Heart Function & Anatomy PDF

I & Approximately the size of your fist Location Superior surface of diaphragm Left of the midline Anterior to the vertebral column, posterior to the sternum  < protect)...

I & Approximately the size of your fist Location Superior surface of diaphragm Left of the midline Anterior to the vertebral column, posterior to the sternum  < protect) perican a + (muscle - , Heart covering Protects and anchors the heart Contains pain receptors and mechanoreceptors that can cause changes in blood pressure and heart rate There is pericardial fluid inside the pericardial cavity that acts as lubricant to minimize friction when the heart beats Rep + hard for blood flow Frontal section of the heart Four chambers: Right atrium and ventricle, left atrium and ventricle Atrioventricular (AV) valves: Tricuspid and mitral valve I backflowcompletely > not - > close blood at Chanded) - Semilunar (SL) valves: Pulmonic and aortic valve E Coronary Circulation Coronary artery disease LPCI/PTCA) Coronary circulation is the functional blood supply to the heart  Physiology of the heart – Vbc) 1. Pathway of Blood through the Heart and Lungs (lung) Oxygenated Blood is carried in a closed system of vessels that begins and ends at the heart The three major types of vessels are arteries, capillaries, and veins (whole body) Arteries carry blood away from the heart, veins carry blood toward the heart Capillaries contact tissue cells and directly serve cellular needs Physiology of the heart – 2. Cardiac cycle Blood flows from higher to lower pressure. Contraction increases pressure. Valves open/close according to the pressure gradient.  Atrial pressure > Ventricular pressure AV valves open Filling of ventricles contract+ pressure artium > value open - Ventricular pressure < Aortic and pulmonary trunk pressure contraction Atrial pressure < SL valves close Ventricular pressure relaxation AV valves close Ventricular pressure > Aortic and pulmonary trunk pressure SL valves open Ejection of blood Cardiac output (CO) ↑ CO is the amount of blood pumped by each ventricle in one minute CO is the product of heart rate (HR) and stroke volume (SV) HR is the number of heart beats per minute SV is the amount of blood pumped out by a ventricle with each beat Normal > - 5L Trained athletes vs. Normal persons & (SV: 100 ml vs 70 ml) S beats low heart high Su  Physiology of the heart – 3. Cardiac conduction system 1. Sinoatrial (SA) node generates impulses about 75 times/minute 2. Atrioventricular (AV) node delays the SA node impulse approximately 0.1 second Linitual) 3. Impulse passes from atria to ventricles via the atrioventricular bundle (bundle of His) AU mode (conductor) 4. AV bundle splits into two pathways in the interventricular septum (bundle branches) Bundle branches carry the impulse toward the apex of the heart Purkinje fibers carry the impulse to the heart apex and ventricular walls Electrical activity is recorded by electrocardiogram (ECG) Part 2 - Assessment for Cardiovascular System 1. Health history and physical examination 2. ECG 3. Blood tests 4. Echo and treadmill 5. Imaging 6. Cardiac catheterization 1. Health history and physical examination BackgroundTravelhisum Past medical history and medications Family history - Habits > cardio problem - Cardiac symptoms Chest pain or discomfort Fatigue Shortness of breath (SOB) Palpitations Syncope Edema 1. Health history and physical examination Vital signs measurement Pulse palpation Vein observation Inspection, percussion, auscultation, and palpation (sound of space) 2. ECG (electrocardiogram) electric impulse Ex P wave corresponds to depolarization of SA node QRS complex corresponds to ventricular depolarization T wave corresponds to ventricular repolarization Horizontally One small box - 0.04 s One large box - 0.20 s Vertically One large box - 0.5 mV 3. Blood tests cell breakdown - released heart attack-> Cardio enzyme Cardiac enzymes (troponin, creatinine kinase) Blood chemistry, haematology, coagulation Lipid profile: LDL-C,HDL-C, cholesterol, triglycerides Chormone) Thyroid function tests  I 2 3 4. Echo, holter and treadmill 2) (heart front) PER Structure blood flow strake volume Two-dimensional echocardiogram > - , , echo Use ultrasound to create image of the heart structure and their motion ↓ t - & 4. Echo, holter and treadmill Holter it A Holter monitor is a machine that continuously records the heart's rhythms. The monitor is usually worn for 24 - 48 hours during normal activity. Holter monitoring is used to determine how the heart responds to normal activity > - to catch imnormal activity 4. Echo, holter and treadmill die heart too hard Treadmill the > stress - exercise An exercise stress test is a screening tool used to test the effect of exercise on your heart The test continues until: You reach a target heart rate You develop chest pain or a change in your blood pressure that worries your doctor ECG changes show that your heart muscle is not getting enough oxygen You are too tired or have other symptoms, such as leg pain, that keep you from continuing closer look to cardio artery CT and MRI Y cardia Muscle  Ex 6. Cardiac catheterization > - I detect C CIPCI blockage of artery 2) PCI During cardiac cath, a catheter is inserted into an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart Cardiac cath can define coronary artery anatomy, cardiac anatomy, and cardiac function to establish diagnoses and help select treatment. Cardiac cath is also the basis for several therapeutic interventions. Part 3 - Common Cardiac Condition Common cardiac condition – Heart failure Heart failure (HF) describes the complex clinical syndrome where the heart is incapable of maintaining a cardiac output (CO) that is adequate to meet metabolic requirements and accommodate venous return. In layman terms: your heart isn’t pumping enough blood. The heart keeps working, but the body’s need for blood and oxygen isn’t being met. Heart Failure - Epidemiology > 60 million heart failure patients worldwide (how many cases) Global prevalence ~ 1-3% incident+ new cases Prevalence increases with age => ~ 1% in age group < 55 years vs I > 10% in age group > 70 years common Recent increase in incidence of heart failure in patients < 50 years old  Heart Failure – Types of heart failure Both side of ventricle I Biventricular heart failure Left, right failure; systolic/diastolic A Cor pulmonale EftE 2) ↑ = - Heart failure secondary to any cause of pulmonary arterial hypertension pulmaartery presea ↓ blood 3) Left-sided heart failure Impaired ability of the left ventricle to maintain adequate cardiac output 4) Right-sided heart failure Impaired ability of the right ventricle to deliver blood flow to the pulmonary circulation  Heart Failure – Types of heart failure 5) Heart failure with reduced ejection fraction (HFrEF) 6) Heart failure with mildly reduced ejection fraction (HFmrEF) 7) Heart failure with preserved ejection fraction (HFpEF) 8) Right ventricular dysfunction 45. · European Society of Cardiology guideline,2021 HFrEF reduced ejection fraction HFmrEF mildly reduced ejection friction HFpEF preserved ejection fraction Symptoms +/- Signs Symptoms +/- Signs Symptoms +/- Signs LVEF =50% Objective evidence of cardiac structural +/- functional abnormalities consistent with presence of LV diastolic dysfunction/ raised LV filling pressures +/- raised natriuretic peptides contraction & blood ↓ poor cardic output. pumping & filling impairments normal but the ventricle pump , heart pumping is , don't relax properly , impairing filling  Heart Failure – Signs and symptoms (na) non-observable > - feeling of patient observable E (subjective) Signs and symptoms What people experience… Why It Happens 1) Shortness of breath (also called Breathlessness during activity Blood "backs up" in the pulmonary dyspnea) (most commonly) or while at rest. veins (the vessels that return blood Sometimes it comes on suddenly at from the lungs to the heart) night, making it very hard to because the heart can't keep up breathe unless you get up and with the supply. This causes fluid to move around. You may need leak into the lungs. several pillows to raise your upper body so you can breathe more easily. 2) Persistent coughing or wheezing coughing that produces white or Fluid builds up in the lungs pink blood-tinged mucus.  Heart Failure – Signs and symptoms Signs and symptoms What people experience… Why It Happens ③ Buildup of excess fluid in body Swelling in the feet, ankles, legs, Not enough blood is pumped out tissues (edema) fingers, abdomen and in other of the heart with each heartbeat. 4 tissues and organs. As a result, Then, because the heart isn’t weight gain is common. emptying as it should, blood returning from the body can’t enter the heart and backs up in the veins. This forces fluid from the blood vessels into other tissues, causing swelling (edema).  Heart Failure – Signs and symptoms Signs and symptoms What people experience… Why It Happens Tiredness, fatigue j 4) A tired feeling all the time and difficulty with everyday activities, The heart can't pump enough blood to meet the needs of body such as shopping, climbing stairs, tissues. The body diverts blood carrying groceries or walking. You away from less vital organs, may also feel sleepy after eating, particularly muscles in the limbs, feel weak in the legs when walking and sends it to the heart and brain. (vital organs) and get short of breath while being active. 5) Lack of appetite, nausea A feeling of being full or sick to The digestive system receives less your stomach. blood, causing problems with digestion.  Heart Failure – Signs and symptoms Signs and symptoms What people experience… Why It Happens 6) Increased heart rate > - ↑ cardia output Heart palpitations, which feel as if To "make up for" the loss in your heart is racing or throbbing. pumping capacity, the heart beats faster. Weight changes Sudden weight gain or loss can be a Reduced blood flow to your 7) sign that you’re developing heart loss : stomach can make it harder to failure, or that your heart failure is absorb nutrients from your food progressing. and mayY cause weight loss./Extra gain : fluid retention may cause your weight increase. Heart Failure – Diagnostic algorithm Heart Failure - Classification New York Heart Association (NYHA) Classification of Heart Failure I Class I No limitation of physical activity. Ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations. Class II Slight limitation of physical activity I Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, dyspnea, or angina  Heart Failure - Classification New York Heart Association (NYHA) Classification of Heart Failure 3) Class III Marked limitation of physical activity Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or angina Class IV Unable to carry out any physical activity 4) without discomfort Symptoms of cardiac insufficiency may be present even at rest  disease coronary artery ( leading neut failure Heart Failure - Causes Heart Failure - Causes Heart Failure - Pathophysiology The most common causes of HF include CAD, diabetes mellitus, hypertension, obesity, and cardiomyopathy. Coronary heart disease 1. Plaques are deposited along the coronary arteries. 2. Over time, these plaques occlude blood flow to the area distal of the deposit. Heart Failure - Pathophysiology Coronary heart disease (Con’t) 3. The oxygen-rich blood that is needed is no longer present in the myocardium and cardiac oxygen demand surpasses supply. 4. This hypoxia can lead to cell injury and death. As cells die, they are not replaced, and other cardiac muscle cells must elongate and stretch to compensate. This leads poorly functioning myocardial cells. 5. These changes lead to a weakened myocardium with decreased cardiac output that is unable to meet the metabolic demands of the body. Heart Failure - Pathophysiology Diabetes Mellitus DM 1. High blood sugar levels and alterations in lipid metabolism cause damage to the vessels that supply blood to the heart. ( can cause blind) 2. This damage leads to decreased blood flow, which in turn leads to decreased myocardial function and potential death of myocardial cells. 3. As cells die, neighboring cells attempt to compensate by altering their shape and workload, but as a result they function poorly. 4. This leaves the heart unable to meet the metabolic needs of the body. Heart Failure – Mortality Eb 1-year mortality up to 15-30% 5-year mortality up to >50% Heart Failure – Risk factors and prevention >is - S Heart Failure – Pharmacological Treatment Angiotensin-converting Enzyme (ACE) Inhibitors /Angiotensin II Receptor Blocker (ARB) Beta-blockers o Aldosterone Antagonists Angiotensin receptor-neprilysin inhibitor (ARNI) SGLT2 inhibitors Ivabradine- selective If channel inhibitor => Improve heart function, reduce heart failure hospitalisation and mortality Heart Failure - Intervention Disease-specific intervention CAD => revascularisation (CABG/ PCI) Valve disease => transcutaneous/ open heart valve repair/ replacement Pacemaker Implantable Cardioverter Defibrillator (ICD) (electrical impulse) Cardiac Resynchronisation Therapy (CRT) Heart Failure – Cardiac rehabilitation Comprehensive supervised cardiac training program Multidisciplinary team- physicians, nurses, physical therapists, occupational therapists, medical social workers, dietitians Provides exercise training, emotional support and education Helps improve heart failure patients’ quality of life, improve cardiopulmonary function, reduce heart failure hospitalisation & mortality Heart Failure – Lifestyle modifications Drug compliance Exercise regularly Fluid restriction (1.5 – 2L/day for patient with severe HF) Salt restriction (Avoid excessive salt intake, i.e. >5g/day) Symptom monitoring Quit smoking References McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier. Rogers, C., & Bush, N. (2015). Heart failure. Nursing Clinics of North America, 50(4), 787–799. https://doi.org/10.1016/j.cnur.2015.07.012 Tortora, G. J., &amp; Derrickson, B. (2009). Principles of anatomy and physiology. Wiley. Widmaier, E. P. (2018). Vander’s human physiology: The mechanisms of body function. McGraw-Hill Education.