NUR 130 Perfusion and circulation.pptx - PERFUSION AND CIRCULATION N Ross NUR 130 Anatomy \u2022 Hollow muscular organ pumps blood to tissues supplies

PERFUSION AND CIRCULATION N. Ross NUR 130

Anatomy • Hollow muscular organ, pumps blood to tissues, supplies 02/nutrients • 3 layers, pericardium • Atria, Ventricles

Diastole • Relaxation phase • Simultaneous • Preparation for contraction • “ventricular filling” • Shortens as HR increases Systole • Contraction phase • Atrial systole first (end of diastole) • Ventricular systole

Right • Right atrium, right ventricle • Distributes venous (deoxygenated) blood to lungs • via pulmonary artery • Receives venous blood returning to the heart Lef • Left atrium, left ventricle • Distributes oxygenated blood • Via aorta • Receives oxygenated blood

Atrium • Thinner walls • Little resistance as blood flows out (diastole) Ventricle • Thicker walls • Must overcome resistance from pulmonary , systemic circulation • Left 2-3x more muscular than right

• 4 Valves • Coronary Arteries • Myocardium • Conduction System—determines heart rate, SA node

Hemodynamics • Cardiac cycle • Cardiac output—Stroke Volume X Heart Rate 4 to 6L/min • Stroke Volume

Gerontologic, Gender Considerations • Loss of function of conduction system (age)  slower heart rate  pacer • Size increases (hypertrophy)  reduces volume chambers hold, reducing CO • Valves stiffen  don’t close properly  backflow  murmurs, valvular disease • Women size < Man • Women narrower arteries

Coronary Artery Disease Cardiomyopathy Heart Failure Hypertension Peripheral Vascular Disease Raynaud’s

Coronary Artery Disease

Atherosclerosis • Monocytes and Lipids enter injured vessel  smooth muscle proliferation  fatty streak and lymphocyte  plaque enlarges  vessels narrow  blood flow decreases  plaque may rupture  platelet attraction  thrombus  obstructs blood flow  Acute Coronary Syndrome  Myocardial Infarction

Risk Factors: • Non-modifiable (family history of CAD, age 45+ men 55+ women, gender-men, race-AA) • Modifiable (hyperlipidemia, smoking, HTN, DM, metabolic syndrome, obesity, physical inactivity)

Metabolic Syndrome • Major Risk factor for CVD, DM • 3 of the following: – Insulin resistance, fasting glucose > 100 – Central obesity, 35in+ women, 40in.+ men – Dyslipidemia— trigylcerides > 150mg/dl, HDL < 50mg/dL women, < 40mg/dl men – Blood pressure > 130/85 – Proinflammatory state, high C-reactive protein – Prothrombotic state, high fibrinogen

Prevention of CAD • Cholesterol control • Tobacco cessation • Manage HTN, DM, Weight • Diet low in saturated fat, high soluble fiber • Physical activity 150 min/week moderate intensity

• Mani: ischemia, angina pectoris, differs men v. women, asymptomatic 15%, jaw pain, indigestion • Myocardial damage  low CO  heart failure  sudden cardiac death

Angina • Episodes of pain/pressure in anterior chest • Caused by insufficient coronary blood flow (atherosclerotic disease) • Need for 02 exceeds the supply • Associated with typical angina: physical exertion, cold exposure, eating heavy meal, stress