CARDIOVASCULAR AND HEMATOLOGIC SYSTEMS Flashcards
The heart is made of how many layers?
3
What are the three layers of the heart?
Endocardium
Myocardium
Pericardium
Endocardium
Smooth, delicate lining of the atria and ventricles
Myocardium
Muscular wall ( makes up most of the heart)
Myocardium of left ventricle very thick because it forces blood to the rest of the body.
Pericardium
Thin, sturdy outer membrane.
Consists of two layers: Visceral and parietal pericadium.
Visceral Pericadium
Adheres to the myocardium
Parietal pericardium
contains the whole heart like a sac
Pericardial cavity
Space between visceral and parietal paricardia. Fluid -filled.
Heart.. how many chambers?
4
Atrium
Where the blood enters the heart.
(Atrium is an entryway of a building).
Ventricle
Blood goes through the entry and is pumped down into the “belly” of the heart, from where it goes back into circulation.
(Ventricle middle english meaning stomach or belly).
Interatrial septum (septa plural)
Partitions the two atria
Interventricular Septum (septa plural)
Partitions the two ventricles
All arteries carry…
blood away from the heart
All veins carry…
blood toward the heart.
Where does oxygen-depleted blood go?
The heart pumps it to the lungs for oxygenation via the arteries.
What happens to oxygenated blood?
It gets pumped back to the heart via veins and gets returned to the body by arteries.
How are ventricles and atrias connected?
Atrioventricular (AV) valves.
Right AV valve (Tricuspid valve)
Goes from the right atrium to the right ventricle.
The cusp flap allows blood to pass through the heart in one direction and prevents backflow into the chamber.
Left AV valve (bicuspid valve/mitral valve)
Goes from left atrium to left ventricle.
The cusp flap allows blood to pass through the heart in one direction and prevents backflow into the chamber.
Two valves guarding the exits of the ventricles.
Pulmonary Semilunar valve
Aortic Semilunar valve
Pulmonary semilunar valve
Opens from right ventricle into the pulmonary artery.
Aortic semilunar valve
Opens from the left ventricle into the aorta.
Coronary Circulation
Process through which the heart receives its own blood supply (capillary networks)
Coronary Sinus
Consist of coronary arteris and coronary veines.
Opens into the right atrium.
Superior and inferior vena cava
Carry blood from the rest of the body to the right atrium.
Single cardiac cycle consist of …
Simultaneous contraction of both atria followed by simultaneous contraction of both ventricles.
Systole
Contaction of the ventricles (relaxation of the atria)
Diastole
Relaxation of the ventricles (ventricles dialate to receive blood)
Bradycardia
Heart rate slower than 60bpm
Tachycardia
Heart rate faster than 100bpm
Sinoatrial node (SA)
Main control center of the heart. At the junction between superior vena cava and right atrium.
Know as “pacemaker” of the heart.
Does cardiac muscle depend on impulses sent from the nervous system?
NO
Pulmonary arteries
Deliver deoxygenated blood from the heart to the lungs.
Pulmonary veines
Deliver oxygenated blood from the lungs back to the heart.
The muscular wall that makes up the bulk of the heart:
Myocardium
Which ventricle is the thicker and larger one?
Left
Atria and Ventricles of each side are connected by a/an
atrioventricular valve
The heart supplies blood to itself via
coronary arteries
The heart pumps blood to the lungs for oxygenation via the
pulmonary artery
Explain blood’s circulation among the heart and the rest of the body
- Deoxygenated blood mixed with waste gases and chemicals is collected from body via veins and brought to heart.
- Hearts pumps deoxygenated blood to lungs via pulmonary arteries.
- Oxygenated blood goes back to the heart via pulmonary veins.
- Oxygenated blood is supplied throughout the body via arteries, including the heart itself through coronary arteries.
Oxygenation of blood in the lungs via…
lung capillaries
Carbondioxide waste is exhaled and oxygen is inhaled.
Veins carry blood … heart
Toward the heart
Arteries carry blood… heart
Away from the heart
What makes the “lub dub” heartbeat sound you hear under a stethscope ?
Closing of valves after cardiac contractions.
Blood pressure =
Pressure placed on arterial walls during systole and diastole.
Bundle of His
Lies in the septum between the two ventricles
Purkinje fibers
Stimulate both ventricles to constract simultaneously.
Hypertension
Elevated blood pressure over a significant period of time and under varied conditions.
Atherosclerosis
Buildup of plaque in the arteries.
Atherosclerosis of the renal arteries
Plaque buildup in the arteries leading to the kidneys
Atherosclerosis of the renal arteries can lead to …
Hypertension (Kidneys play vital role in bp regulation)
Uncontrolled hypertension can lead to …
Strokes
Heart Attack (myocardial infarctions)
Peripheral vascular disease
Chronic kidney disease
Retinal disease
Idiopathic hypertension
Cause unknown
Risk factors for high blood pressure
- Increased Age
- High salt and saturated fat intake
- Hyperlipedemia
- Being overweight or obese
- Not having an active lifestyle
- Smoking
- Family history of high bp
Lifestyle changes for treatment of high bp:
- Losing weight
- Drinking less alcohol
- Decreasing salt intake
- Exercising
- Quitting smoking
- Eating a healthy diet
Classes of medications to treat hypertension :
- Diuretics
- Beta blockers
- ACE inhibitors
- ARBs
- CCBs
- Vasodilators
Diuretics
Stop kidneys from reabsorbing water and electrolytes. Leads to increased loss of water and electrolytes in the form of urine. Increased water loss lowers the blood volume, which lowers the blood pressure.
Diuretic medication names
- Spironolactone (Aldactone)
- Furosemide (Lasix)
- Bumetanide (Bumex)
- Hydrochlorothiazide (Esidrix)
Side effect of taking diuretics
- Hypotension
- Dehydration
- Electrolyte deficiencies
- Arrythmias
Precautions when taking diuretics
- Avoid taking at bedtime
- May need electrolyte supplements
- Spironolatone, a potassium- sparing diuretic , may not require a potassium supplement
Beta Blockers define functions
Beta receptor antagonists that act on the beta receptors in the heart.
This causes decreased heart rate and cardiac output and lowers the bp.
Beta blocker names end in -lol
Beta blocker names
- Metoprolol (Lopressor)
- Atenolol (Tenormin)
- Metoprolol XL (Toprol XL)
- Carvedilol (Coreg)
- Labetalol (Normodyne)
- Propranolol (Inderal)
Side effects of Beta Blockers
- Hypotension
- Dizziness
- Syncope
- Bradycardia
- Fatigue
- Hepatic toxicity
Precautions taking beta blockers
Don’t abruptly discontinue
Major drug-drug interactions with certain asthma medications
Beta blockers end in the suffix….
-lol
Angiotensin Converting Enzyme (ACE) inhibitors
Restrain the conversion of Angiotensin I to Angiotensin II. They decrease the fluid volume and also cause peripheral vasodilation resulting in lower bp.
Suffix of most ACE inhibitors
-pril
ACE inhibitor medications
- Captopril (Capoten)
- Lisinopril (Prinvil)
- Enalapril (Vasotec)
- Benazepril (Lotensin)
ACE inhibitor side effects
- Hyperkalemia (increased potassium in blood)
- Hypotension
- Dry, persistent cough
- Angioedema (swelling of tongue, lips and mouth; immediate treatment required!)
- Increased serrum creatinine (kidney failure indicator)
Precautions ACE inhibitors
- Monitor kidney function
- If cough not tolerable switching to different class of hypertensive
Angiotensin II receptor blockers (ARBs)
Inhibit binding of Angiotensin II to the Angiotensin II receptors. Produce similar end results as ACE inhibitors to lower bp.
Medication suffix for Angiotensin II receptor blockers (ARBs)
- sartan
Common ARB mediccations
- Losartan (Cozaar)
- Valsartan (Diovan)
- Irbesartan (Avapro)
Side effects ARBs
- Hyperkalemia (increased potassium in blood)
- Hypotension
- Dry, persistent cough
- Angioedema (swelling of tongue, lips and mouth; immediate treatment required!)
- Increased serrum creatinine (kidney failure indicator)
Precautions when taking ARBs
- Monitor kidney function
- If cough not tolerable switching to different class of hypertensive
Calcium Channel Blockers (CCBs)
Hinder the calcium ion influx (calcium required during contraction) in the vascular smooth muscle of the heart, resulting in heart muscle relaxation- decreasing bp.
suffix CCBs
-pril
CCB Medications
- Diltiazem (Cardizem)
- Verapamil (Calan)
- Amlodipine (Norvasc)
- Felodipine (Plendil)
Side effects CCBs
- Hypotension
- Dizziness
- Flushing
- Headache
- Tachycardia
- Exacerbation of CHF (congestive heart failure)
Precautions CCBs
Monitor for signs of peripheral or pulmonary edema
Vasodilators
- Work by directly dilating the blood vessels to produce rapid and significant reduction in bp.
- Used to treat dangerously high bp in emergency situations due to rapid effect
Vasodilator prefix
Nitro-
Vasodilator Medications
- Hydralazine (Apresoline)
- Nitroprusside (Nitropress)
- Nitroglycerin (Nitrostat)
- Isosorbide mononitrate (Imbdur)
Vasodilator Side efffects
- Tachycardia
- Edema or fluid retention
- Lupus
- Postural hypotension
Precautions Vasodilators
- Don’t suddenly stand up
- Monitor for signs of swelling
CHF
Congestive Heart Failure
Congestive Heart Disease (CHF)
Happens when the heart can’t pump blood efficiently to deliver an adequate supply of blood to the metabolizing tissues, usually because of water and sodium retention.
It may precede or follow a heart attack.
It also may be associated with other cardiovascular problems, such as high blood pressure, aortic stenosis, and coronary artery disease.
Congestive
implies edemous state commonly associated with fluid retention.
Symptoms CHF
- Fatigue
- Increased urination at night
- Swelling
- Shortness of breath
- Tachycardia
- Nausea/Vomiting
Treatment CHF
Medications to relieve symptoms, prevent further damage and prolong survival.
Damaged heart muscle can’t be repaired.
Risk factors CHF
- Increased age
- Infections
- Valve disease
- Arrythmia
- Traum to heart muscle
- Chemotherapy and certain illicit medications
- Congenital heart disease
Nonpharmacologic Therapy for CHF
- Bed rest to decrease cardiac load
- Progressive ambulation
- Dietary control with small, frequent meals
- Salt restriction
Medications used to treat CHF
- Digoxin (Lanoxin)
- Diuretics
- Beta Blockers
- ACE inhibitors and ARBs
Narrow Therapeutic Index (NTI)
Narrow therapeutic index (NTI) drugs are drugs
where small differences in dose or blood
concentration may lead to serious therapeutic
failures and/or adverse drug reactions that are
life-threatening or result in persistent or
significant disability or incapacity.
Digoxin
Medication that’s proven to be very effective treating CHF symptoms and reducing hospitalization.
Digoxin levels in the blood have to be closely monitored to avoid digoxin toxicity due to its narrow therapeutic Index (NTI)
Diuretics as treatment for CHF
Diuretics are slowly titrated to minimize or eliminate fluid retention. Diuretics increase urination and sodium excretion.
Beta Blockers as treatment for CHF
Reduce heart rate and prevent arrhythmias to help reduce CHF symptoms. Beta Blockers are known to reduce the risk of mortality and hospitalization and improve the overall clinical status of CHF patients. Sometimes beta blockers are used in conjuction with diuretics.
ACE inhibitors and ARBs in CHF treatment
Generally used for long-term management of chronic CHF.
Hyperlipidemia (High Cholesterol)
Increase in circulating concentration of cholesterol, cholesterol esters, triglycerides, or phospolipids.
Cholesterol classified as…
Steroid-based and primary component of cell membrane.
Two main types of cholesterol
- HDL (High-Density Lipoprotein. Good cholesterol associated with a decreased risk of heart disease.
- LDL (Low-Density Lipoprotein). Bad cholesterol associated with an increased risk of heart disease and stroke.
Triglycerides
Provided by deitary fats and hepatic conversion of carbohydrates.
Also increase the risk of heart disease.
Risk Facotors Hyperlipidemia
- A genetic defect in the recptor and/or enzyme abnormality or deficiency
- Obesity
- High fat and cholesterol dietary intake
-Certain medications that cause increased cholesterol
Treatment for hyperlipidemia
- Dietary restrictions to avoid fatty foods
- Exercise
- Weight reduction
- Smoking cessation
Medications (Statins) that are used to treat hyperlipidemia include
Atorvastatin (Lipitor)
Simvastatin (Zocor)
Pravastatin ( Pravachol)
Rosuvastatin (Crestor)
Statin Side effects
-Nausea
-Headache
-Abdominal Pain
-Muscle Pain (May be an indicator of a serious side effect of statins, called rhabdomyolysis, which is a breakdown of skeletal muscle. Routine monitoring of CK (creatine kinase) is recommended for high-risk patients.
-Liver damage (Liver function tests are recommended periodically while patients are on statins).
Other medications used to treat hyperlipidemia
Niacin (Niaspan)
Fenofibrate (Tricor)
Gemfibrozil (Lopid)
Ezetimibe (Zetia)
Rhabdomyolysis
Breakdown of skeletal muscle.
CAD
Coronary Artery Disease