A 60-year-old woman has experienced a myocardial infarction (heart attack)
Upstream Effect
Background
Downstream Effect
Anatomy
Physiology
The pathway of blood through the heart
The role of valves and papillary muscles in heart physiology
The normal sounds of the heart and what causes them
The relationship between heart function and blood pressure
The relationship between heart function and respiratory rate
The concepts of heart rate, stroke volume, cardiac output, mean arterial pressure, preload, afterload, peripheral resistance, and others relevant to this case.
What indirect and direct factors are relevant for this patient?
Explain the direct effects of a failed mitral valve.
How will this have further consequences on the body? How might her current circulatory problems affect other systems like the respiratory, urinary, or nervous systems?
Indirect Factors
Direct Factors
Consequences
Pulmonary Hypertension
History of Obesity
Experienced Myocardial Infarction (Heart Attack)
1) Once blood travels through the pulmonic valve, it enters your lungs. ("Pulmonary Circulation")
A normal heartbeat has two sounds, a lub (sometimes called S1) and a dub (S2). These sounds are caused by the closing of valves inside your heart.
your heart pushes your blood through a network of blood vessels called arteries
As the blood travels through the arteries it pushes against the sides of these blood vessels and the strength of this pushing is called your blood pressure
As your heart squeezes and pushes your blood through your arteries, your blood pressure goes up
As your heart squeezes and pushes your blood through your arteries, your blood pressure goes up
So, with each heartbeat, your blood pressure will rise to a maximum level and then fall to a minimum level.
Respiratory System
Urinary System
Nervous System
Blood pressure is 95 over 55
Breathing rate is about 30 breaths per minute
Heart rate is about 125 beats per minute
Permanent damage to the papillary muscles of the mitral valve to close
Diabetes Mellitus II
Valves in the heart
Papillary Muscles
Bicuspid Valve
Mitral Valve
Tricuspid Valve
Aortic Valve
Closes off the upper right chamber (or atrium) that holds blood coming in from the body
Closes off the lower right chamber
Closes off the upper left chamber (or left atrium) collecting the oxygen-rich blood coming in from the lungs.
Closes off the lower left chamber that holds the oxygen-rich blood before it is pumped out to the body.
Opens to allow blood to flow from the top right chamber to the lower right chamber
Prevents the back flow of blood from the ventricle to the atrium when blood is pumped out of the ventricle
Opens to allow blood to be pumped from the heart to the lungs (through the pulmonary artery) where it will receive oxygen.
Opens to allow blood to pass from the upper left side to the lower left side (or from the left atrium to the left ventricle).
Opens to allow blood to leave the heart (from the left ventricle to the aorta and on to the body).
Prevents prolapse of anterior and posterior cusps of mitral valve during systole
The Pulmonary Loop
Mean Arterial Pressure
Preload
Cardiac Output
Afterload
Stroke Volume
Peripheral Resistance
Heart Rate
The right side of the heart picks up the oxygen-poor blood from the body and moves it to the lungs for cleaning and re-oxygenating
The Systemic Loop
Once the blood is re-oxygenated, the left side of the heart moves the blood throughout the body, so that every part receives the oxygen it needs
2) From your pulmonic valve, blood travels to the pulmonary artery to tiny capillary vessels in the lungs
3) Here, oxygen travels from the tiny air sacs in the lungs, through the walls of the capillaries, into the blood
4) At the same time, carbon dioxide, a waste product of metabolism, passes from the blood into the air sacs
5) Carbon dioxide leaves the body when you exhale
6) Once the blood is purified and oxygenated, it travels back to the left atrium through the pulmonary veins.
This is a condition in which there's increased pressure in the arteries that carry blood from your heart to your lungs (pulmonary arteries), causing your heart to work harder.
Define: The number of heartbeats per unit of time
Define: The amount of blood pumped by the left ventricle of the heart in one contraction
Define: The amount of blood the heart pumps through the circulatory system in a minute
Define: As the average pressure in a patient's arteries during one cardiac cycle
Define: The initial stretching of the cardiac myocytes prior to contraction
Define: The force against which a ventricle contracts that is contributed to by the vascular resistance especially of the arteries and by the physical characteristics of the blood
Define: The resistance of the arteries to blood flow
Mitral Valve Disease
Allowing blood to flow backward into the left atrium
As a result, your heart does not pump enough blood out of the left ventricular chamber to supply your body with oxygen-filled blood.
Renal Failure, when the kidneys don't work as well as they should, not getting enough blood to filter
Heart may become too full of blood. This causes pressure to build in the main vein connected to your kidneys, which may lead to a blockage and a reduced supply of oxygen rich blood to the kidneys
The sympathetic nervous system (SNS) is activated and the imbalance of the activity of the SNS and vagal activity interaction occurs
The abnormal activation of the SNS leads to further worsening of heart failure
Define: that contains chiefly adrenergic fibers and tends to depress secretion, decrease the tone and contractility of smooth muscle, and increase heart rate
causing irregularities in the way fluid is carried away from the lung
Pulmonary Edema
When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs
As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs
Circulatory System
A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle and damaging it
Coronary Artery Disease the narrowing or blockage of the coronary arteries caused by atherosclerosis ("hardening" or "clogging" of the arteries)
Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly
Later on, can lead to a myocardial infarction
Immune System
The damage caused by a heart attack triggers an inflammatory reaction which degrades the affected tissue
Activation of the response occurs in clusters of immune cells (lymphocytes) within the fatty tissues of the so-called pericardium, which surrounds the heart
In the aftermath of an acute heart attack, these clusters are responsible for initiating and coordinating the ensuing immune response
Lymphocytes are activated and signaling molecules called cytokines are secreted, which recruit neutrophils to the damaged area of the heart muscle.
The neutrophils in turn induce an inflammation reaction that results in the degradation of the damaged tissues by phagocytes, and they subsequently help resolve the primary inflammation reaction and promote tissue repair.
Cardiac Arrest
Arrhythmias
Death results when the heart suddenly stops working properly
Irregular Heart Rhythm
Stroke
The sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain
The anatomy of the heart and all relevant structures
Trabeculae Carneae
Rounded or irregular muscular columns which project from the inner surface of the right and left ventricle of the heart
Intraventicular Septum
the wall of the heart intermediate to the right and left ventricles
Heart Wall 3 layers
Myocardium
Chordea Tendinea
A group of tough, tendinous strands in the heart
Superior Vena Cava
It is a large-diameter (24 mm) short length vein that receives venous return from the upper half of the body, above the diaphragm.
Pulmonary Artery
Arises from the right ventricular outflow tract and courses posteriorly and superiorly to the left of and posterior to the aorta
Pulmonary Vein
Two main pulmonary veins emerge from each lung hilum, receiving blood from three or four bronchial veins apiece and draining into the left atrium.
Left Atrium
The left atrium consists of three parts: the vestibule, the left atrial appendage, and the pulmonary-vein component.
Right Atrium
the right atrium forms the right border of the heart
Mitral Valve
The mitral valve connects the left atrium (LA) and the left ventricle (LV)
Left Atrium
The left atrium consists of three parts: the vestibule, the left atrial appendage, and the pulmonary-vein component
Aortic Valve
a valve in the human heart between the left ventricle and the aorta
Tricuspid Valve
consists of the annulus, leaflets, right ventricle, papillary muscles and chordae tendinae
Left Ventricle
the thickest of the heart's chambers
Pulmonary Valve
the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps.
Right Ventricle
the most anterior of the four heart chambers.
Inferior Vena Cava
formed by the joining of the left and right common iliac veins and brings collected blood into the right atrium of the heart.
An inferior and superior main vein drains each lung
the left in front of the descending thoracic aorta.
The right main pulmonary veins (contains oxygenated blood) pass behind the right atrium and superior vena cava
Behind the pulmonary artery is the bronchus.
the inferior is situated at the lowest part of the lung hilum.
The left atrium is more or less oval-shaped.
Its extension is greater in the superior-inferior aspect than in the antero-posterior or medial-lateral aspect.
lies between the right atrium and the right ventricle and is placed in a more apical position than the mitral valve
Also joins with the azygos vein (which runs on the right side of the vertebral column) and venous plexuses next to the spinal cord.
extends from the right atrium to the apex of the heart
located in a posterior and lateral location relative to the right ventricle. With right ventricle, it forms apex of heart.
It is one of the two semilunar valves of the heart, the other being the pulmonary valve.
The left atrium is more or less oval-shaped
Its extension is greater in the superior-inferior aspect than in the antero-posterior or medial-lateral aspect
Plays a vital role in holding the atrioventricular valves in place while the heart is pumping blood
thick middle layer
Epicardium
Endocardium
The outer layer of the pericardium, a conical sac of fibrous tissue that surrounds the heart and the roots of the great blood vessels
the outer layer of the heart wall
the innermost layer of tissue that lines the chambers of the heart
Its cells are embryologically and biologically similar to the endothelial cells that line blood vessels
Its surface markings correspond to the anterior and posterior interventricular grooves
the septum is as muscular as the left ventricle
It is an involuntary, striated muscle that constitutes the main tissue of the walls of the heart