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60 year old female hx: obesity, diabetes mellitus type 2 (Background (The…

- - - - The heart is made of many layers that all have many responsibilities. The most superficial layer is distinguished by the different Sulci (grooves) that hold the coronary arteries and veins that feed the heart. The Epicardium is the outer most layer of serous membrane.
        
        The heart wall varies in thickness throughout based on what area is underneath. The wall surrounding the ventricles is noticeably thicker because they pump blood out of the heart whereas the atria only receive blood. The wall of the Left Ventricle is particularly thick because it is pumping blood to the rest off the body and works harder. This is the middle layer also known as the Myocardium.
        
        The Endocardium is the inner most layer of connective tissue that covers the inside of the heart.
        
        The inside wall of the Right side of the heart is smooth with muscular ridges called Pectinate muscles on the anterior wall and auricle. There is a small depression in the atrium called the fossa ovalis that in fetuses is the foramen ovale. The ventricle has irregular muscular ridges called trabeculae carneae. Papillary muscles attach collagen strands called chordae tendineae to the AV valves.
        
        The left side of the heart has pectinate muscles in auricle and trabeculae carneae with two papillary muscles anchored by chordae tendineae These internal structures protect the valves from blowing back the wrong way and only allow blood to flow in the proper direction.
        
        When the heart beats and pushes blood through the body the blood pushes on the arteries creating blood pressure. When your heart contracts blood pressure goes up also known as systole. When the heart relaxes blood pressure goes down known as diastole.
      - The Pericardial cavity that is located within the Mediastinum in the Thoracic cavity.
        
        Inside the Pericardial cavity is the Pericardium that encloses the heart. The pericardial sac is made of many layers beginning with the outer most Fibrous Pericardium that is made of dense irregular connective tissue. It is attached to the diaphragm, Aorta, and keeps the heart from bouncing inside the cavity.
        
        The parietal layer of serous pericardium is the inner portion of the pericardial sac.
        
        Visceral layer of the serous Pericardium adheres directly to the surface of the heart and is also known as the Epicardium.
        
        The Pericardial cavity is the space between parietal and visceral layers that is filled with serous fluid. The fluid lubricates the area and allows the heart to beat without much friction.
      - The heart is a two pump structure so it is divided into a right and left portion. Each side has an upper portion known as the Atrium and a lower portion known as the Ventricle. The inside of the heart is covered in Endocardium.
        
        The Right side of the heart receives deoxygenated blood from the body via the Inferior and Superior Vena Cava to the right atrium.
        
        The deoxygenated blood travels from the Atrium to the right ventricle via the Atrioventricular Valve known as the Bicuspid. When this valve closes this is also the LUB sound.
        
        The deoxygenated blood is then in the right ventricle and leaves the heart via the Pulmonary Semilunar Valve. Also known for the DUB sound when it closes.
        
        Because the heart needs its own blood to supply itself with oxygen and nutrients there is also a Vein that comes back from the capillary beds on the heart and the blood enters the right Atrium via the Coronary Sinus
        
        The left portion of the Heart receives oxygenated blood from the lungs via two sets of 2 pulmonary veins in the atrium.
        
        The oxygenated blood then travels through a valve known as the atrioventricular valve, also known as the tricuspid or mitral valve. The LUB sound in the heart beat when the valve closes
        
        The oxygenated blood is then in the left ventricle where is travels to through the next valve known as the aortic semilunar valve. The DUB sound when the valves close.
      - When the heart and lungs are working properly and efficiently the respiratory rate is usually around 1 fifth of the heart beats per minute. Both can be overridden if fight or flight response is activated increasing both respiratory rate and heart rate. If the lungs do not function efficiently the chemoreceptors will often increase the heart rate as a means to rid the body of carbon dioxide and to increase oxygenation.
    - - The Aortic Trunk also leads away from the heart but to the rest of the body carrying oxygenated blood. There are 2 systems that the blood travels. Systemic or the Body and Coronary or the Heart.
        
        The Aortic trunk has 4 branches that lead to specific parts of the body
        
        The Aortic Arch is the Second segment and finished the ascending aorta before it arches superiorly, then posteriorly and to the left before moving inferior to the heart and separating to its own 3 branches.
        
        Second is the left common artery and it supplies the left side of the neck and head
        
        The subclavian artery supplies the left upper limb.
        
        The Brachiocephalic Trunk is the first and largest trunk. It ascends and splits into the right carotid and right subclavian arteries that supply the head and neck.
        
        The descending or Thoracic Aorta finishes the aortic arch and travels inferior of the heart and leaves the thorax via the aortic hiatus through the diaphragm. It branches off 7 times supplying things like the bronchi, lymph, mediastinum, pericardium, diaphragm and inter and subcostals.
        
        The ascending Aorta is the initial segment of the Aorta and begins at the heart. It is only around 2 inches long and is the location that gives rise for the branches of the coronary arteries
        
        The abdominal Aorta is the continuation of the Thoracic Aorta branching off into 4 unpaired and 8 paired arteries. These arteries supply the lower limbs, spine, kidneys, mesentery, GI tract, Adrenal glands and diaphragm.
        
        The coronary arteries are the right and left arteries that run along the coronary sulcus.
        
        The right coronary artery breaks into two arteries known as the Right marginal and the posterior interventricular artery.
        
        The right marginal artery supplies the right border of the heart
        
        The Posterior Interventricular Artery supplies the posterior surface of the left and right ventricles.
        
        The Left coronary artery also branches into two more smaller arteries: Circumflex and the Anterior Interventricular
        
        The Circumflex artery supplies the left atrium and ventricle
        
        The Anterior Interventricular Artery supplies the anterior surface of both ventricles and most of the interventricular septum
        
        From largest to smallest: Aortic Trunk, Aorta, Arteries, arterioles, capillaries.
      - The Vena Cava bring deoxygenated blood from the body to the heart. There are two main portions: Inferior and Superior.
        
        Superior Vena Cava is a large valveless vein that returns blood from the upper half of the body to the right atrium. Two main veins give rise this branch.
        
        The Right brachiocephalic vein comes from the right portion of the upper body
        
        The left Brachiocephalic vein comes from the left upper half off the body.
        
        The Inferior Vena Cava is where all venous drainage below the diaphragm empty. 7 Main veins with valves lead to and form the inferior aspect of the Vena Cava
        
        The venous system from smallest to largest: Capillary beds, venules, veins portal veins, Vena Cava
      - The pulmonary Trunk leads away from the right ventricle, splits into two arteries: right and left to the respective lungs. Arteries carry blood away form the heart.
      - The Pulmonary veins bring oxygenated blood back to the heart from the lungs.
  - - - Cardiac Output is the amount of blood pumped through the body in 1 minute. This is generally calculated by multiplying the Heart Rate by the Stroke volume.
        
        The Mean Arterial Pressure(MAP) is the average arterial pressure during one cardiac cycle: Systole, Diastole.
      - Preload also known as left ventricular diastolic end pressure(LVDEP) The amount of stretch at the end of Diastole
        
        Afterload is the pressure the heart must work against to eject the blood during systole(ventricular contraction)
        
        Peripheral Resistance is the resistance of arteries to the blood flow. As the arteries constrict resistance increases and as the arteries dilate the resistance decreases.
- - - - Obesity puts more strain on the heart and with it being a muscle it can thicken with the extra over activity.
        
        With added strain on the heart it wouldn't be operating efficiently and the patient would begin to be increasingly tired.
        
        With added exhaustion building the patient would lessen physical activity and her obesity would increase worsening all of her symptoms
    - - DM II Increases the likelihood for tertiary illnesses
        
        Blood flow is decreased in her lower extremities and blood clots become increasingly more likely with poor blood flow and poor exercise to help move lymph fluid and venous blood from extremities.
        
        Blood Clots can easily break loose from the blood vessel walls and travel to important structures like the Heart or Brain.
- - - - The Patient throws a blood clot and it lodges in her heart causing a Myocardial Infarction otherwise known as a Heart Attack.
        
        It wasnt treated in a timely manner and caused tissue death to part of her papillary muscle that is responsible for maintaining the stability of the Mitral Valve.
        
        With her Mitral Valve not operating properly this will wreak havoc because the blood will not be efficiently passed through the heart to the Body. It will just swish around.
        
        With the oxygenated blood not able to reach the body properly chemoreceptors will begin to alarm and increase Heart rate and Respiratory rate as a means to rid the body of Carbon Dioxide and encourage Oxygenation.
        
        The body is not receiving proper oxygen including the Nervous System, Urinary, and Respiratory so the body will continue to try to rid the body of the poisons and get oxygenated blood to the important tissues and organs causing the patient to become increasingly distressed.
        
        A Mitral Valve replacement would most likely need to occur to help the patients body return to a better homeostasis and allow the heart to function properly.
        
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        The patients body would most likely begin shutting down extremities as to lessen the strain and reserve essential nutrients for the vital organs.