DallasMcGregor

4/3/16
Period4

CardiovascularStudyGuide
ParagraphQuestions

1.Anarteryhasathickmusclelayerstructure.Thisstructureallowsittowithstandthepressure
causedbythebloodasithitsthesurfaceofthearteriolewallsandisejectedfromtheheart.A
veinhasathinnermusclelayerandonewayvalves.Thisstructureallowsittodistendwhenan
increasedamountofbloodentersit,and,onewayvalvesensurebloodflowblacktotheheart.A
capillaryhasasinglelayerendotheliumandextensivebranchingsystem.Thisstructureallows
forefficientexchangeofgasandliquidmoleculesduetoitsthinstructureandincreasedsurface
areaandvolumeprovidedforbyitsextensivebranchingsystem.

2.Cardiacoutputistheamountofbloodejectedintotheaortaperminute.Thecardiacoutputis
determinedbytheamountofbloodpercontractionorthestrokevolumeaswellasthenumberof
beatsperminuteorthepulserate.CO=strokevolumeXpulserate=70mlX75beats/min=
5250ml/min=5.25liters/min.

Clinical

1.Thispatienthashypertension,aconditioninwhichtheforceofthebloodagainsttheartery
wallsistoohigh.Weknowthispatienthashypertensionbecausethenormallevelforblood
pressureis120/70,andthispatientsis140/90.Additionally,atherosclerosisisaconditionin
whichthearterywallsthickenfromabuildupoffattysubstancessuchascholesterol.Thisplaque
stickstotheinnerwallsofthearteriescausingthemtonarrow.Theconnectionbetween
hypertensionandatherosclerosisisthatifhypertensiongoesuntreatedfora1015yearperiod,it
canleadtoextensivearterialdamage,andatherosclerosis.Thesignificanceofthepatients
weightinregardstohishypertensionisthattheheartmustworkhardertopushtheblood
throughtheexcesssurfacefatcoveringthemuscle.Continuously,thispatient'snicotine
consumptionresultedinexcessivetearingontheinnerwallsofthearterieswhichisrepairedby
extensiveplaquelikescabformationsthatnarrowthearteries.Thisdamagetothearteriescan
alsoleadtoatherosclerosisbecausewhenthearteriesaredamaged,scabsthatarelaiddownto
repairtherippedareaalsonarrowthearteries.Anginapectorisoccurswhenthemyocardiumis
deprivedofoxygen.Thisdeprivationofoxygencausesthenervoussystemtosendamessageto
thebrainintheformofcrushingchestpain.Anginapectorisrelatestothispatientssymptoms
becausethenarrowingofhisarteriesarecausingarestrictedbloodflowwhichsendsamessage
tobrainintheformofcrushingchestpainthatheisexperiencing.Ischemiaoccurswhenthereis

alocalizeddecreaseinbloodflowwhichstarvesandsuffocatesthecellsimpacted.Ischemia
couldbethediagnosesforthispatientbecausehisnarrowarteriesarerestrictingbloodflow
preventingthecellsaffectedfromreceivingoxygenatedblood.Myocardialinfarctionoccurs
whenthereisadecreaseinbloodflowtoalocalizedareaofthemyocardium,starvingand
suffocatingtheheartcells,eventuallyleadingtoaheartattack.Myocardialinfarctioncouldalso
explainthispatientssymptomsbecausethepatientsheartcellsaresuffocatingfromalackof
oxygenduetohisrestrictedbloodflowcausedbyhisnarrowarteries.Myocardiumisthemuscle
oftheheartandissuppliedwithbloodthroughthecoronaryarteries.Itisincrediblydangerous
forthecoronaryarteriestobecomeblockedbecausetheheartcouldsufferfromischemiaoreven
aheartattackduetothelackofoxygenatedbloodflow.Thefinaldiagnosisforthispatientis
anginapectoris.Basedonthepatient'sseverecrushingchestpain,enlargedheart,andclogged
coronaryartery,anginapectorisisthebestfit.ThesurgeryIwouldrecommendforthispatient
wouldbeacoronaryangioplasty.Beforetheprocedurestarts,themedicalstaffwillinsertanIV
linetogivethepatientpainmedicationsotheydonotexperiencediscomfort.Medicationswill
alsobegiventhroughtheIVtohelppreventbloodclots.Thenthepatientwillliedownona
table,andbecomesleepy.Themedicalstaffwillwrapabloodpressurecuffaroundthepatient's
armtomonitorbloodpressure,andhookupanEKGmachinetomonitortheelectriccurrent
acrosstheheart.Thenthedoctorswillshavetheareaofthepatientsskinwherethecutwillbe
madebeforecleaningtheareawithanantisepticandnumbingtheskin.Thenthedoctorwill
maketheincisionwherethecatheterwillbeinserted.Thedoctorwillthreadthecatheterintothe
incisionandinsidethecoronaryartery.Thedoctorwillwatchwherethecatheterisplacedonthe
Xray.Dyeisinjectedintothecatheter,whichwillclearlyshowwherebloodisandisnot
flowing.TheXrayimagesanddyewillshowthedoctorwheretheblockagesareintheblood
vessels.Next,thedoctorwillthreadatinywireintotheblockedbloodvessel,toserveasaguide
foraballooncatheter.Thedoctorwillinserttheballooncatheterovertheguidewire,andthen
inflateittoopenuptheblockagebysqueezingthefatandcholesterolbuildupagainstthearterial
wall.Thisallowsbloodflowfromthehearttoresume.Stenting,isalsoperformedduring
angioplasty.Astentisatinytube,madeofwiremesh,whichthedoctorwillplaceinsidethe
arterytohelpitstayopenandpreventfutureblockages.Thedoctorwillpullthecatheteroutof
thearteryandputabandageovertheincision.Finally,theIVisremoved,andthepatientcanrest
andrecover.

2.Thesinoatrialnodeistheheartsnaturalpacemaker.Agroupofnervecellsthatinitiate
depolarizationwaveoriginateonthesinoatrialnodeandcontinueacrosstheentiresurfaceofthe
heart.Whenthesinoatrialnodeisdysfunctionaldepolarizationisdelayedresultinginaslow
heartrateandirregularheartrhythms.Thepartofthepatientsintrinsicconductionsystemofthe
heartthatisdamagedissinoatrialnodebecausethepatienthasalowheartrate,lessthan60per
minute,resultingintheirseverefatigueandinabilitytomaintainanormalactivitylevel.In
explanation,thepatientsheartisnotbeatingefficientlyenoughforthepatienttoengageina

normalactivitylevelexplainingthepatientsfatigue.AnECGorEKGmeasurestheflowofthe
electricalcurrentacrosstheheart.Thispatient'sECGisirregularbecausehissinoatrialnodeis
damaged,preventingproperdepolarizationacrosstheentiresurfaceoftheheart.Bradycardiais
definedasaslowheartrate.Anormalheartrateis60100beatsperminute.Thispatientis
sufferingfrombradycardiabecausetheirheartrateisbelow60.Whenyourbiologicalpumpis
sluggishthisdecreasesbloodflowintothetissuesalloveryourbody.Ifthelackofbloodflowis
severethebodytissueswillbegintostarveandsuffocate.Bradycardiaisdangerousbecauseit
canleadtoischemiaandmyocardialinfarction.Ischemiaisalocalizeddecreaseinbloodflow
whichstarvesandsuffocatestheaffectedcells.Ischemiarelatestothepatientbecausethepatient
hasrestrictedbloodflow,starvingandsuffocatedcellsaffected.Myocardialinfarctionisaheart
attack,whichthepatientisatriskforifbradycardiacontinuestoensue.Aninfarctiswhen
oxygendeprivedcellsandtissuesdiewhichcouldverywellhappentothispatientduetotheir
restrictedbloodflow.ThetreatmentIwouldrecommendforthispatientwouldbetheinsertion
ofapacemaker.Toinsertapacemaker,asmallincisionwillbemadeintheupperchest.Oneor
twothininsulatedwireswillbeguidedthroughaveinintotheheart.Thedoctorwillthen
connecttheleadtothepacemakerandprogramthedevice.Thenthepacemakerwillbeinserted
beneaththeskin,andtheincisioninthechestwillbeclosed.Lastly,thedoctorwilltestthe
pacemakertoensureitisworkingproperly.

3.RheumaticfeverisuntreatedStreptococcusAwhichdamagestheheartvalves.Itisimportant
tonotethatrheumaticfeveronlyoccursinunderdeveloped,impoverished,andunsanitary
countries,notindevelopedones.Theheartvalveskeepbloodflowingintheproperdirections.
Damagedvalveswillbackflush,resultinginpooledbloodatthebottomoftheventricles.This
poolofbloodcausesexcessivestrainontheventricularwallsmakingthemstretchedoutand
flabbyasbloodcontinuestopoolatthebaseoftheheart.Unfortunately,therepercussionto
flabbystretchedoutlungsiscongestiveheartfailure.Congestiveheartfailurecanoccurifthe
heartcannotpumporfillproperly.Restrictedbloodflowacrossaheartvalveiskindoflikethe
pinchingofagardenhorse.Theoutcomeofthisrestrictedbloodflowisabnormalsoundsknown
asheartmurmurs.Heartmurmursareamutationthatcanbeanindicationofvalvedysfunction.
Mitralstenosisisthenarrowingofthemitralvalvecausingrestrictedbloodflow.Thisrestricted
bloodflowpreventsthemitralvalvefromclosingproperly.Continuously,ifthemitralvalveis
partiallyopenduringventricularcontraction,bloodwillbackflushintotheatria.And,ifthis
occurs,thebloodwillnotoxygenated,resultinginnonoxygenatedbloodbeingsystematically
transportedintothebodytissues,causingfatigue.Thetreatmentforthispatientwouldbemitral
valvesurgerytoreplacetheirmitralvalve.Inthissurgery,theheartsurgeonwillmakea2inch
to3inchlongcutnearthepatientssternum.Musclesintheareawillbedividedtoallowthe
surgeontoreachintotheheart.Asmallcutismadeintheleftsideoftheheartsothesurgeoncan
replacethemitralvalve.Fortheirreplacementvalve,thepatientmaychooseamechanicalvalve,
madeofmanmadematerials,suchastitaniumandcarbon,whichlastthelongest.Butifthe

patientchoosesthismanmadevalve,theywillhavetotakeintoconsiderationthemany
bloodthinningpillstheywillhavetotakefortherestoftheirlife.Insteadofamanmadevalve
thepatientcouldchooseabiologicalvalve,madeofhumanoranimaltissue.Thesevalveslast10
to15yearsorlonger,but,thepatientwillprobablynotneedtotakebloodthinnersforlife.