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
Chest Pain Assessment 1. Where is the pain? Can you point to it?
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- Spring '20
- Venous insufficiency