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A 60-year old female is brought in with a history of obesity and DM 2, who…
A 60-year old female is brought in with a history of obesity and DM 2, who has suffered a heart attack.This has caused permanent damage to the papillary muscles of the left ventricle, resulting in a failed mitral valve closing. Her blood pressure is 95 over 55, her breathing is about 30 breaths per minute and her heart rate is 125 bpm. Also we can hear gurgling and labored breathing through the stethoscope. Her son is very worried and wonders what all this means?
Upstream Effects: Simply enough, her failed mitral valve is due to her heart attack which can be a result of a multitude of problems, starting with poor exercise and diet. If she was a mobile person who eats relatively healthy, this could have been avoided. .
Now she could have genetic problems to cause her myocardium to be developed weak, or her DM 2 could have caused this as well, causing too much plaque build up in the heart
Downstream Causes: Once again her DM 2 (caused by poor life choices) causes her blood pressure to raise and in turn make the heart and valves work harder for longer, which caused her heart attack. If our patient does take this as a life or death warning, and continues on this path of poor diet and no exercise, her heart will fail her again.
The reason she is having a hard time breathing is because her heart is working overtime to get blood to the lungs and back to the heart. As well as blood too much blood being left in the ventricle after sistole, causing the swishing we heard on the stethoscope
This could lead to Hypovolaemic shock, causing the body's ability to form clots, regulate body temperature and transport oxygen.
Which could lead to too much pressure build up from the heart not being able to pump efficiently, which can causes pressure to build in the main vein to the kidneys, causing kidney disease.
Background Info:
Anatomy of the Heart:
Our hearts have 4 main chambers, the 2 upper atria and the 2 lower ventricles.
Poorly oxygenated blood from the body is brought into the atria via large veins called the vena cava.
In the very middle of our heart is the interventricular septum, which is a thick piece of myocardium that separates the left and right ventricles blood from mixing.
There are 2 valves that lead into both ventricles that prevent backlow of blood back into the atria. These valves are known as the tricuspid valve and mitral valve. Which are anchored by thin muscles called chordae tendineae.
Blood leaving the ventricles pass through 2 more valves. One connecting the right ventricle to the pulmonary trunk, the pulmonary valve. And one connecting the left ventricle to the aorta, the aortic valve.
We also have pacemaker cells in our hearts to set the pace for which our heart contracts. The first is called the SA node, which sends action potential to the atria to perform systole.
The second is the AV node, located on the opposite side of the atria of the SA node, and has a latent action potential for the ventricles to allow all of the blood to be moved out of the atria, resulting in smooth beats and flow of blood.
Even though the heart supplies the body with all the nutrients it needs, the heart also needs its own nutrients, which are supplied by the coronary arteries that are located on the exterior of the heart wall.
The aorta supplies to the entire body. There are 2 smaller arteries that supply both sides of the heart with oxygen rich blood.
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The concept of heart rate, stroke volume and cardiac output.:
Stroke volume is how much blood is being filled and the pumped to the body via the left and right ventricles in the heart. This goes hand in hand with Preload.
Where the atria stretch beyond normal diameter to allow more blood into the atrium resulting in much more blood being sent though the heart when needed.
Heart rate is how many times our heart beats in one minute, Which is controlled by our autonomic nervous system which we have no control over.
Our heart rate is actually automatically set at 100 bpm. But when we are at rest or not doing physical activities, our vagal tone sets in reducing the heart rate by about 25 bpm. Th severing of this vagal nerve would cause bpm of over 100.
The stroke volume and the heart rate determine the cardiac output, which is the amount of blood the left ventricle pumps through the circulatory system every minute. CO goes up, so does pressure.