Cardiovascular+Pathology

Back to Home Page

=**Chapter 29 - Structure and Function of the Cardiovascular and Lymphatic Systems**= I began an outline of the chapter but found websites with the same information plus some excellant information that supplements the text. Please print out the information from these sites. If you need to review, the first site is about the structure and function of the cardiovascular system. It also provides some interactive links to review electocardiogram and heart sounds as it is related to the anatomy of the heart. [|Basic Cardiac Anatomy and Physiology]

The next website provides review of the circulatory system in general [|Lumen: Learn your arteries] and an interesting view of the heart is provided by MRI study here [|Cardiac MRI Anatomical Atlas]

The conduction system of the heart can be reviewed by going to the following website and clicking on the animated tutorial of heart electrical conduction. [|How the Heart Works] .

The next website defines the laws mentioned in the text. The information is printer friendly as is most of that at the previous websites. [|Cardiac physiology] Structure of the blood vessels - [|Structure of Blood Vessels] Hemodynamics, including pressure, flow and resistance as well as the effects of hormones on total peripheral resistance are discussed at the next two sites [|Regulation of Blood Pressure] and [|Resistance to Blood Flow] The natriuretic peptides are important regulators of blood pressure by managing blood plasma volume. Their measurement can be important in the diagnosis of CHF. An explanation of each peptide is found at [|Natriuretic Peptides] [|Adrenomedullin (ADM)] is a recently discovered peptide, according to our text, so I have provided a link to further information about its effects on the cardiovascular system. According to this study, it may act to protect the body during periods of shock by having a hypertensive effect (Hinson, Kapas & Smith, 2000). It appears to play an importance in many disorders, including diabetes, renal disorders, bone and skin disease. [|Coronary Perfusion Pressure] is "the difference between pressure in the aorta and the coronary vessels of the right atrium" (McCance, 2006). [|autoregulation] maintains mean arterial pressure by controlling arterial resistance and the [|Autonomic regulation] controls blood flow by regulating heart rate. According to McCance & Huether, the [|lymphatic system] is "a special vascular system" that is responsible for containing dissolved proteing that cannot be absorbed by the capillary system. The website link provides extensive information about its functions. Assessment of cardiac function can be done noninvasively first by physically assessing the patient's level of consciousness, then checking the color of the mucouse membranes (which should be pink) and by palpating the pulses. [|Auscultation of heart sounds]will reveal information about heart rate and rhythm. Accessing the weblink will let you hear the sounds of murmurs, rubs and other abnormal heart sounds. The [|electrocardiogram] (EKG) is a critical tool in evaluating the heart. It can show the effects of medications, and evolving myocardial infarction, problems with electrical conduction and diagnose hypertrophy of the ventricles. An [|echocardiogram] can show conditions such as cardiomyopathy and pericardial effusion and give a good picture of the function of the valves of the heart. Today I saw a [|benign tumor], or mxyoma, on the mitral valve that was very rare. The patient had presented with chest pain with no other risk factors. All tests were negative for MI. She was sent for a C-CTA (see below) for further diagnosis before surgery was arranged. [|Coronary computed tomography angiography] (C-CTA) is an advanced type of CT scan which looks at the blood flow through the heart as well as the structure of the heart and can be 99% accurate in diagnosing that there is NO blockage. A qualified physician can read the images using special software and find areas of calcium in the blood vessels that may be suspicious and recommend a cardiac catheterization to further investigate. This test is ideal for patients who present with chest pain with few to no risk factors for coronary artery disease because it is non-invasive. It is also a good tool for cardiac surgeons to use for follow-up for patients who have undergone bypass surgery to be sure that the new grafts are remaining patent. [|Cardiac stress testing] is a useful tool to show evidence of coronary artery disease that cannot be revealed when the heart is at rest. It usually involves a patient actively participating on a treadmill, but can be accomplished by injecting adenosine or dobutamine if the patient is unable to tolerate physical activity. Further information can be gained from a stress test by injecting thallium, a radioactive substance and performing a [|nuclear perfusion study] which will reveal "cold spots" or areas of the heart that are not being perfused. [|Cardiac catheterization] is commonly called the "gold standard" for diagnosis of coronary artery disease. The link offered offers a complete history of this procedure, including how and when the first one was done on a horse! Now it is done on a routine basis in many hospitals and usually includes angiography. Often [|percutaneous coronary intervention] is done after visualization of the blockage is found and a stent may be placed to open the blood vessel.
 * __Tests of Cardiac Function__**

McCance & Huether have addressed changes in the cardiovascular system that occur with aging and have made a concept map (Fig 29-42) that specifically shows the results of arterial stiffness. I have also found a good reference for care of the older patient (Burke & Laramie, 2000) and have made a copy of the changes related to cardiac care and have posted them both on the following word doc for you to review

=Chapter 30 - Alterations of Cardiovascular Function= http://mercury.mwsu.edu:8900/SCRIPT/NURS5043X1/scripts/serve_home**
 * Here is a link back to WebCT, Unit VII on the discussion board for a ppt presentation I did on Measures to prevent Atherosclerosis.

[|Hypertension] (HTN) is "a sustained elevation of systemic arterial blood pressure" (McCance & Huether, 2006, pg 1086) and is diagnosed by two or more consecutive elevated readings by a clinician in excess of 140mmHg systolic or 90 mmHg diastolic. Hypertension with no known cause is called [|primary hypertension] while that which is related to increased cardiac output, increased systemic vascular resistance or both is [|secondary hypertension]. The text lists the factors associated with HTN and has a list of complications related to sustained primary HTN on page 1091 (Tbl 30-3). An interesting note about the [|pressure-natriuresis relationship] if you have time to glance at the study in the link, is that the effects of diuretics and sodium restriction are antagonistic. The study found that diuretics work best when sodium levels are elevated. Vasodilators, such as calcium antagonists, and a combination of beta-blockers and ACE-inhibitors work well in combination with sodium restriction however (Fumio & Genjiro, 1996). [|Malignant hypertension] is a potentially life threatening medical emergency in which papilledema is the key diagnostic feature (Bisognano & Orsini, 2006). According to the definition of the disorder on Medline Plus, it can be seen in women with [|toxemia of pregnancy] as well. [|Orthostatic hypertension] is a decrease in blood pressure 20/10 mmHg upon standing and be the result of disease process, drug interaction, or common changes in the elderly. Refer to the ppt presentation in Unit VII on Web CT for information concerning the following topics. An [|aneurysm] is a weakened area of a blood vessel that bulges outward. It generally may occur in the brain, the aorta (anywhere in the thoracic or abdominal cavity) or in the heart. The size and location of the aneurysm is an indication of its severity, generally less than 5 cm does not require surgery. Control of blood pressure is important to decrease the risk of dissection. A blood clot that forms within the blood vessel is called a [|thrombus] and is formed at areas where stimulation of clotting factors is likely to occur. The concept map at this link shows the steps involved in the formation. It can occur due to blood pooling and venous stasis or because of venous inflammation [|(thrombophlebitis).] Once the clot detaches it is called a [|thromboembolus] (pictured at this link) and can move to critical areas in the heart, lungs or brain causing myocardial infarction (MI), pulmonary embolism (PE), or stroke. Treatment with warfarin can help to prevent this for patients who are at risk (chronic atrial fibrillation, following heart surgery - especially valve replacement, and those with known clots). [|Peripheral artery disease (PAD)] is another disorder that can be linked back to atherosclerosis. Buildup of placque in the blood vessels can lead to hardening and occlusion of the blood vessels of the lower extremities causing pain that worsens with activity called [|intermittent claudication]. The study found at this link shows evidence that regular exercise can effectively decrease the pain felt with PAD. It can usually be managed medically but may need [|percutaneous intervention.] There are two types of PAD that occur due to vasospasm. First is [|thromboangiitis obliterans] or Buerger's disease, which is strongly associated with cigarette smoking and more common in males (McCance & Huether, 2006) and can lead to gangrene of the fingertips (see the weblink for pictures). Second is [|Raynaud's phenomen and disease], which generally affects the upper extremities. According to the Merck Manual (2006), Raynaud's phenomen can be associated with "migraine headaches,...angina, and pulmonary hypertension" while the disease often has no known cause. [|Chronic venous insufficiency] is a common complaint often manifested by varicose veins, complaints of leg discomfort and leg edema. Left untreated it can lead to problems such as deep vein thrombosis and venous stasis ulcers. Use of stockings adn elevation of lower extremities can help to treat it without surgical intervention. [|Deep vein thrombosis] (DVT) can occur in many patients who have been hospitalized for other conditions due to decreased activity (stroke, MI, cancer) or because of surgical procedures (orthopedic, obstretic, or from traumatic injury). Non hospitalized patients may experience this disorder due to genetic factors, medications (birth control pills) or from dehydration and decreased activity (travel). Merck states there are three main factors contributing to DVT called "Virchow's triad" vascular injury, increased coagulation tendency, and slowed blood flow. DVT is considered serious because if the clot breaks free, patient death could occur due to pulmonary embolism. [|Superior vena cava syndrome] is most often caused by bronchogenic cancer but can occur acutely due to placement of central venous lines. Some later symptoms include dyspnea, cough, nasal stuffiness and facial swelling which is pictured at the link provided. [|Coronary artery disease] (CAD) has historically been one of the leading causes of death, primarily from MI, and is generally caused by atherosclerosis. Please refer again to the ppt presentation for information on the risk factors for CAD and other details on this topic as well. Left untreated CAD can lead to [|myocardial ischemia] which is an insufficient blood flow to the cells of the heart causing chest pain or [|angina pectoris]. Angina can be classified as stable, or predictable, occurring with exertion or stress; unstable, occurring randomly, often at rest; or [|Prinzmetal's angina] (variant angina), which is caused by vasospasm of one or more coronary arteries. Please follow the link provided to view a coronary angiography of a patient's proximal left circumflex artery occluding due to hyperventilation and being reopened by intracoronary nitroglycerin and diltiazem. Extended periods of ischemia can result in [|myocardial infarction] (MI) which leads to cardiac cell death and decreased cardiac function. MI differs from angina by the degree of pain felt. Angina may be constant and nagging but an MI will be evidenced by suddenly occurring intense pain usually in the midsternal area. It often will radiate to areas such as the left arm, jaw or back. Quite often this pain is manifested as severe back pain in women and is missed as a "classic" MI. EKG and lab result should be reviewed ( [|cardiac enzymes] ) for definitive diagnosis. Treatment should be initiated at once according to institution protocol, including aspirin, beta-blockers, morphine and the patient should be taken to the cardiac cath lab. If percutaneous intervention cannot resolve any blockages, then [|coronary artery bypass grafting (CABG)] may be necessary. Complications of MI, depending on treatment pursued and the amount of damage post infarct, according to McCance & Huether (2006) may include dysrhythmias, decreased cardiac output (some patients develop congestive heart failure depending on the location of the infarct), pericarditis (2-3 days post infarct), Dressler's syndrome (an possible immune response causing pericarditis one week after MI), organic brain syndrome, rupture of heart structures including the affected ventricle, thromboembolism (often due to dysrhythmias or decreased activity) and sudden death due to dysrhythmia, most often ventricular fibrillation.

= = Since we all read our chapters I just outlined the chapter and found websites to assist if there is something you would like to know a little more about. I hope this helps ya’ll. I know I need all I can get.

Here is an interesting site someone told me about. http://www.blaufuss.org/

Pericardial Disorders
· Acute Pericarditis http://heartdisease.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.merck.com%2Fpubs%2Fmmanual%2Fsection16%2Fchapter209%2F209b.htm · Pericardial Effusion http://www.emedicine.com/med/topic1786.htm · Constrictive Pericarditis http://www.medstudents.com.br/cardio/cardio6.htm

Cardiomyopathies
· Dialated Cardiomyopathy http://www.cardiomyopathy.org/html/which_card_dcm_text.htm · Hypertrophic Cardiomyopathy http://www.cardiomyopathy.org/html/which_card_hcm_text.htm · Restrictive Cardiomyopathy http://www.cardiomyopathy.org/html/which_card_restrictive.htm

Valvular Dysfunction
· Valvular Stenosis http://www.cvphysiology.com/Heart%20Disease/HD004.htm o Aortic Stenosis http://www.medicinenet.com/aortic_stenosis/article.htm o Mitral Stenosis http://www.priory.com/med/mitsten.htm · Valvular Regurgitation http://www.echoincontext.com/doppler02/doppler02_02.asp o Aortic Regurgitation http://www.mayoclinic.com/health/aortic-valve-regurgitation/DS00419 o Mitral Regurgitation http://www.mayoclinic.com/health/mitral-valve-regurgitation/DS00421 o Tricuspid Regurgitation http://www.mayoclinic.org/tricuspid-valve-disease/tricuspid-regurgitation.html o Mitral Valve Prolapse Syndrome http://www.mayoclinic.com/health/mitral-valve-prolapse/DS00504/DSECTION=1 · Acute Rheumatic Fever and Rheumatic Heart Disease http://www.americanheart.org/presenter.jhtml?identifier=4709 · Infective Endocarditis http://www.clevelandclinicmeded.com/diseasemanagement/infectiousdisease/infectendo/infectendo.htm

Heart Failure
· Typeshttp://www.heartfailure.org/eng_site/hf.asp o Congestive Heart Failure http://www.americanheart.org/presenter.jhtml?identifier=337 o Systolic Heart Failure http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/understanding_hf.htm o Diastolic Heart Failure http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/understanding_hf.htm o Right Heart Failure http://www.wrongdiagnosis.com/r/right_heart_failure/intro.htm o High-Output Heart Failure http://www.amc.edu/amr/archives/200201/review01.html//

Dysrhythmias
· Impulse Formation Page 1135 and 1136 of our text · Impulse Conduction Page 1137 and1138 of our text As best I can find the book has the best overview of the dysrhythmias. Individually there are lots of different sites for the specific formation on conduction disorders.

=Chapter 31=

Developmental Anatomy
· Embryology http://www.nervenet.org/EMBRYO/heart.html · Cardiac Septation This was difficult to find but I think this does a pretty good job at explaining Cardiac Septation http://www.pedresearch.org/cgi/content/full/57/2/169/F41

Transitional Circulation
· Closure of Fetal Shunts http://mcb.berkeley.edu/courses/mcb135e/fetal.html

Postnatal Development
· Postnatal Hemodynamics Difficult to find something reasonable, mostly alterations in hemodynamics. The book is the best I have found thus far. · Postnatal Circulation This is a pretty good site. http://www.indiana.edu/~anat550/cvanim/fetcirc/fetcirc.html

Congenital Heart Defects
http://www.lpch.org/diseaseHealthInfo/healthLibrary/cardiac/fcchd.html

Congestive Heart Failure
http://www.medicineonline.com/reference/Health/Conditions_and_Diseases/info/CHF-in-Children/Congestive-Heart-Failure-in-Children/ Hypoxemia This site gives a history and description of Eisenmenger Syndrome http://www.emedicine.com/med/topic642.htm

Defects in Pulmonary Blood Flow
· Patent Ductus Arteriosus http://www.heartpoint.com/congpda.html · Atrial Septal Defect http://www.americanheart.org/presenter.jhtml?identifier=1664 · Ventricular Septal Defect http://americanheart.com/presenter.jhtml?identifier=11066 · Atrioventricular Canal Defect http://texasheart.org/HIC/Topics/Cond/canal.cfm

Defects Decreasing Pulmonary Blood Flow
· Tetralogy of Fallot http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/tof.htm · Tricuspid Atresia http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/tricuspid.htm · Coarctation of the Aorta http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/coarctation.htm · Aortic Stenosis http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/avs.htm · Pulmonary Stenosis http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/pvs.htm · Hypoplastic Left Heart Syndrome http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/hlhs.htm

Mixed Defects
· Transposition of the Great Arteries http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/transposition.htm · Total Anomalous Pulmonary Venous Connection http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/tapvr.htm · Truncus Arteriosus http://www.cincinnatichildrens.org/health/heart-encyclopedia/anomalies/truncus.htm

Acquired Cardiovascular Disorders
· Kawasaki Disease http://www.kidshealth.org/parent/medical/heart/kawasaki.html · Systemic Hypertension http://heart.healthcentersonline.com/bloodpressure/hypertensioninchildren.cfm · Childhood Obesity http://www.obesity.org/subs/childhood http://www.mayoclinic.com/health/childhood-obesity/FL00058

I hope this helps so you don’t have to search and read sites that don't help much. I hope this narrows the search down for you.

=References= American Heart Association. (2006). Angina Pectoris. http://www.americanheart.org/presenter.jhtml?identifier=4472 Bandolier. (2006). Exercise and intermittent claudication. http://www.jr2.ox.ac.uk/bandolier/band52/b52-4.html. Basic Cardiac Anatomy. (2006).http://filer.case.edu/~dck3/heart/intro.html Beeson, M. (2006). Superior vena cava syndrome. eMedicine from WebMD.// http://www.emedicine.com/emerg/topic561.htm#target11////// Brown Medical School, (2006).Thromboembolus. http://www.brown.edu/Courses/Digital_Path/systemic_path/pulmonary/thromboembolus.html Burke, M. & Laramie, J. (2000). Primary care of the older adult (2nd ed.). St. Louis: Mosby. Cable, C. (1997). The Auscultation Assistant. http://www.wilkes.med.ucla.edu/intro.html Chen, H. & Pinto, D. (2003). Prinzmetal's angina. The New England Journal of Medicine. 349:e1. https://content.nejm.org/cgi/content/full/349/1/e1 Cleveland Clinic.(2006). Coronary computed tomography angiogram. http://www.clevelandclinic.org/heartcenter/pub/guide/tests/radiograph/coronarycta.htm De Sanctis, J. (2001). Percutaneous interventions for lower extremity peripheral vascular disease. American Family Physician. 64:XII. http://www.aafp.org/afp/20011215/1965.html Doctors Corner Internet Group (2004). How the Heart Works. http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/conductiontutorial.html Duke University Medical Center. (2000). Cardiac tumors. http://www.echoincontext.com/int2/skillI2_09.asp Fogoros, R. (2003). The cardiac stress test. About Health/Fitness. http://heartdisease.about.com/cs/cardiactests/a/stress.htm Fumio,S. & Genjiro, K. (1996). Antihypertensive mechanism of diuretics based on pressure-natriuresis relationship. Hypertension. 27:914-918. http://hyper.ahajournals.org/cgi/content/full/27/4/914 Gandleman, G. (2006). Echocardiogram. MedLine Plus. http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm#Normal%20Values Gomersall,C. (1999). Post operative management of the patient with cardiac disease. http://www.aic.cuhk.edu.hk/web8/post_operative_management_of_the.htm Grayson, C. (2006). Thrombophlebitis. Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/001108.htm Grech, F. (2003). Percutaneous coronary intervention. II: The procedure.bmj.com http://bmj.bmjjournals.com/cgi/content/full/326/7399/1137 Hinson, J., Kapas, S. & Smith, D. (2000). Adreomedullin, a multifunctional regulatory peptide. Endocrine reviews. 21:II (138-167). http://edrv.endojournals.org/cgi/content/full/21/2/138 Internet Stroke Center at Washington University. (2006). Atherosclerosis and thrombus formation. http://www.strokecenter.org/education/ais_pathogenesis/11_thrombus_formation_III.htm Johns Hopkins Vasculitis Center. (2006). Types of vasculitis: Buerger's disease. http://vasculitis.med.jhu.edu/typesof/buergers.html Klabunde, R. (2006) Cardiovascular physiology concepts. Kumm, Sharon. (2005). Cardiac enzymes. University of Kansas School of Nursing. http://classes.kumc.edu/son/nurs420/unit5/cardiac_enzymes.htm McCance K & Huether S. (2006). Pathophysiology the biologic basis for disease in adults and children. (5th ed.)St. Louis: Mosby, Inc. McNulty, John. (2006). http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/learnem/arteries/main_art.htm Merck Manual. (2006). Orthostatic hypotension. http://www.merck.com/mrkshared/mmanual/section16/chapter200/200a.jsp Merck Manual (2006). Raynaud's disease and phenomen. http://www.merck.com/mrkshared/mmanual/section16/chapter212/212d.jsp Merck Manual's Online Medical Library. (2006). Deep vein thrombosis. http://www.merck.com/mmhe/sec03/ch036/ch036b.html National Institute of Health Office of Technology. (2006). The many roles of adrenomedulin in human pathology and physiology. http://ott.od.nih.gov/db/abstxt.asp?refno=390 Olade, R. & Safi, A. (2006). Cardiac catheterization (left heart). eMedicine from WebMD. http://www.emedicine.com/med/topic2958.htm Rowe, V. (2005). Peripheral arterial occlusive disease. eMedicine from WebMD. http://www.emedicine.com/med/topic391.htm Sundt,T. (2006). Coronary artery bypass grafting (CABG). The Society of Thoracic Surgeons. http://www.sts.org/sections/patientinformation/adultcardiacsurgery/cabg/index.html Tessier, D. & Podnos, Y. (2006). Chronic venous insufficiency. http://www.emedicine.com/med/topic2760.htm#target1 Texas Heart Institute at St. Lukes's Institute. (2006). Coronary artery disease. http://texasheart.org/HIC/Topics/Cond/CoronaryArteryDisease.cfm Three D heart. (2006). http://www.google.com/imgres?imgurl=http://www.barco.com/barcoview/downloads/BarcoVoxar3DCardia.jpg&imgrefurl=http://www.barco.com/medical/en/Pressreleases/show.asp%3Findex%3D1662&h=680&w=680&sz=57&hl=en&start=1&tbnid=Arh6Yt46rdsIOM:&tbnh=139&tbnw=139&prev=/images%3Fq%3Dcardiac%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DRNWN,RNWN:2006-38,RNWN:en Thrupp,S., Hedley, W., Occleshaw, C., Cantell, A., Cowan, B., & Young, A. (2001). Cardiac MRI anatomical atlas. An introduction to cardiac anatomy. University of Auckland. http://www.scmr.org/education/atlas/intro/index.html What are natriuretic peptides? (2006). Chest Pain Perspectives. http://www.chestpainperspectives.com/content/Cardiovascular%20Disease%20State%20Management/natriureticpeptides.cfm Zevitx, M. & Vibhuti, S. (2006). Myocardial ischemia. eMedicine from WebMD. http://www.emedicine.com/med/topic1568.htm