because it is on the left side of the heart

between the left ventricle and the aorta

and left sided heart problems are more common.

symptoms of artic stenosis...progressive shortness of breath, sleepiness, once progresses will see syncope, chest pain, and heart failure

valve leaflets or cusps do not shut or close completely

valves of the heart we may see

aortic

Mitral

Tricuspid

1 or both valves prolapse into the left atrium during systole

most common valve disorder in the US

many cases are asymptomatic

may pose increase risk of infective endocarditis, stroke (cardiac source), and sudden death

discuss rheumatic fever to rheumatic heart disease

systemic inflammation disease

delayed reaction to group A beta hemolytic streptococcus

inflammation of joints, skin, nervous system and heart

rheumatic fever can cause scarring and deformity of cardiac structures.

most typical causes for infective endocarditis?

and things typically associated with?

causes- bacteria-most common

viruses, fungi, ricketssiae, and parasites

typically associated with

prosthetic valves

indwelling catheters

heart surgery

anticoagulant effectiveness

international normalized ratio

also goes with prothrombin time

The pericardium is the fluid filled sac that surrounds the heart and the proximal ends of the aorta, vena cava, and the pulmonary artery.

• Epicardium - outer protective layer of the heart.
• Myocardium - muscular middle layer wall of the heart.
• Endocardium - inner layer of the heart that is continuous with the inner lining of blood vessels.

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed

usually caused by virus (hepatitis, influenza, HIV) or trauma

1.  what is the myocardium?

2.  what is the general definition of cardiomyopathies?

1.  the "muscle" of the heart

2.  diseases that affect the heart muscle , and there are many causes and many different types

Dilated –the heart becomes weakenend and enlarged and cannot pump efficiently. Causes can include alcohol or cocaine abuse, autoimmune diseases(Lupus or rheumatoid arthritis), pheochromocytoma, end-stage kidney disease, coronary artery disease, atrial fib, SVT, etc.

Restrictive-a group of disorders where the heart chambers are unable to properly fill with blood because of stiffness in the heart. Symptoms of heart failure are most common, in restrictive the heart is normal size, but during normal relaxation (diastole) it doesn’t do this. As the disease progresses it stops pumping efficiently and ultimately affects the lungs, liver and other body systems. It frequently occurs after a heart attack,  causes are from unknown scarring of the heart tissue, iron overload, radiation fibrosis, sarcoidosis, scleroderma, tumors of the heart,

inadequate tissue perfusion or increased diastolic filling pressure of the left ventricle

this increases the pulmonary capillary pressures

ischemic heart disease

hypertension

inability of the left ventricle to generate adequate cardiac output to perfuse tissues

this is a form of left sided heart failure/CHF

pulmonary congestion despite normal stroke volume and cardiac output

this is a form of left sided heart failure/chf

inability of the right ventricle to provide adequate blood flow into pulmonary circulation

this increases left ventricular filling pressure that reflects back to pulmonary circulation

aka cor pulmonale

causes of right sided heart failure

(cor pulmonale)

diffuse hypoxic pulmonary disease

such as COPD, cystic fibrosis, ARDS

formula for cardiac output?

CO= ___ X _____

cardiac output= Stroke volume X Heart rate

stroke volume is the amt. of blood pumped by the left and right ventricle in one contraction

stroke volume/EDV

stroke volume=

stroke volume is the amt. of blood pumped by the left and right ventricle in one contraction

end-diastolic volume (EDV) is the volume of blood in the right and/or left ventricle at end Load or filling in (diastole)

Preload can be defined as the initial stretching of the cardiac muscle.

preload is the volume and pressure in the ventricle at the end of diastole VEDV(ventricular end diastolic volume)

refers to the volume of blood in the ventricle after atrial contraction

accoding to Frank-Starling law states that as the heart has more stretch it will have what?

but also excessive stretch causes what ?

1.  increased force of the contraction

2.  decreased force of contraction

Frank-Starling Law- the bigger the stretch (to a point), the stronger the contraction.
*stretch of the myocardium is increased by increased filling.
*increase or decrease in the volume of blood = an increase or decrease in the force of contraction (like a rubber band flying)
*this can max out...your actin and myosin can disengage and your force of contraction will drop to zero (like a rubber band breaking)

the volume of blood and the constriction of the blood vessels within the system

increased aortic pressure

increased peripheral vascular resistance

change in tension at a given resting fiber length

and the ability of the heart muscle to shorten is the

which chemicals are positive inotropes?

Negative?

positive-epi, norepi, thyroid hormone, dopamine

negative-Acetylcholine

main area is in the brain stem-medulla

secondary areas in the hypothalamus, cerebral cortex, and thalamus and connecting neurons

Atrial volume receptors are low pressure baroreceptors that are found in the atria of the heart.

When these receptors detect a pressure drop in the atria, which indicates a decrease in blood volume, a signal is transmitted from the receptors to the hypothalamus in the brain. The hypothalamus, in turn, increases the production of vasopressin(ADH, AVP, or arginine vasopressin). Furthermore, a low volume also stimulates sympathetic nerves, which stimulate renin release from the juxtaglomerular cellsof the afferent arteriole in the kidneys. Renin leads to the activation of angiotensin II, a potent agent in increasing blood pressure

increases HR

enhances myocardial contractility

constricts Blood vessels

dilates vessels of liver and skeletal muscles

increased myocardial contractility

enhances sympathetic activity

increases CO

systolic 15-30

diastolic 3-12

mean 14

range 0-8

mean=4

systolic 15-28

mean=24

end diastolic 0-8 mean 4

systolic 96-140

diastolic 60-90

mean 120

range 4-12 mmHG

mean 8

systolic 90-140 mmhg

mean 130

end-diastolic 4-12

mean 7

in the heart are pressures higher in the right or the left side?

right-lower pressures

left-higher

pressure and resistance

pressure-force exerted on a liquid, per unit area

resistance-opposition to force, diameter and lenght of the blood vessels contribute to resistance

velocity

laminar vs. turbulent flow(1)

vascular compliance

(1)Generally in the body, blood flow is laminar. However, under conditions of high flow, particularly in the ascending aorta, laminar flow can be disrupted and become turbulent. When this occurs, blood does not flow linearly and smoothly in adjacent layers, but instead the flow can be described as being chaotic

John Ritter

3's company

Who died from an AAA

abdominal aortic aneurysm?

ex true: fusiform and circumferential

false: saccular

according o laplace if have smaller chambers and thicker chamber walls what will happen?

cardiovascular system us unable to perfues the tissues, widespread impairment of cellular and tissue metabolism

can progress to organ failure and death!

multifactoral

defective heart function

blood volume changes

changes in blood vessels and BP

decreased BP, CO, urine output

increased RR

variable s/s

weak, feeling "sick"

cold and hot

nauseated, thirsty

dizzy, confusion, short of breath

anaerobic

in shock the body is unable to maintain electochemical gradient, what happens?

also multisystem problems..describe...

Na and Cl build up in cells,

water then follows which reduces extracellular volume

K leaves the cell,

activates feedback loop that further impairs oxygen use

activates coagulation pathway, decreases circulatory blood volume, releases lysosomal enzymesn

becomes impaired

1.impaired delivery to tissues or uptake by tissues

2.cells shift to glycogenolysis, gluconeogenesis, lipolysis

3.gluconeogenesis- proteins used for fuel no longer available to maintain cellular structure, function, repair and replication

4.Toxic ammoina and urea production

5. body begins metabolic acidosis-enables cardiac and skeletal muscles to use lactic acid as a fuel source, but only for a limited time

caused by inadequate perfusion to the heart and end organs

Myocardial ischemia, infarct, CHF, myocardial or pericardial infections, dyshrythmias, drug toxicity

decrease CO and have a compensatory/adaptive response

activation of the renin-angiotensis, neurohormonal and sympathetic nervous systems

this causes fluid retention, systemic vasoconstriction and tachcardia

catacholamines increase contractility and HR

resulting  in increased stress and metabolic demands on the failing heart

insufficient intravascular fluid volume(loss of whole blood, blood plasma, interstitial fluid, or fluid sequestriation)

eg. hemorrhage or  burn

the body has begins compensatory vasoconstriction, increased SVR(systemic vascular resistance), and afterload to improve BP and perfusion to core organs

if these fail, the body will have impaired nutrient delivery and failing cellular metabolism

discuss neurogenic shock

causes in the body?

what does it do systemically?

clinical manifestations?

from widespread vasodilation-imbalance between parasympathetic and sympatheti stimulation

causes persistent vasodilation, creating relative hypovolemia

blood volume is unchanged, but the amount of space containing the blood has increased, so SVR decreases drastically

inadequate pressure to drive nutrients across capillary membranes, alters nutrient delivery to cells

causes:  severe pain and stress, anesthesia agents, antidepressants

clinical manifestations: decreased SVR(systemic vascular resistence), bradycardia

anaphylactic shock

causes?

effects?

allergen causes extensive immune and inflammatory response

ex. snake bite, insects, PCN

widespread hypersensitivity reaction(vasodilation, increased vascular permeability, peripheral pooling, tissue edema, relative hypovolemia)

extravascular effects:  constriction extravascular smooth muscle

constriction often causes respiratory difficulty

occurs suddenly, can progress to death quickly

from an infectious process

eg: lungs, bloodstream, intravascular catheter, intraabdominal, urinary tract, surgical wound

Bacteremia, endotoxins, and exotoxins caues host to initiate inflammatory process

complement, coagulation, kinin, and cellular immunity

inflammation response initiates and promotes widespread vasodilation

symptoms similar to neurogenic/anaphylactic shock

what is multiple organ dysfunction syndrome (MODS)

progressive dysfunction or two or more organ systems due to uncontrolled inflammatory response to severe illness or injury

ex shock and sepsis

can be from any injury or disease that initiates massive systemic inflammation

eg trauma, major surgery, burns, acute pancreatitis, acute renal failure, ARDS

maldistribution of blood flow

hypermetabolism

myocardial depression

supply-dependent oxygen consumption

reperfusion injury

• cellular damage caused by restoration and reperfusion of oxygen cells that were exposed to reversible hypoxic condition
• occurs from generation of oxygen free radicals

• control initial inflammatory process
• restore intravascular volume
• administer oxygen
• provide nutrition to support failing organs

Arterial blood gases

serum lactate concentration

Blood pressure (will be low in shock)

ventilation and oxygenation

blood chemistry (electrolytes, glucose, BUN, liver functions, calcium, phosphorus, cardiac enzymes)

HGB, HCT

normal HGB

and what is HGB

HGB is the oxygen carrying part of RBC

normal 13-18

remember 15!

what is the HCT

and the avg?

1.010 to 1.020

normal urine output

30 cc/hr

30 cc= 1 oz

provide adequate oxygen delivery

monitor body temp

transfusion of blood components

intravenous fluids ( volume resuscitation)

monitor urine output and specific gravity

monitor BP

normal ejection fraction

is?

inflammatory damage caused by rheumatic heart disease

congenital malformation

degeneration, thickening, and calcification

tetralogy of fallot

4 congenital defects

1.  pulmonary stenosis

2.  R ventricular hypertrophy

3.  overriding aorta

4.  ventral septal defects