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74 year old female patient has a myocardial infarction causing permanent…

- - - - systolic pressure is the arterial pressure during ventricular contraction
      - diastolic pressure is the arterial pressure during ventricular relaxation
      - normal is 120/80 mmHg
      - hypotension: systolic lower than 90 mmHg or diastolic lower than 60 mmHg
      - hypertension: systolic greater than 140 mmHg or diastolic greater than 90 mmHg
    - - average pressure driving blood into vessels that serve tissues
      - MAP= Diastolic +1/3 Pulse pressure
      - if MAP is low, the blood pressure isn't high enough to ensure sufficiency delivery of oxygenated blood to tissues
    - - measures elasticity & recoil of arteries
      - PP= systolic pressure - diastolic pressure (120-80= 40 mmHg)
    - - peripheral resistance (K14.3)
        
        vessel diameter
        
        smaller lumen (ie: vasoconstriction)
        
        increased resistance
        
        larger lumen (ie: vasodilation)
        
        decreased resistance
        
        vessel length
        
        longer vessel will increase resistance
        
        shorter vessel will decrease resistance
        
        blood viscosity
        
        decreased viscosity will decrease resistance
        
        increased viscosity will increase resistance
        
        amount of friction blood experiences as it travels through vessels
        
        increased peripheral resistance will decrease blood flow & increase blood pressure
      - blood volume
        
        increased blood volume (ie: water and sodium retention)
        
        increased blood pressure
        
        decreased blood volume (ie: dehydration, bleeding, vomiting)
        
        decreased blood pressure
      - cardiac output
        
        decreased cardiac output
        
        decreased blood pressure
        
        increased cardiac output
        
        increased blood pressure
    - - decreased systemic blood pressure
        
        low glomerular filtration rate
        
        less filtrate and NaCl in renal tubule
        
        macula densa cells of the juxtaglomerular complex sense low NaCl concentration
        
        macula densa signal granular cells
        
        granular cells of juxtaglomerular complex in kidneys release renin
        
        1 more item...
        
        low pressure sensed by baroreceptors in blood vessels
        
        sympathetic nervous system stimulation (K14.11c)
        
        vasoconstriction to increase blood pressure
      - increased systemic blood pressure
        
        heart secretes atrial natriuretic peptide (K14.11d)
        
        decreased Na+ reabsorption in renal tubules
        
        increased Na+ and water excretion in urine
        
        lowers blood volume and blood pressure
  - - - regulate blood pressure throughout body
      - arteriole stays slightly contracted to lower pressure of blood approaching capillaries
    - - smooth muscle of tunica media contracts
        
        increased blood pressure and decreased lumen size
    - - smooth muscle of tunica media relaxes
        
        decreased blood pressure and increased lumen size
  - - - inside the vessel where blood flows
    - - innermost layer
      - composed of endothelium
    - - composed of smooth muscle supported by elastic fibers
      - middle layer
      - vasoconstriction
        
        narrowing of lumen
      - vasodilation
        
        widening of lumen
    - - outermost layer
      - composed of areolar tissue with elastic fibers
      - anchors blood vessel to other structures
    - - network of arteries that supply the tunica externa
  - - - volume of blood in veins that can be returned to circulation if needed
    - - smallest veins that leave capillaries
    - - pushes reservoir blood into circulation faster when more is needed
  - - - contains gaps between endothelial cells to allow passage of small molecules
      - muscle, skin, lungs
    - - small intestines & kidneys
      - numerous holes for fluid transport and passage of small molecules
      - blocked passage for large molecules & formed elements
    - - discontinuous lining with large openings
      - allows large molecules & formed elements to pass
      - red bone marrow, spleen, liver
  - - - 2+ arteries joining together to supply a region
    - - 2+ veins draining the same body region
    - - transports blood from artery directly to vein, bypassing capillary bed
      - common in fingers, toes, palms, & ears
        
        bypassed if body is hypothermic
  - - - coronary arteries branch off the aorta and supply the heart with oxygenated blood
      - collateral coronary circulation
        
        a network of vessels used to bypass blockages
    - - deoxygenated blood from the side of the heart
        
        pulmonary arteries
        
        lungs
        
        pulmonary veins return oxygenated blood to the left side of the heart
    - - transport oxygenated blood from left side of the heart to tissues via arteries
      - veins bring back deoxygenated blood from tissues to the right side of the heart to be reoxygenated in lungs
    - - transports nutrient rich, deoxygenated blood from digestive organs and liver to the liver for processing
        
        back to heart
- - - - right atrium
        
        tricuspid valve
        
        right ventricle
        
        pulmonary semilunar valve
        
        pulmonary trunk
        
        pulmonary arteries
        
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    - - left and right ventricle pump at the same time in contraction
    - - aorta
        
        coronary arteries
        
        supplies heart with oxygenated blood
        
        pumps oxygenated blood systemically
      - pulmonary trunk
        
        pulmonary arteries
        
        carries deoxygenated blood to the lungs
    - - inferior vena cava
        
        drains deoxygenated blood from inferior body vessels into right atrium
      - superior vena cava
        
        drains deoxygenated blood from superior body vessels into right atrium
      - coronary sinus
        
        drains deoxygenated blood from from coronary veins into right atrium
      - pulmonary veins
        
        carries oxygenated blood from the lungs to the left atrium
  - - - atrial systole (K10.4)
        
        atria contract to push blood into ventricles
        
        ventricles are relaxed and filling
        
        ventricular pressure is low (K10.8)
        
        AV valves open, SL valves closed (K10.5)
        
        P wave on EKG (K10.3)
      - early ventricular systole
        
        isovolumetric contraction of ventricles
        
        atria relax
        
        atrial pressure low
        
        ventricular pressure building (K10.8)
        
        AV & SL valves closed (K10.5)
      - late ventricular systole
        
        ventricles contract and eject blood into pulmonary and arterial trunks
        
        atria relaxed
        
        AV valves closed and SL valves open (K10.5)
        
        QRS wave on EKG (K10.3)
      - early ventricular diastole
        
        isovolumetric relaxation of ventricles
        
        atria and ventricles relax
        
        AV & SL valves closed (K10.5)
        
        T wave on EKG (K10.3)
      - late ventricular diastole
        
        atria relax as ventricles fill
        
        atrial pressure higher than ventricular pressure (K10.8)
        
        AV valves open & SL valves closed (K10.5)
    - - AV valves close
        
        1st sound: "lub"
        
        beginning of ventricular systole
      - SL valves close
        
        2nd sound: "dub"
        
        end of ventricular systole
  - - - depolarization
        
        Na+ channels on the sarcolemma open and rapidly influx into the cell
        
        depolarizes cells from -90 to +30mV
        
        Na+ channels close
      - plateau
        
        at +30 mV, K+ channels open and potassium move outside the cell
        
        Ca2+ channels enter the cell to create a plateau to maintain a depolarized state
        
        plateau prevents tetany and irregular heartbeats (K7.3)
      - repolarization
        
        Ca2+ channels close while K+ channels remain open to repolarize the cell back to -90 mV
    - - cardiac pacemaker cells
        
        exhibits autorhythmicity
        
        depolarize spontaneously without any external influence
        
        action potential originates from pacemaker cells
        
        propagates to cardiac contractile cells
        
        influenced by activity of the autonomic nervous system
    - - without oxygen supply, the myocardium will not function
  - - - contains pacemaker cells (K9.1a)
        
        exhibit autorhythmicity (K9.1b)
        
        capable of generating and firing an action potential without any external influence
        
        generated action potential spread throughout atria
        
        action potential reaches Atrioventricular (AV) Node in inferior right atrium
        
        action potential passes from AV node to the Atrioventricular Bundle in the superior interventricular septum
        
        action potential is conducted down the left and right bundle branches in the interventricular septum
        
        action potential conducted to the Purkinje fibers in the ventricular myocardial walls
        
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      - initiates heartbeat
      - located in superior right atrium
    - - P wave
        
        atrial depolarization
      - QRS Complex
        
        atrial repolarization
        
        ventricular depolarization
      - T wave
        
        ventricular repolarization
      - monitors electrical signals from the heart
    - - housed in medulla oblangata
        
        SA node initiates heart rate
        
        autonomic nervous system regulates heart rate & strength of contractions
        
        parasympathetic division
        
        cardioinhibitory
        
        vagus nerve decreased heart rate
        
        sympathetic division
        
        cardioacceleratory
        
        increases heart rate and force of contraction
  - - - right atrium
        
        right superior portion of the heart
        
        site where all blood enters the heart and is sent to the right ventricle
      - right ventricle
        
        right inferior portion of the heart
        
        blood comes from the right atrium and is sent to the lungs
      - left atrium
        
        left superior portion of the heart
        
        blood comes from the lungs and is sent to the left ventricle
      - left ventricle
        
        left inferior portion of the heart
        
        blood comes from the left atrium and is sent throughout the body
    - - anterior interventricular sulcus
        
        separates ventricles anteriorly
      - coronary sulcus
        
        separates atria and ventricles externally
      - posterior interventricular sulcus
        
        separates ventricles posteriorly
    - - interatrial septum
        
        separates atria internally
      - interventricular septum
        
        separates ventricles internally
    - - pericardium (K6.5)
        
        fibrous layer is most superficial & anchors heart to thoracic cavity
        
        parietal pericardium is a serous layer that adheres fibrous layer to inner surface
        
        visceral pericardium is a serous layer that directly covers heart wall externally
        
        pericardial cavity lies between the serous layers, contains serous fluid to prevent friction during heart contractions
      - myocardium (K6.6)
        
        cardiac muscle tissue
        
        involuntary, striated muscle
        
        embedded with intercalated discs
        
        contains gap junctions to allow low resistance flow of ions
        
        continuous action potential
        
        results in heart acting as a functional syncytium
      - endocardium (K6.7)
        
        simple squamous epithelium continuous with endothelium, which lines blood vessels
    - - function to prevent backflow of blood into chambers
      - atrioventricular valves
        
        closed by chordae tendineae anchored by papillary muscles in each ventricle
        
        tricuspid valve
        
        between right atria and right ventricle
        
        bicuspid/mitral valve
        
        between left atria and left ventricle
        
        closure marks the beginning of systole & creates the "lub" sound
      - semilunar valves
        
        pulmonary semilunar valve
        
        between right ventricle and pulmonary trunk
        
        closure marks the end of systole & creates the "dub" sound
        
        aortic semilunar valve
        
        between left ventricle and aorta
    - - arteries
        
        delivers oxygenated blood to heart tissue
        
        coronary arteries are the first branches off the aorta
        
        right coronary artery
        
        right marginal artery
        
        supplies oxygen to right border of heart
        
        posterior interventricular artery
        
        supplies oxygen to the posterior surface of ventricles
        
        left coronary artery
        
        anterior interventricular artery
        
        supply oxygen to anterior surfaces of ventricles and the interventricular septum
        
        circumflex artery
        
        supply oxygen to left atrium and ventricle
      - veins
        
        small cardiac vein, great cardiac veins, & middle cardiac vein
        
        drain deoxygenated blood into the coronary sinus
        
        drains into the right atrium
  - - - determined & maintained by stroke volume & heart rate
        
        when stroke volume is increased, heart rate will decrease (vice versa) (K11.1c)
      - CO = HR X SV (K11.1b)
      - amount of blood pumped by a single ventricle per minute (K11.1a)
      - measures how well the cardiovascular system delivers oxygen & nutrients to tissues
        
        increased cardiac output
        
        increased oxygen/nutrient rich blood delivery to tissues
        
        decreased cardiac output
        
        decreased oxygen/nutrient rich blood delivery to tissues
        
        tissue deprivation, damage, or eventually death
    - - volume of blood ejected during one heartbeat
      - variables that influence SV (K11.2b)
        
        afterload
        
        pressure & resistance the ventricles must overcome to eject blood
        
        vasoconstriction
        
        increased resistance/afterload
        
        decreased stroke volume
        
        vasodilation
        
        decreased resistance/afterload
        
        increased stroke volume
        
        preload
        
        degree of heart wall stretch before contraction
        
        determined by venous return
        
        volume of blood returned to the heart via veins
        
        increased blood volume, increased venous pressure
        
        increased venous return & preload
        
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        decreased blood volume, decreased venous pressure
        
        decreased venous return & preload
        
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        Frank-Starling Law (K11.2c)
        
        as the volume of blood increases, there is a greater stretch of the heart, resulting in greater force of contraction
        
        contractility of heart muscle (K11.2d)
        
        positive intropes
        
        increased Ca2+, norepinephrine, epinephrine, & thyroid hormone
        
        increased contractility
        
        increased stroke volume
        
        negative inotropes
        
        electrolyte imbalances, decreased Ca2+, high potassium
        
        decreased contractility
        
        decreased stroke volume
    - - number of heart beats per minute
      - positive chronotrope (K11.3a)
        
        sympathetic stimulation (ie: exercise)
        
        epinephrine and norepinephrine released
        
        cardioacceleratory
        
        increased heart rate
      - negative chronotrope (K11.3a)
        
        parasympathetic stimulation (ie: relaxing)
        
        cardioinhibitory
        
        decreased heart rate
      - autonomic nervous system controls
        
        parasympathetic nervous system signals pacemaker cells via vagus nerve to slow heart rate
        
        atrial reflex
        
        baroreceptors in atria stimulated by venous return send signals to cardioacceleratory center
        
        causes sympathetic stimulation of heart to increase rate to prevent overfilling of heart
- - - - vessel inflammation causes plaque in endothelium to rupture into lumen
        
        atherosclerosis
        
        damages endothelium of vessels and thickens arterial walls
        
        persistent high blood pressure
        
        cigarettes contain nicotine, which stimulates heart, raises cardiac output, and causes vasoconstriction
        
        genetic predisposition to hypertension (family history, African American ethnicity)
        
        kidney damage impairs the body's ability to create urine, increasing fluid volume and on blood vessels
        
        obese patients have more fatty tissue, which increases vascular resistance to blood flow
        
        high dietary sodium intake results in water retention, increasing fluid volume and work on blood vessels
        
        diet high in fats causes increased circulating cholesterol and fatty buildup in vessels
- - - - pulmonary congestion causes decreased gas exchange between oxygen and carbon dioxide
        
        increased carbon dioxide retention
        
        converts into carbonic acid
        
        decreased pH
        
        respiratory acidosis (chemoreceptors send signals to medullary respiratory center)
        
        stimulate respiratory muscles to increase ventilation
        
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      - blood backflows into right ventricle, atrium, and great veins
        
        increased venous pressure
        
        increased preload
        
        increased workload on the heart
        
        stress and hypertrophy of cardiac muscle
        
        decreased space in ventricles to pump blood
        
        1 more item...
        
        Frank-Starling Law: increased preload will increase cardiac contractile strength only up to a certain point until cardiac stress occurs
        
        increased stimulation of baroreceptors in atria
        
        atrial reflex from cardioacceleratory center
        
        increased heart rate in attempt to empty heart
  - - - decreased cardiac output
        
        decreased blood pressure (hypotension)
        
        decreased oxygenated blood supply to body tissues (circulatory shock)
        
        ischemia to cerebral vasculature
        
        kidney damage
        
        respiratory failure
        
        further cardiac damage
        
        death
        
        decreased afterload
        
        less kidney perfusion
        
        low glomerular filtration rate
        
        macula densa cells sense low NaCl concentration and filtrate amount
        
        signal granular cells to release renin
        
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      - heart rate increases in attempt to maintain cardiac output
- - - - 7% proteins
        
        most abundant is albumin
        
        colloid osmotic pressure (oncotic pressure)
        
        greatest influence on blood volume and pressure
        
        produced in liver
        
        fibrinogen
        
        necessary for clot formation
        
        globulins
        
        gamma-globulins made by leukocytes
        
        antibodies for body defense
        
        alpha & beta globulins produce in liver
        
        transport insoluble substances in blood
        
        regulatory proteins (ie: enzymes)
      - 1% other solutes like electrolytes, nutrients, gases, & waste products
      - 92% water
    - - erythrocytes (red blood cells)
        
        transports respiratory gases in the blood (K3.3a)
        
        hemoglobin acts as the gas carrier (K3.3b)
        
        oxygen bound to hemoglobin when delivering blood to tissues
        
        carbon dioxide bound to hemoglobin when delivering blood from tissues back to the heart to be reoxygenated in the pulmonary circuit
      - leukocytes (white blood cells)
        
        body's defense against pathogens (K3.3c)
      - platelets
        
        cellular fragments responsible for clot formation (K3.3d)
  - - - initiated by damage to tissue outside of vessel
    - - initiated by damage to the inside of the vessel
    - - 1) vascular spasms
        
        vasoconstriction of vessels to limit amount of blood lost
      - 2) platelet plug
        
        platelets attach to exposed collagen fibers in damaged vessel wall with the help of von Willebrand factor
        
        aggregated platelets act as a temporary block
      - 3) coagulation
        
        insoluble protein network of fibrin (from fibrinogen) trap other elements to form clot
    - - procoagulants are proteins or drugs that promote coagulation (K4.6)
        
        ie: prothrombin
      - anticoagulants are proteins or drugs that reduce coagulation (K4.6)
        
        ie: Aspirin & heparin
      - fibrinolytic drugs dissolve clots by working against fibrin (K4.6)
      - vitamin K is required to synthesize select plasma proteins and clotting factors (K4.4)
      - inflammation, atherosclerosis, vessel damage and impaired blood flow can initiate blood clotting
    - - a thrombus is a clot within a blood vessel
        
        a thrombus that dislodges and travels within circulation is referred to as a embolus
        
        both thrombi & emboli can obstruct blood flow to tissues
        
        stroke
        
        pulmonary embolism
        
        tissue ischemia & death
    - - plasminogen is converted into plasmin
        
        fibrin degrades fibrin framework of the clot
- - - - high blood pressure that can damage blood vessels, specifically in the heart and kidneys
    - - coronary arteries become blocked, leading to cardiac muscle cell death
    - - fatty plaque buildup in the lumen of blood vessels causing increased resistance and decreased blood flow to tissue
  - - - chemoreceptors in large arteries sense low O2 concentration
        
        substantial drop in oxygen concentration stimulates increased ventilation
        
        increased oxygen intake
    - - increased amount of carbonic acid conversion
        
        low pH
        
        chemoreceptors in large arteries and brain stem sense concentration
        
        medullary respiratory centers stimulate respiratory muscles to increase ventilation
        
        more carbon dioxide expelled
        
        increase pH and lower saturation of CO2
- - - - smoking cessation will also prevent further lung damage, which contributes to ineffective gas exchange
    - - patient should not participate in rigorous exercise since heart damage has occurred
        
        gradually increase exercise from mild to moderate intensity to prevent severe increase in heart workload