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Cardiovascular A

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Cardiovascular A&P and Patho-physiology Irene Mueller, EdD, RHIA Montana Hospital Association May 26, 2010 Objectives First Hour Functions of Circulatory System ... – PowerPoint PPT presentation

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Title: Cardiovascular A


1
Cardiovascular AP and Patho-physiology
  • Irene Mueller, EdD, RHIA
  • Montana Hospital Association
  • May 26, 2010

2
Objectives First Hour
  • Functions of Circulatory System
  • Heart Vessels
  • Anatomy
  • Normal physiology
  • Congenital ?
  • VSD
  • PDA
  • Coarctation of Aorta
  • ASD
  • Tetralogy of Fallot
  • Transposition of Great Arteries
  • ? Pathologies
  • HTN

3
Objectives - 2nd hour
  • ? Pathologies
  • CAD
  • MIs
  • Anginas
  • Arrhythmias
  • CHF
  • Cor Pulmonale
  • Emboli
  • Vessel Pathologies
  • Congenital
  • AV Malformations
  • Pathologies
  • Phlebitis
  • Thrombophlebitis
  • Emboli
  • Arteriosclerosis
  • Resources

http//www.alleganynutrition.com/images/upload/blo
od-vessels-an.jpg
4
Functions of Circulatory System
  • 2 primary functions
  • Delivery of oxygen, nutrients, hormones, other
    essential body substances to body cells
  • Removal of waste products from cells
  • CO2 waste product of respiration
  • Metabolism wastes carried to kidneys, skin,
    intestines
  • Nitrogenous
  • RBCs carry O2 to cells CO2 away from cells to
    lungs

5
3 sub-circulation systems
  • Pulmonary
  • Exchange of O2 and CO2
  • Carries blood to lungs
  • to receive O2 and remove CO2
  • Coronary
  • Nutrition and health of heart muscle
  • Systemic
  • Delivers blood and components to all tissues
  • Except lungs and myocardium

6
? AP
  • Pericardium
  • Muscle (myocardium)
  • Chambers
  • Valves
  • Arteries
  • Veins
  • Flow of Blood
  • Systole
  • Diastole
  • Coronary Arteries

7
? Enclosure
  • Pericardium
  • 2 layers
  • Inner serous
  • Visceral pericardium OR epicardium
  • Outer fibrous
  • Parietal
  • Between layers
  • Serous fluid
  • Reduces friction during heartbeat (function)

8
? Facts
  • The heart is about the size of your fist
  • Usu pumps about 50 of blood present in chamber
    at beginning of contraction (ejection fraction)
  • Pumps about 5 quarts/minute
  • Up to 5 gallons/min during exercise
  • Pumps about 4,000 gallons/day

9
? Chambers
  • ? is 4-chambered hollow organ of strong muscle
    tissue
  • Located in thorax between lungs
  • 2 pumps side-by-side
  • R atrium and R ventricle
  • Blood from body pumped to lungs (pulmonary circ)
  • L atrium and L ventricle
  • Blood from lungs to body (systemic circulation)

10
? Valves
  • 4 valves prevent backflow of blood in ?
  • AV Valve (Tricuspid)
  • Between R atrium and R ventricle
  • Pulmonic/Pulmonary valve
  • Between R ventricle and pulmonary arteries
  • Bicuspid (Mitral)
  • Between L atrium and L ventricle
  • Aortic Valve
  • Between L ventricle and Aorta

11
? Chambers
  • Atria (upper chambers)
  • Thin-walled
  • Receive and hold blood before ventricles
  • Ventricles
  • Thick-walled
  • Main pumps
  • Septa walls between chambers
  • Atrial septum
  • Ventricular septum

Where else do you have a septum?
12
Flow of Blood through ? (Cardiac cycle)
  • http//kidshealth.org/misc/movie/parent/ASD_rev/AS
    D_rev.html

13
Cardiac Cycle
  • Cardiac muscle contraction cycle
  • One sequence of conduction pathway
  • One heartbeat
  • PQRST segment on EKG
  • Electrical stimulation triggers contractions
  • Sinoatrial (SA) node
  • Atrioventricular (AV) node
  • Bundle of His, R L Bundle Branches
  • Purkinje fibers

14
PQRST
  • http//cygnus.et.put.poznan.pl/piotrw/nauka/fibon
    acci/heartelec2.gif

15
? AP
http//www.nhlbi.nih.gov/health/dci/Diseases/shock
/shock_heartworks.html
16
Coronary Arteries
  • 1st vessels to branch from the aorta
  • Right Coronary Artery supplies posterior ?
  • Left Main Coronary Artery divides into
  • Left Anterior Descending
  • Supplies front of ?
  • Left Circumflex
  • Wraps around the left and posterior ?
  • http//myhealth.ucsd.edu/library/healthguide/en-us
    /images/media/medical/hw/h9991261_001.jpg

17
Great Vessels
  • the large arteries and veins entering and
    leaving the heart. They include
  • the aorta, (3 cm diameter as leaves ?)
  • the pulmonary arteries and veins, and
  • the superior and inferior vena cava.
  • Superior drains upper body (about size of thumb)
  • Inferior drains lower body

http//medical-dictionary.thefreedictionary.com/gr
eatvessel
18
Greys Anatomy. Figure 489
19
Vessel AP
  • Arteries
  • Carry Oxygenated Blood
  • Exception
  • Pulmonary Arteries
  • Very high pressure
  • Elastic, muscular
  • Thick Walls
  • Tunica adventitia/externa
  • Tunica media (sm. muscle)
  • Tunica intima

http//www2.merriam-webster.com/mw/art/med/artery.
htm
20
Vessel A P
  • Arterioles
  • Arteries branch into smaller and smaller sizes
  • Smallest arteries branch into arterioles
  • Less smooth muscle in walls
  • Arterioles branch into metarterioles
  • Loss of connective tissue/muscle layers
  • Give rise to Capillaries

21
Vessel AP
  • Capillaries
  • Smallest vessels
  • Microscopic
  • Connect metarterioles
  • to venules
  • Endothelial layer only
  • Very thin walls
  • Selective permeability
  • O2/CO2
  • Nutrition
  • WBCs/Plasma

http//www2.merriam-webster.com/mw/art/med/circula
t.htm
22
Artery Anatomy
http//www.kidney-hypertension.com/arteries.gif
23
Vessel A P
  • Venules
  • Little larger than capillary, then larger, etc.
  • Have muscular layer also

24
Vessel AP
  • Veins
  • Carry de-oxygenated blood
  • 3 layers
  • Tunica Externa, Media, Intima
  • Much Less elastic/muscular
  • Thinner walls/less pressure
  • Valves
  • One-way flow to heart
  • More in lower body

http//www2.merriam-webster.com/mw/art/med/vein.ht
m
25
Vessel A P
  • Venous Return
  • Contraction of skeletal muscles help
  • Breathing pressure changes help
  • http//www.youtube.com/watch?vHNuPWdfjDoc
  • 62,000 miles of blood vessels in a human body

26
Vessel Anatomy
http//umanitoba.ca/faculties/medicine/units/anato
my/images/ArtVeincopy.JPG
27
Circulatory Physiology
  • Blood pressure
  • Systolic (Top Number)
  • Moment of contraction in heart
  • Pressure against vessel walls/resistance
  • Diastolic (Bottom Number)
  • Moment of relaxation of the heart
  • Less pressure against vessel walls
  • Pulse pressure systolic - diastolic

28
Pulse
  • Pulse is usu. same as ? rate
  • Alternating, beating throbs at body points
  • Brachial
  • Carotid (common)
  • Femoral
  • Dorsalis pedis
  • Popliteal
  • Radial
  • Temporal
  • Where is each of these points on your body?

29
Congenital ? Disease
30
Congenital ? Disease
  • Congenital Heart Defects (CHD) are the most
    common birth defect in the United States. About
    35,000 children (1 of 120) are born with a CHD
    every year. ACHA
  • Can be diagnosed at any age
  • 10 of cases dx as adults
  • 2008 - 1 million people w/congenital heart
    disease have survived to adulthood

31
Etiologies of Congenital ? disease
  • Genetic
  • Other risk factors
  • Maternal rubella (German measles)
  • Poor maternal nutrition
  • Alcoholism/Drug abuse
  • Some medications during pregnancy

32
Congenital ? Conditions
  • VSD (Ventricular Septal Defect)
  • PDA (Patent Ductus Arteriosus)
  • ASD (Atrial Septal Defect)
  • Tetralogy of Fallot
  • Coarctation of Aorta
  • Transposition of Great Arteries

33
Fetal Heart
  • Fetal lungs not used for breathing
  • Blood enters R atrium, most of blood flows to L
    atrium through a special fetal opening - foramen
    ovale
  • Fetal circulation shunts (bypasses lungs) from
    pulmonary artery to aorta through a connecting
    blood vessel - ductus arteriosus
  • After Birth, normally both close

34
VSD (Ventricular Septal Defect)
  • Opening in the ventricular septum remains
  • Most common heart defect (25)
  • "Hole in the heart
  • If small, often "heals"  (closes) on its own
  • Blood flows from L ventricle to R ventricle at
    high pressure, often a loud "murmur"
  • Larger VSD requires surgery as baby
  • Smaller may be watched for years
  • http//www.med.ucla.edu/wilkes/Systolic.htm

35
PDA
  • Ductus Arteriosus
  • Connection between pulmonary artery and aorta
    Normal in fetal ?
  • Patent does NOT close after birth
  • Oxygenated blood goes back to lungs instead of to
    body increases workload
  • 2x more common in girls

36
ASD
  • Opening between R and L atria
  • Usu. Due to foramen ovale NOT closing
  • Oxygenated blood goes from L to R atria
  • Never leaves lungs and heart
  • More common in girls

37
Tetralogy of Fallot
  • Tetra Four in Greek
  • Very serious heart defect Blue Baby
  • Combination in varying degrees of
  • Pulmonary valve stenosis
  • R ventricle Hypertrophy
  • Ventricle Septal Defect
  • Abnormal placement of Aorta

38
SS of Tetralogy of Fallot
  • Cyanosis increases with age
  • Clubbing of fingers/toes
  • Resting in squatting position
  • Breathe easier, improves venous return
  • Growth retardation
  • Severe dyspnea with exercise
  • Frequent Respiratory infections

39
Coarctation of Aorta
  • Stricture (Varying degrees) of
  • Descending or thoracic aorta
  • High blood pressure proximal to narrowing
  • Lower blood pressure distal
  • May cause bl press in arms, in legs
  • Increases workload on heart
  • May NOT be dx until adulthood

40
Transposition of Great Arteries
  • Aorta and Pulmonary artery are "transposed" from
    normal position
  • Aorta arises from the R ventricle
  • Pulmonary artery arises from the L ventricle
  • Oxygen-poor ("blue") blood from body is sent back
    to body
  • Oxygen-rich ("red") blood from lungs is sent back
    to lungs
  • Untreated, 50 of infants die in 1st month ,
    90 percent in 1st year
  • If no unusual risk factors, surgery successful
    for 95 of NBs
  • http//www.cincinnatichildrens.org/health/heart-en
    cyclopedia/anomalies/graphicsummaries/transwf.htm

41
? Pathologies
  • HTN
  • CAD
  • MIs
  • Anginas
  • Arrhythmias
  • CHF
  • Cor Pulmonale
  • Emboli

42
Common SS of ? Disease
  • Chest Pain
  • Dyspnea
  • Fatigue
  • Tachycardia
  • Cardiac palpitations
  • Strong, rapid, irregular heartbeats that pt feels
  • Diaphoresis
  • Edema of extremities
  • NV

43
HTN
  • Silent Killer no symptoms
  • Leading cause of stroke/heart failure
  • Reduced life expectancy
  • When Diastolic is 90
  • Can be primary OR
  • 2nd (due to other disease)
  • Cerebrovascular
  • Cardiovascular
  • Kidney
  • 20 of Americans w/HTN
  • Higher in
  • Blacks
  • Postmenopausal women
  • South (Stroke Belt)
  • Diet variation
  • More salt
  • More cholesterol
  • Less micronutrients

44
HTN
  • Normal LESS than 120/80
  • Pre-HTN 120-130/80-89
  • Stage 1 HTN 140-159/90-99
  • Stage 2 HTN 160/100
  • Determined by action of heart and/or blood vessel
    resistance
  • Kidney also has role

45
Primary/Essential HTN
  • 90 of cases
  • Idiopathic, but risk factors
  • Heredity (Black, Family Hx)
  • Diet High salt and fat
  • Age
  • Obesity increased heart workload
  • Smoking - vasoconstriction
  • Stress - vasoconstriction
  • Type A personality

46
Salt and HTN
  • Action of salt in body
  • Kidneys excrete if too much, stays in blood
  • Excess salt holds water, increases volume
  • high blood pressure
  • Excess salt increases ouabain (hormone)
  • Keeps calcium in artery muscle cells
  • Triggers constriction and HTN
  • Salt-sensitivity (50 of Americans)
  • African-Americans, elderly, diabetics

47
Salt in American Diet
  • 3,436 mg sodium daily (Average)
  • Many experts now (2010)
  • Lowering daily consumption to 1,500 mg of sodium
    daily
  • Prevent/lower high blood pressure
  • Most dietary sodium in processed foods
  • 1/4 teaspoon salt 
  • 600 mg sodium
  • 1/2 teaspoon salt
  • 1,200 mg sodium
  • 3/4 teaspoon salt
  • 1,800 mg sodium
  • 1 teaspoon salt
  • 2,300 mg sodium
  • 1 teaspoon baking soda 1,000 mg sodium

48
Complications of HTN
  • Arteriosclerosis and atherosclerosis
  • Aneurysm
  • CAD/Angina/MIs
  • Enlarged L heart
  • Heart Failure
  • TIAs/Stroke/Dementia
  • Kidney failure/scarring
  • Retinopathy
  • Optic neuropathy
  • Sexual Dysfunction ?
  • Osteoporosis
  • Sleep Apnea, but
  • Sleep apnea increases blood pressure

49
Malignant HTN
  • SS
  • Severe headache, blurred vision, dyspnea
  • Organ damage
  • Sudden onset
  • Risk factor for CVA, renal damage, MI
  • Etiology unknown, but stress may contribute
  • 200/120

50
Break Time
51
Coronary Artery Disease(CAD)
  • Narrowing of arteries that supply ? muscle
  • 1cause of death in US (men and women)
  • Usu due to atherosclerosis
  • Ischemia, necrosis of muscle tissue
  • Causes CHF
  • Blocked artery (occlusion)
  • Slow plaque (may have collateral arteries)
  • Fast thrombus/embolus
  • Infarct (MI)
  • AKA CHD and arteriosclerotic ? disease

52
Risk Factors for CAD
  • Atherosclerotic risk factors
  • Heredity
  • Age
  • Sex (more in males until menopause in women)
  • Diabetes
  • Diet (more fat and carbs more athero)
  • Sedentary lifestyle
  • Smoking
  • NOT smoking 10 X more effective than
    diet/exercise control
  • Stress
  • HTN

53
Anginas
  • Types of angina (an-JI-nuh or AN-juh-nuh) stable
  • unstable
  • variant (Prinzmetal)
  • microvascular
  • Have different symptoms and require different
    treatments

54
Stable Angina
  • AKA Angina Pectoris, Cardiac Angina, Exertion
    Angina, Vasomotor Angina, Angina Syndrome, Angina
    Attack, Chest Pain
  • Caused by lack of oxygen to ? muscle
  • Myocardial ischemia
  • Symptom of impending MI
  • Triggered by exercise, stress, large meal
  • Consistent pattern of events that trigger

55
Unstable Angina
  • Doesn't follow a pattern
  • Can occur w/wo physical exertion
  • May not be relieved by rest or medicine
  • Very dangerous
  • Requires emergency treatment
  • Sign that MI may happen soon

56
Variant (Prinzmetal) Angina
  • Rare
  • Usually occurs at rest, between midnight and
    early morning
  • Pain can be severe
  • Medicine can relieve this type of angina

57
Microvascular angina
  • Can be more severe and last longer than other
    types of angina
  • Medicine may not relieve it
  • May be a symptom of coronary MVD
  • Also called cardiac syndrome X and nonobstructive
    CHD
  • More common in women

58
Myocardial Infarction (MI)
  • Infarct necrosis
  • Decrease in blood supply to muscle
  • CAD plaque
  • Thrombus, Embolus
  • Mortality from MI
  • About 35
  • Anything that increases oxygen need may lead to
    MI
  • Physical exertion
  • Shock
  • Hemorrhage
  • Stress

59
Risk Factors for MI
  • HTN
  • Smoking
  • Sedentary lifestyle
  • Burn fewer calories watching TV than sleeping
  • Obesity
  • High-cholesterol diet

60
SS of MI
  • Severe chest pain
  • Diaphoresis
  • Nausea
  • Referred pain
  • L arm, neck, jaw
  • Feeling of indigestion
  • Cardiogenic shock

61
Areas of Referred Pain
  • Pain sites can be helpful, but require more
    evaluation to eliminate differential dx
  • http//images.emedicinehealth.com/images/4453/4453
    -4478-10907-25156.jpg

62
SS of MI in Women
  • Frequently no chest pain silent MI
  • Can begin up to a month before MI occurs
  • SS BEFORE MI
  • Unusual fatigue - 70
  • Sleep disturbance - 48
  • Shortness of breath - 42
  • Indigestion - 39
  • Anxiety - 35
  • SS DURING MI
  • Shortness of breath - 58
  • Weakness - 55
  • Unusual fatigue - 43
  • Cold sweat - 39
  • Dizziness - 39

63
  • http//www.womenshealth.gov/heart-stroke/heart-att
    ack-signs/heart-attack-signs.gif

64
Arrhythmias (Irregular Heartbeats)
  • Any deviation from normal
  • Abnormalities due to problem in conduction system
  • Often idiopathic

http//www.spike.com/video/ekgecg-intrpretation/31
82500?cmpnid790ptsrrefsite7118
65
SS of Arrhythmias
  • Palpitations
  • Tachycardia
  • Skipped beats
  • Bradycardia
  • Syncope
  • Fatigue

66
Etiologies of Arrhythmias
  • Disturbance of
  • SA node (slow impulse)
  • AV node
  • Bundle branches
  • Purkinje fibers
  • Block between SA and AV nodes (conduction)
  • Ischemia
  • Meds

67
Normal ? Rhythm
  • Normal sinus rhythm
  • Between 60 and 100 beats/minute
  • Normally, women have slightly higher in range
  • Regular
  • Normal conduction
  • Originating in SA node

68
Fast Arrhythmias
  • Flutter
  • Up to 350 beats/minute
  • Regular
  • Fibrillation (Irregularly Irregular)
  • Uncoordinated, Irregular
  • Atrial usually not serious
  • Ventricular (vfib) life-threatening/emergency

http//filer.case.edu/dck3/heart/sounds/af.wav
69
Fast Arrhythmias
  • Atrial Tachycardia
  • 150-250 bpm
  • Normal rhythm
  • Sudden onset
  • Irritable atrium
  • Normal conduction
  • Atrial Fibrillation
  • gt350 bpm
  • Ectopic discharging
  • AV node blocks some impulses
  • Ventricle responds irregularly
  • No P waves

70
Fast Arrhythmias
  • Ventricular Tachycardia
  • 150-250 bpm
  • Usu regular
  • 4 PVCs at rapid rate
  • Advanced irritability of myocardium
  • P wave buried in QRS complex
  • Often forerunner of vfib
  • Ventricular Fibrillation
  • Lethal
  • Loss of consciousness immediately
  • No peripheral pulses
  • No heart sounds
  • No blood pressure
  • Fibers twitch

71
Slow Arrhythmia
  • Sinus Bradycardia
  • Less than 60 bpm
  • Regular
  • P wave unform
  • Slow impulse in SA node
  • Normal Conduction

72
Heart Block Arrhythmias
  • Interrupted conduction system
  • 1st Delay at AV node
  • 2nd AV node blocks impulse intermittantly
  • 3rd SA impluse is completely blocked
  • Atria and ventricles beat independently
  • Requires pacemaker

73
Premature ? Contractions
  • Can affect atria or ventricles
  • Ectopic beat starts in irritable ventricle
  • Followed by compensatory pause
  • AKA - "extrasystoles"

74
Multifocal Arrhythmia
  • Regularly irregular PVCs
  • Ectopic beat(s) no prior P wave
  • Coupling two beats in a row
  • regular occurrence of a premature beat
  • Bigeminy every other beat
  • Trigeminy every third beat
  • 2 normal QRS complexes are followed by a PVC
  • Quadrigeminy every fourth beat
  • heartbeats are grouped in fours
  • usually one sinus beat followed by three
    extrasystoles
  • a repetitive group of four of any composition is
    quadrigeminal

75
CHF
  • ? cant pump enough blood for body
  • Failure of ventricles
  • Develops slowly
  • Usu. Follows cardiac condition increasing
    workload
  • Acute CHF after MI
  • Chronic CHF after HTN, CAD, COPD, valve,
    arrhythmias, cardiomyopathy
  • Other - thyroid disease, kidney disease,
    diabetes, or congenital heart defects
  • R-sided congestion of liver and spleen
  • L-sided lung congestion
  • http//www.health-res.com/EX/08-03-22/HeartFailure
    Zones.gif

76
Progression of CHF
  • Decreased Cardiac Output (many etiologies)
  • Compensation mechanisms
  • Vasoconstriction, increased resistance in L V
  • Increased rate and force, incr. work
  • Incr. sodium and water retentioin, incr volume,
    increased work for heart
  • L CHF - LV weakens pulmonary congestion
  • Increased resistance for RV
  • R CHF increased blood in systemic circ
  • Edema in legs and Digestive system

77
SS of CHF
  • Depend on which ventricle fails
  • Dyspnea - L
  • Tachycardia
  • Tachypnea
  • Neck vein distention R
  • Ascites - R
  • Pedal edema - R (CHF)
  • Pitting edema (fluid is forced into interstitial
    spaces)
  • pitting is an assessment using grading scale of
    1 for mild and up to 4 for deep pitting.
  • http//www.health-res.com/EX/07-28-04/55PJ35JA.jpg

78
Assessment of pitting edema
  • 1 2mm or less
  • Slight pitting
  • Disappears rapidly
  • No visible distortion
  • 2 2-4mm
  • Somewhat deeper pit
  • Disappears in 10-15 secs
  • No easily detected distortion
  • Assessment Chart for Pitting Edema adapted from
    the Guelph General Hospital Congestive Heart
    Failure Pathway
  • 3 4-6mm
  • Pit noticeably deep
  • May last more than 1 minute
  • Dependent extremity looksfuller and swollen
    (4-6mm)
  • 4 Edema 6-8mm
  • Pit is very deep
  • Lasts as long as 2-5 minutes
  • Dependent extremity isgrossly distorted
    (6-8mm)

79
Cor Pulmonale
  • Right-sided heart disease
  • R ventricle enlarges due to lung disease
  • Acute pulmonary emboli
  • Chronic - pulmonary HTN, emphysema, lesions
  • Hypoxia More RBCs thicker blood
  • SS
  • Dyspnea, distended neck veins, edema of
    extremities, enlarged/tender liver

80
Vessel Pathologies
  • Congenital
  • Arteriovenous Malformations
  • Pathologies
  • Phlebitis
  • Thrombophlebitis
  • Emboli
  • Arteriosclerosis

http//www2.merriam-webster.com/mw/art/med/vein.ht
m
81
Common SS of Vessel Disease
  • Pain
  • Edema
  • Cyanosis

82
Arteriovenous Malformations
  • Formed in fetus
  • Usu. NOT discovered before age 20
  • Usu. in brain, but can occur anywhere
  • Abnormal connection (no capillaries)
  • Fragile, tend to bleed/hemorrhage
  • When in brain, bleed can lead to SS similar to
    stroke
  • Cerebral AVMs have 10 mortality rate

83
Phlebitis
  • Inflammation of vein
  • Usu in lower legs, but can occur anywhere
  • Superficial
  • Swelling, redness, warmth, cordlike mass
  • Deep
  • Affects tunica intima, can cause clots
  • Thrombophlebitis

84
Thrombophlebitis
  • Formation of a thrombus on vein wall due to
    inflammation (phlebitis)
  • Interferes with blood flow, causes edema
  • SS - Pain, swelling, warmth, tender, chills
    fever
  • Causes
  • Venous stasis (sitting in car/plane for long
    time, etc.), Hypercoagulability, blood disorders,
    injury to wall

85
Embolus
  • Material transported by blood stream, sticks in
    small vessel, impedes circulation
  • Thrombus - blood clot breaks loose and travels
    (DVTs, cardiac arrhythmias)
  • Cholesterol -often from atherosclerotic plaque in
    vessel
  • Fat bone fracture or fat droplets
  • Air (Gas) air bubbles surgery, injury,
    central cath, diving

86
Embolus
  • Material transported by blood stream, sticks in
    small vessel, impedes circulation
  • Septic pus-containing bacteria, bacterial
    clumps
  • Tissue of small fragments of tissue (placenta,
    etc)
  • FB foreign materials such as talc and other
    small objects
  • Amniotic fluid amniotic fluid, fetal cells,
    hair, or other debris enters mother's bloodstream
    via placenta and triggers allergic reaction

87
SS of Emboli
  • Depend on Location and amount of tissue served by
    vessel
  • Severe pain
  • Pale, numb, cold extremities
  • Arterial pulses absent beyond occlusion
  • NV, Fainting, Shock IF large artery

88
Causes of Emboli
  • Bed rest
  • Physical Inactivity
  • Heart failure
  • Arrhythmias
  • Pressure on veins
  • Decreased flow in veins

89
Arteriosclerosis
  • Group of diseases - hardening of arteries
  • 3 forms
  • Atherosclerosis
  • Plaque w/in arterial tunica intima
  • Monchebergs arteriosclerosis
  • Medial calcific sclerosis, tunica media
  • Destruction of muscle/fibers w/calcium deposits
  • Arteriosclerosis
  • Arteriole walls thicken, lose elasticity/contracti
    lity

90
Homework
  • Please access these two case studies and identify
    ALL (not just Cardiovascular) narrative dx
    statements that you would code. (DO NOT code
    yet)
  • N.B.The second case covers several encounters
  • Congestive Heart Failure Case Study. VHCT.
    School of Health Professions. University of
    Missouri Columbia.
  • http//www.vhct.org/case1899/phys_exam.htm
  • Lifestyle Issues in Cardiac Health. Robert L.
    Blake, Jr., MD. VHCT. School of Health
    Professions. University of Missouri Columbia.
  • http//www.vhct.org/case2800/index.htm

91
15 leading causes of death 2006
  • Diseases of heart (heart disease) (CV,
    Lifestyle)
  • Malignant neoplasms (cancer)
  • Cerebrovascular diseases (stroke) (CV,
    Lifestyle)
  • Chronic lower respiratory diseases
  • Accidents (unintentional injuries)
  • Diabetes mellitus (diabetes) (CV, Lifestyle)
  • Alzheimers disease
  • Influenza and pneumonia
  • Nephritis, nephrotic syndrome and nephrosis
    (kidney disease)
  • Septicemia (CV)
  • Intentional self-harm (suicide)
  • Chronic liver disease and cirrhosis
  • Essential hypertension and hypertensive renal
    disease (hypertension)
  • (CV, Lifestyle)
  • Parkinsons disease
  • Assault (homicide)

92
Questions ? ? ?
imueller_at_email.wcu.edu
Thank You !
93
AP/Pathophys Resources
  • American Heart Association/American Stroke
    Association. Cardiovascular media library.
    http//www.medmovie.com/mmdatabase/mediaplayer.as
    px?MessageVG9waWNpZD0wO0NsaWVudElEPTY1O1Zlcm5hY3V
    sYXJJRD0x2DP83bCzVaVLA3D
  • American Heart Assoc. Adults With Congenital
    Heart Defects. 12/14/09. http//www.americanheart
    .org/presenter.jhtml?identifier11062
  • American Heart Assoc. Blood Pressure.
    (n.d.) http//www.americanheart.org/presenter.jhtm
    l?identifier4473.
  • Cable, C. MD. Auscultation Assistant. 1997.
  • http//www.med.ucla.edu/wilkes/intro.html
  • The Cardiac Exam Auscultation
  • http//filer.case.edu/dck3/heart/listen.html
  • Cincinnati Children's Hospital Medical Center.
    Cardiac Anomalies / Congenital Heart Defects
  • http//www.cincinnatichildrens.org/health/heart-en
    cyclopedia/anomalies/default.htm
  • EKG/ECG Interpretation (4 minute video).
  • http//www.spike.com/video/ekgecg-intrpretation/31
    82500?cmpnid790ptsrrefsite7118

94
AP/Patho Resources
  • Frazier, M. S. and Drzymkowski, J. W. 2009.
    Essentials of Human Diseases and Conditions, 4th
    ed. Saunders.
  • Fulcher, E.M., Soto, C.D., Fulcher, R.M.
    Pharmacology Principles Applications. A
    worktext for Allied Health Professionals,
    Saunders, 2003.
  • Grays Anatomy. 1918. At Bartleby.com Great Books
    Online.
  • http//www.bartleby.com/cgi-bin/texis/webinator/si
    tesearch?FILTERcol107queryx12y10
  • Health Resources. Heart Failure Zones.
  • http//www.health-res.com/EX/08-03-22/HeartFailure
    Zones.gif
  • Heartpoint Gallery. http//www.heartpoint.com/gall
    ery.html

95
AP/Patho Resources
  • KidsHealth For Parents
  • http//kidshealth.org/misc/movie/parent/ASD_rev/AS
    D_rev.html
  • Maryland Heart Center. About the Heart.
    University of Maryland Medical Center.
  • http//www.umm.edu/heart/anatomy.htm
  • Mayo Clinic. High Blood Pressure (Hypertension).
  • http//www.mayoclinic.com/health/high-blood-pressu
    re/HI00062
  • Mayo Clinic. Coarctation of the Aorta.
  • http//www.mayoclinic.com/health/coarctation-of-th
    e-aorta/DS00616/DSECTIONsymptoms
  • MedlinePlus. U.S. National Library of Medicine
    and the National Institutes of Health.
  • http//medlineplus.gov/

96
AP/Patho Resources
  • Moisio M. A. E. W. Moisio, Understanding
    Laboratory and Diagnostic Tests, Delmar, 1998
    (2nd ed? later)
  • National Heart Lung and Blood Institute. What Is
    Angina?
  • http//www.nhlbi.nih.gov/health/dci/Diseases/Angin
    a/Angina_WhatIs.html
  • National Institute of Nursing Research. Womens
    symptoms are new or different Prior to heart
    attack.
  • http//www.ninr.nih.gov/NR/rdonlyres/C76323E9-822F
    -47D9-853F-61032685AC9E/4820/WomensSymptomsAreNewo
    rDifferentPriortoHeartAttack.pdf
  • Neighbors and Tannehill-Jones. Human Diseases.
    2000. Delmar
  • PQRST graphic
  • http//cygnus.et.put.poznan.pl/piotrw/nauka/fibon
    acci/heartelec2.gif

97
AP/Patho Resources
  • Robert Wood Johnson University Hospital. Heart
    Illustrations - Fetal Circulation
  • http//www.rwjuh.edu/health_information/ce
    nters_heart_fetlcirc.html
  • Scott, A. S. Fong, E. Body Structures and
    Functions, 11th ed., Delmar, 2009
  • St. Jude Medical. Heart Library.
  • http//www.heartlibrary.com/site-map.aspx
    (medical technology and services vendor)
  • Tetralogy of Fallot. American Heart Assoc.
  • http//www.americanheart.org/presenter.jhtml?ident
    ifier11071
  • WebMD. Congenital Heart Disease.
  • http//www.webmd.com/heart-disease/guide/congenita
    l-heart-disease

98
VHCT Cases
  • Congestive Heart Failure Case Study. VHCT.
    School of Health Professions. University of
    Missouri Columbia.
  • http//www.vhct.org/case1899/phys_exam.htm
  • Lifestyle Issues in Cardiac Health. Robert L.
    Blake, Jr., MD. VHCT. School of Health
    Professions. University of Missouri Columbia.
  • http//www.vhct.org/case2800/index.htm
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