copyright © 2015 cengage learning ®. chapter 8 cardiovascular system diseases and disorders

Chapter 8

Cardiovascular System Diseases and Disorders

Anatomy and Physiology

• Cardiovascular system– Heart, arteries, and veins with blood

• Heart– Size of man’s fist– Located slightly left of the middle of the chest– Composed of cardiac muscle, 4 chambers, 4

valves

The Heart

Anatomy and Physiology

• Heart:

– Wall of heart has three layers

• Epicardium

• Myocardium

• Endocardium

Common Signs and Symptoms

– Chest pain

– Shortness of breath

– Tachycardia

– Cardiac palpitations

Diagnostic Tests

• Noninvasive procedures:

– Auscultation– Doppler– Arterial blood pressure– Electrocardiogram– Echocardiography– PET scan

Diagnostic Tests

• Cardiac catheterization– Invasive procedure to determine oxygen

content and blood pressure

• X-rays– To determine normal function of heart and

vessels

Diagnostic Tests

• Common X-rays:– Angiocardiography– Angiography– Venogram

• Blood tests– Enzymes

• Creatine phosphokinase (CPK)• Lactate dehydrogenase (LDH)

Diseases of the Cardiovascular System

• Cardiovascular disease

– CVD

– Leading cause of death in the United States

– High blood pressure is common cause

Diseases of Arteries

• Hypertension

– Indicator of development of cerebrovascular, cardiovascular, and kidney disease

– Chronic disease

– Leading cause of stroke and heart failure

Diseases of Arteries• Hypertension

– Normal blood pressure• 120/80

– Top number (systolic)• Measures highest pressure in artery when ventricles

contract

– Bottom number (diastolic)• Measures pressure in artery when ventricles relax

– High blood pressure• Greater than 140/90

Diseases of Arteries• Hypertension

– Primary• Idiopathic with gradual onset• Also known as essential hypertension

– Risk factors:• Heredity• Diet• Age• Obesity• Smoking• Stress

• Hypertension

– Treatment:• Antihypertensive medications• Lifestyle changes• Low-salt diet• Stress-reducing exercise• Smoking cessation• Diuretics

• Arteriosclerosis and atherosclerosis

– Loss of elasticity and thickening of artery wall

– Also known as hardening of arteries

– Plaque• Deposits of fatty or lipid material in wall of artery

• Atherosclerosis

– Major areas affected:

• Coronary arteries

• Cerebral arteries

• Aorta

• Peripheral arteries

• Atherosclerosis– Risk factors:

•Noncontrollable factors

– Heredity– Age– Sex– Diabetes

• Atherosclerosis– Risk factors:

•Controllable factors– Diet– Sedentary lifestyle– Cigarette smoking– Stress– Hypertension

• Atherosclerosis

– Diagnosis by blood pressure, arteriograms, X-rays, and Doppler

– Symptomatic treatment:• Bypass surgery of occluded arteries and plaque

removal

• Peripheral vascular disease (PVD)

– Caused by atherosclerotic plaque in arteries supplying blood to legs

– Intermittent claudication• Muscle cramps relieved with rest and increased with

activity

• Peripheral vascular disease (PVD)

– Treatment:• Endarterectomy

– If necrosis occurs, amputation or resection may be necessary

Diseases of Arteries• Aneurysm

– Weakening in wall of artery leading to bulge or rupture

– Usually asymptomatic and discovered accidentally

– Aorta• Most common location

– Treatment:• Repairing aneurysm before rupture through resection

and grafting

Types of Aneurysms

• Coronary artery disease

– Narrowing of arteries that supply blood to myocardium

– Single leading cause of death in United States

– Commonly due to atherosclerosis

– Progressive narrowing of vessels may lead to ischemia of heart muscle and symptoms

– Scar tissue replaces muscle

– Occlusion may progress slowly or suddenly as result of thrombus or embolus

– Myocardial infarction• Death of heart muscle

– Diagnosis by history, electrocardiogram (ECG), and angiograms

– Treatment:• Aimed at increasing blood flow or decreasing oxygen

Diseases of Arteries• Coronary artery disease

– Treatment:• Angina treated with vasodilators

• Angioplasty

• Coronary artery bypass graft (CABG)

• Reduction of atherosclerotic risk factors– Diet– Exercise– Smoking

Diseases of the Heart• Angina pectoris

– Chest pain

– Lack of oxygen to heart

– Sign of impending myocardial infarction

– Treatment:• Decrease workload of heart• Use nitroglycerin

Diseases of the Heart

• Myocardial infarction

– Heart attack

– Occurs when heart does not get enough oxygen

– Symptoms:• Severe chest pain with diaphoresis and nausea• Referred pain to neck, arm, and jaw with discomfort

similar to bad or unrelieved indigestion

• Myocardial infarction– Treatment:

• Give immediate attention to prevent shock

• Relieve respiratory distress

• Decrease workload

• If cardiac arrest, cardiopulmonary resuscitation (CPR) must be performed

• Myocardial infarction– Treatment:

• Oxygen and pain medication

• Medications to treat arrhythmias

• Clot-busting medications

• Education on prevention by lifestyle changes– Smoking cessation– Diet– Exercise

Diseases of the Heart• Hypertensive heart disease

– Result of long-term hypertension

– Causes:• Disease or disorder causing chronic elevation in

blood pressure

– Treatment:• Treat cause of hypertension• Can only be controlled

– No cure

• Rheumatic heart disease– Autoimmune disorder caused by streptococcal

throat infection

– All layers of heart and valves can be affected

– Treatment:• Prevention/treatment of streptococcal infections• Rest during acute stage• Valve replacement to correct deformity

• Congestive heart failure (CHF)

– Heart fails to pump adequate blood supply

– Develops slowly and increases workload of heart

– Symptoms:• Gradual increase in dyspnea• Tachycardia• Tachypnea

• CHF

– Symptoms:

• Neck vein distention

• Edema in ankles and lower legs

• Right-sided leads to congestion of liver and spleen

• Left-sided leads to congestion of lungs

• CHF

– Diagnosis by history and physical, chest X-ray, and ECG

– Treatment:• Decrease workload• Diuretics• Salt and fluid restrictions• Medications to strengthen and slow heart

– E.g., digitalis

• Cardiomyopathy

– Disease of heart muscle

– Characterized by dilated, enlarged, thin, flabby heart muscle

– No cure

– Leads to CHF, myocardial infarction, and death

Diseases of the Heart• Carditis

– Inflammation of heart• E.g., pericarditis, myocarditis, endocarditis

– Often secondary to respiratory, urinary tract, or skin infection

– Treatment:• Rest• Antibiotics• Analgesics• Antipyretics

• Valvular heart disease

– Malfunction of heart valves

– Murmurs or abnormal heart sound

– Causes:• Congenital abnormalities or malformations• Rheumatic fever• Endocarditis

Diseases of the Heart• Arrhythmias

– Abnormal heart rhythm– Sinus rhythm is normal heart rhythm

• 60 to 100 beats per minute

– Flutter• Unusually fast heart rate

– Fibrillation• Wild and uncoordinated

– Heart block• Interruption in conduction system

• Arrhythmias

– Divided into first-, second-, or third-degree

– Premature or early contractions (PVCs) may affect atria or ventricles

– Treatment:• Unnecessary if asymptomatic

Diseases of the Veins

• Phlebitis

– Inflammation of superficial veins

– Symptoms:• Pain• Swelling• Red, cord-like hardening along vein toward heart

• Phlebitis– Treatment:

• Analgesics

• Warm compresses

• Elevation of area above heart level

• Elastic stockings

• Exercise

• Thrombophlebitis– Clotting in vessels of legs, thighs, and pelvis

– Asymptomatic until embolization occurs

– Risk factors:• Immobility• Dehydration• Varicose veins• Leg/pelvic surgery, obesity, pregnancy

Phlebitis and Thrombus

• Deep vein thrombosis (DVT)

– Treatment:

• Reduce clot

• Prevent embolization

• Use anticoagulants

• Varicose veins

– Dilated, tortuous, and elongated veins in legs

– Causes:• Prolonged sitting or standing• Pregnancy• Obesity

• Varicose veins– Symptoms:

• Leg fatigue and cramps• Thickening veins• Edema• Fluid

– Treatment:• Elevate legs• Walk• Use support or elastic hose• Strip vein

Trauma

• Hemorrhage– Abnormal loss of blood

– May be acute or chronic

– Exsanguination• Loss of circulating blood

– Internal bleeding can lead to anemia or shock due to blood loss

Trauma

• Hemorrhage

– Low-pressure vessels lead to petechiae or ecchymosis of purpura

– High-pressure vessels lead to squirting of bright red blood

Trauma

• Shock– Extremely low blood pressure that leads to

decreased tissue perfusion

– Types:• Cardiogenic• Septic• Hypovolemic• Neurogenic• Anaphylactic

Trauma

• Shock– Symptoms:

• Facial pallor• Cool and clammy skin• Cyanosis• Tachycardia• Tachypnea• Altered mental status• Syncope• Unconsciousness• Oliguria or anuria

Trauma

• Shock

– Treatment:

•Rest in supine position•Move to warm, quiet environment•Elevate feet and legs above heart

Rare Diseases

• Malignant hypertension• Cor pulmonale• Raynaud’s disease• Buerger’s disease• Polyarteritis nodosa

Effects of Aging

• Decreased contractility of heart muscle

• Decreased elasticity of vessels

• Thickening of valves– Becoming sclerotic

copyright © 2015 cengage learning ®. chapter 8 cardiovascular system diseases and disorders

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