Paramedic Science - The Circulatory System PDF

Paramedic Science Health & Human Development 2 The Circulatory System  Structure The circulatory system is made up of the vessels that carry blood to or from the heart. Arteries carry blood away from the heart. Whilst veins carry blood towards the heart. The system is unidirectional....

Paramedic Science Health & Human Development 2 The Circulatory System  Structure The circulatory system is made up of the vessels that carry blood to or from the heart. Arteries carry blood away from the heart. Whilst veins carry blood towards the heart. The system is unidirectional. Structure Your heart is roughly the size of a fist and sits in the middle of your chest, slightly to the left. It’s the muscle at the centre of your circulation system, pumping blood around your body as your heart beats. This blood sends oxygen and nutrients to all parts of your body. It carries away unwanted carbon dioxide and waste products. Structure Pericardium is double walled layer that surrounds the heart. This is divided into two sub layers. Parietal Pericardium - the outer layer of the pericardial sac. Visceral Pericardium - the innermost layer of the pericardial sac. Also known as the Epicardium Structure Myocardium layer is made up of mostly cardiac muscle tissue that is made up in planes and is richly supplied by blood capillaries, lymph capillaries and nerve fibres. It pumps blood out of the chambers of the heart. Structure Endocardium layer is the innermost layer of the heart and it rests against the inner myocardial surface. Lining the chambers of the heart and covering the fibrous tissue that forms the heart valves. Structure The heart is divided into four main chambers. The Right Atrium The Right Ventricle The Left Atrium The Left Ventricle Structure The Right Atrium receives blood from the rest of the body. Returning via the Superior and Inferior Vena Cava. This blood is transporting deoxygenated blood high in carbon dioxide back to the heart. It then passes through the tricuspid valve to. Structure The Right Ventricle receives blood from the Right Atrium. Where after ventricular contraction the blood is passed from the Right Atrium to the lungs for reoxygenation via the Pulmonary Semilunar Valve and Left & Right Pulmonary Arteries. Structure Oxygenated blood returns to the Left Atrium via the pulmonary veins and after Atrial Contraction passes through the Bicuspid Valve into Structure The Left Ventricle. Once the blood enters the left ventricle and after ventricular contraction the blood passes through the Aortic Valve and into the Circulatory System. The Circulatory System can be divided into two main categories.  Pulmonary Circulation (Circuit) Pulmonary circulation moves blood between the heart and the lungs. It transports deoxygenated blood to the lungs to absorb oxygen and release carbon dioxide. The oxygenated blood then flows back to the heart Systemic Circulation The systemic circulation provides the functional blood supply to all body tissue. It carries oxygen and nutrients to the cells and picks up carbon dioxide and waste products. Electrical Conduction System The specialized electrical conduction system of the heart allows for the synchronous contraction of the left and right sides of the heart and the sequential contraction of the atria and ventricles. Coronary Circulation Coronary circulation is the circulation of blood in the blood vessels that supply the heart muscle (myocardium). Coronary arteries supply oxygenated blood to the heart muscle. Cardiac veins then drain away the blood after it has been deoxygenated.  Pathophysiology Angina Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked, also called ischemia. Pathophysiology Atherosclerosis Atherosclerosis is the build up of fats, cholesterol and other substances in and on the artery walls. This build up is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot  Pathophysiology Stable Angina Stable angina (angina pectoris) is a type of chest pain that happens when your heart muscle needs more oxygen than usual but it's not getting it at that moment because of heart disease. It is usually predictable and comes on at times of exertion. It passes when this exertion stops or is eased by the use of vasodilators.  Pathophysiology Unstable Angina Unstable angina, also called crescendo angina, is a type of angina pectoris that is irregular. It can be unpredictable and present during periods of rest. It can be an escalation of Stable Angina and generally indicates a deterioration in cardiac health, which if uncorrected could lead to Myocardial Infarction. It is also classified as a type of acute coronary syndrome (ACS).  Pathophysiology Angina Signs & Symptoms The most common symptom of acute coronary syndromes is severe pain in the chest and/or in other areas (for example, the arms, back or jaw), which can last for several hours. Other symptoms include sweating, nausea and vomiting, breathlessness and feeling faint.  Pathophysiology Treatment Follow JRCALC Acute Coronary Syndrome Guideline.  Pathophysiology ST Elevation Myocardial Infarction (STEMI) A STEMI is the most serious type of heart attack where there is a long interruption to the blood supply. This is caused by a total blockage of the coronary artery, which can cause extensive damage to a large area of the heart.  Pathophysiology Non ST Elevation Myocardial Infarction (NSTEMI) A Non STEMI is just as serious as a STEMI. It is type of heart attack where there is a long interruption to the blood supply. This is caused by a total blockage of the coronary artery, which can cause extensive damage to a large area of the heart. However, the patient shows no ST Elevation on their ECG. They will have the same symptoms as a MI but no clinical ECG Evidence.  Pathophysiology Silent Myocardial Infarction (Silent MI) A Silent Myocardial Infarction is a heart attack that has few, if any, symptoms or has symptoms not recognized as a heart attack. However, when an electrocardiogram is carried out there is clinical evidence of STEMI.  Pathophysiology MI Signs & Symptoms Chest discomfort, pain or pressure is often the first and most obvious symptom of a STEMI. It may be described as a heaviness, aching, tightness, throbbing or constriction. This discomfort is usually located in the centre or left side of the chest, though it may also occur in the jaw, neck, back, arms or upper part of the stomach, and occasionally only at these secondary sites. Other symptoms may include: Shortness of breath Fatigue Dizziness or light-headedness A cold sweat Nausea and vomiting  Pathophysiology Treatment Follow JRCALC Acute Coronary Syndrome Guideline.  Pathophysiology Heart Failure Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath. Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.  Pathophysiology Heart Failure Signs & Symptoms The signs and symptoms generated can be grouped together depending on whether the left or right side of the heart is involved. Left ventricular failure is the most common and most frequently caused by a previous myocardial infarction. Poor ventricular contraction occurs, and blood backs up into the lungs. This increases pulmonary vein hydrostatic pressure and subsequently causes fluid to enter the alveoli, seen as pulmonary oedema. The presence of this fluid causes a reduction in gas exchange.  Pathophysiology Heart Failure Signs & Symptoms Right heart failure is primarily caused by left heart failure but can also be caused in isolation by lung disease, such as COPD or pulmonary embolism as well as valvular disease. An increase in pressure in the pulmonary vasculature causes an increase in right ventricular afterload, resulting in ventricular hypertrophy and subsequently leads to progressive dilation and eventual failure. This mechanism gives rise to the common signs and symptoms seen in a right-sided pathology ‒ raised JVP, hepatomegaly, ascites and significant peripheral oedema.  Classification of Oedema Classification Description Class 1 2mm depression, barely detectable. Immediate rebound. Class 2 4mm deep pit. A few seconds to rebound. Class 3 6mm deep pit. 10-12 seconds to rebound. Class 4 8mm very deep pit. > 20s seconds to rebound  Pathophysiology Treatment Follow JRCALC Heart Failure Guideline  Takotsubo Cardiomyopathy Takotsubo cardiomyopathy is a temporary heart condition that develops in response to an intense emotional or physical experience. It’s also known as stress cardiomyopathy or broken heart syndrome. In this condition, the heart’s main pumping chamber changes shape, affecting the heart’s ability to pump blood effectively. The heart’s chamber looks like a Tako -Tsubo pot, which is a Japanese fishing pot used to catch octopus.  Pathophysiology Left Ventricular Assist Device (LVAD) An LVAD is a kind of artificial heart pump. It is used to treat people with severe heart failure and is sometimes given to people on the waiting list for a heart transplant. Normally, the left ventricle, one of your heart’s four chambers, pumps blood into your aorta (the large artery leaving the heart) and around your body. In the event that someone has severe heart failure, the heart is too weak to pump enough blood around the body. Some patients being considered for a heart transplant may need to have an LVAD implanted if they are unlikely to survive until a suitable donor heart becomes available. The device helps the failing heart and aims to restore normal blood flow. Pathophysiology Left Ventricular Assist Device (LVAD)  Pathophysiology Treatment Follow JRCALC Guideline Management and Resuscitation of Patients with Left Ventricular Assist Devices (LVADs)  Pathophysiology Aortic Dissection An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's main artery (aorta). Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect). If the blood goes through the outside aortic wall, aortic dissection is often deadly.  Pathophysiology Aortic Dissection DeBakey classification: Type I: Dissection originates in the ascending aorta and involves the descending aorta. Type II: Dissection involves only the ascending aorta. Type III: Dissection involves only the descending aorta (distal to the subclavian artery). Type IIIa: ends above the diaphragm Type IIIb: extends below the diaphragm  Pathophysiology Aortic Dissection Stanford classification: Type A: involvement of the ascending aorta Type B: involvement of the descending aorta (distal to the origin of the left subclavian artery)  Pathophysiology Signs & Symptoms Aortic dissection symptoms may be similar to those of other heart problems, such as a heart attack. Typical signs and symptoms include: Sudden severe chest or upper back pain, often described as a tearing or ripping sensation, that spreads to the neck or down the back Sudden severe stomach pain Loss of consciousness Shortness of breath Symptoms similar to those of a stroke, including sudden vision problems, difficulty speaking, and weakness or loss of movement (paralysis) on one side of your body Weak pulse in one arm or thigh compared with the other Leg pain Difficulty walking  Pathophysiology Treatment Follow JRCALC Vascular Emergencies Guideline  Pathophysiology Abdominal Aortic Aneurysm (AAA) An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from the heart through the centre of the chest and abdomen.  Pathophysiology Signs & Symptoms Sudden, severe pain in the stomach or lower back. Pulsatile Mass. Mottling of the abdomen. Distension. Ischemia to the lower limbs. Dizziness. Sweaty, pale and clammy skin. Tachycardia Tachypnoea Dyspnoea. Lightheaded or collapse.  Pathophysiology Treatment Follow JRCALC Vascular Emergencies Guideline  Pathophysiology Arteriovenous Fistula Haemorrhage An arteriovenous (AV) fistula is an irregular connection between an artery and a vein. Usually, blood flows from the arteries to tiny blood vessels (capillaries), and then on to the veins. Nutrients and oxygen in the blood travel from the capillaries to tissues in the body. With an arteriovenous fistula, blood flows directly from an artery into a vein, avoiding some capillaries. When this happens, tissues below the avoided capillaries receive less blood. Pathophysiology  Pathophysiology Treatment Follow JRCALC Vascular Emergencies Guideline  Pathophysiology Pericarditis Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other. Pericarditis is usually mild and goes away without treatment.  Pathophysiology Pericarditis Typical ECG findings in acute pericarditis are present in no more than 60% of cases and evolve in four stages. In particular, ECG initially (within hours to days) depicts diffuse concave ST-segment elevation (in all leads, except aVR and often V1).  Pathophysiology Signs & Symptoms Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain. Pericarditis pain usually occurs behind the breastbone or on the left side of the chest.  Pathophysiology Signs & Symptoms Spread to the left shoulder and neck Get worse when coughing, lying down or taking a deep breath Get better when sitting up or leaning forward Cough Fatigue or general feeling of weakness or being sick Leg swelling Low-grade fever Tachycardia Orthopnoea Distension of the abdomen  Pathophysiology Treatment Rapid transportation to Hospital and manage associated symptoms.  Pathophysiology Cocaine Toxicity Cocaine toxicity occurs within minutes to hours of excessive cocaine use. Some patients may die suddenly before treatment is given.  Pathophysiology Signs & Symptoms Hypermania, Chest Pain, Tachycardia, Tachypnoea, Hypertension, Hyperthermia, Diaphoresis, Mydriasis, Agitation.  Pathophysiology Treatment Follow JRCALC Overdose and Poisoning in Adults and Children. Also consider Midazolam.  Pathophysiology Sickle Cell Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia. Sickle cell disease is particularly common in people with an African or Caribbean family background. People with sickle cell disease produce unusually shaped red blood cells that can cause problems because they do not live as long as healthy blood cells and can block blood vessels. Pathophysiology  Pathophysiology Signs & Symptoms Pain in hands or feet (particularly in young children), ribs and breastbone, spine, pelvis, stomach, legs and arms. Frequent Infections Anaemia Dyspnoea Tachypnoea Tachycardia Reduced SPO2  Pathophysiology Treatment Follow JRCALC Sickle Cell Disease Guideline.  Pathophysiology Symptomatic Bradycardia When the electrical impulses produced by the sinus node are disturbed, the heart beats at a slower rate than normal (this is called bradycardia). This can cause problems such as faints, falls, dizziness, confusion, palpitations (when the person is aware of the heartbeat), difficulty breathing and chest pain. When bradycardia occurs with these symptoms it is called symptomatic bradycardia.  Pathophysiology Signs & Symptoms Bradycardia, Dyspnoea, Light-headedness Collapse, Hypotension, Poor peripheral perfusion. Tachypnoea, cyanosis, signs of shock.  Pathophysiology Treatment Rapid transportation to hospital. Consider Atropine and manage associated symptoms.  Pathophysiology Gastro-intestinal Bleeding Haematemesis is the vomiting of blood, which may be obviously red or have an appearance similar to coffee grounds. Melena is the passage of black, tarry stools. Haematochezia is the passage of fresh blood per anus, usually in or with stools. Haematuria blood in the urine. Haemoptysis the coughing up of blood from your lungs or airways Epistaxsis when a blood vessel inside the nose bursts.  Contact Information Should you have any questions you should contact the module lead in the first instance. Followed my your syndicate lead if appropriate. Module Lead: Will Hendry [email protected] Programme: Paramedic Science [email protected]