomyopathies Diverse group of diseases that impact the myocardium itself. The myocardium may be too thin or too thick.
Dilated cardiomyopathy The ventricular walls are too thin and stretched. Myocardium losses contractility.
Hypertrophic Cardiomyopathy The ventricular walls are abnormally thick. This reduces the volume of the left ventricle itself.
The function of all 4 heart valves is to make the flow of blood through the heart unidirectional (One way
The abnormal heart sound is called a heart murmur
Regurgitant murmurs are (moving wrong way) are heard when the valve is closed.
LAVV murmurs occur during Systole…When the LAVV is closed
LSLV murmurs occur during diastole ….When the LSLV is closed.
valve murmur is loudest. The LSLV (Aortic
valve murmur is most common The LAVV (Mitral
Time between Lub-Dup systole
time between Dup-Lub diastole
Lub is when the AVVs slam shut
dub is when the When SLVs slam shut
Stenosis means a passage is constricted, too narrow. The constriction limits blood flow
mitral valve prolapse Occurs when the flaps bulge into left atrium (LAVV). The bulge can be large enough to not allow the value to close. This causes a prolapse murmur.
Typically, valves are replaced on the left side because of pressure stress over a lifetime.
Rheumatic Heart disease is a Long term inflammatory disease caused by Group A Beta-hemolytic Streptococcus
CHF involves left or right ventricular failure
Cardiogenic Shock Heart failure to generate pressure.
Hypovolemic Shock Loss of blood volume to the extent blood pressure cannot be maintained.
Neurogenic Shock. The CNS (vasomotor centers that control BP) fails to control BP.
Septic Shock. Sepsis becomes massive. Gram – release endotoxins. Gram + release exotoxins.Both cause vasodilation.
Anaphylactic Shock Allegan causes massive degranulation of mast cells. Heparin cause vasodilation.
Created by: Brian Wade Brian Wade