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    DSQCardio

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    DSQCardio

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    of 7

    Blood Flow Through The Heart: See McCounough Lecture 2 Page

    2 highlighted.

    Blood arrives to heart through superior and inferior vena cava by


    draining the body and entering the right atrium and then entering the
    right ventricle.

    In cardiac cycle, the atria contract first.

    Blood goes from the left atrium to the left ventricle. It passes through
    the mitral valve, which ensures that the blood doesn’t go from the left
    ventricle back to the left atrium by accident.

    The Aortic valve is the final valve the blood passes through. Aortic
    valve divides the left ventricle from the Aorta.

    Blood goes through aorta to rest of the body.

    Right Atrium, Tricuspid Valve, Right Ventricle, Pulmonary outflow


    tract through Pulmonary Valve. Lungs. Blood returns to heart after
    going through the lungs into the left atrium mitral valve, left ventricle,
    out the aortic valve, aorta, blood then supplied to body for circulation.

    Arteries carry blood away from heart; oxygenated except for pulmonary
    artery, which carries the blood to the lungs for oxygenation.

    Veins carry blood back to hear for recirculation; desaturated blue blood
    except for pulmonary circuit/vein which carries oxygenated blood back
    to the heart from the lungs where blood was freshly oxygenated.

    Capillaries are small cell passages that connect arterial side to vein side.
    Nutrients are delivered, waste collected and oxygen is diffused out into
    the tissue while carbon dioxide is infused back into circulatory system.
    Right Heart = pulmonary circulation Right coronary artery perfuses the
    sections of the heart EXCEPT left ventricle.
    Left Heart = Rest of body Left coronary artery, a short branch that
    comes directly off the aorta, supplies most of the nutrients and oxygen to
    the left ventricle and a lesion is life threatening.
    Myocardium = Muscle of heart that does the pumping,
    Pericardium = 1st layer of heart that protects the heart from friction with
    the lubricant pericardial fluid.
    Endocardium = Deepest layer of heart; lining of smooth epithelial tissue
    to prevent blood from coagulating/clotting.
    Volume of ventricular output is the same on both sides; however the
    mean systemic arterial pressure is much higher than in the pulmonary
    artery.

    Coronary Arteries and Perfusion: McDonough lecture bottom of pg 3-


    pg 4 highlighted Most perfusion takes place during Diastole, because
    when the heart relaxes, blood flow is easier because the heart is not
    contracting and generating pressure.

    Faster the heart rate, Shorter the diastolic period, and the Less time for
    coronary perfusion. Can cause Tachycardia, which increases myocardial
    oxygen demand while at same time decreasing supply. Diastolic period
    depends on heart rate.

    Pacemaker of Heart: SA Node Sinoatrial Node: Where the impulse


    and rhythm begins. The impulse is stopped at the AV node. The
    impulse waits for a period of time before proceeding through the heart in
    order to give the atria time to empty and the ventricles to fill with blood
    before the impulse is carried further in the conduction system, which
    results in the ventricles contracting. Lecture Pg 5 highlighted also
    discusses electromechanical disassociation.

    Great Vessels: Bring blood back to the heart joined by right atrium.
    Superior Vena Cava: Drains from head and upper body into right atrium.
    Inferior Vena Cava: “”from rest of body.
    Pulmonary Artery: Runs from right ventricle to lungs. Brings back
    blood from lungs to left atrium and aorta.
    Aorta: Main artery of body. Leaves left ventricle and branches out to
    supplies blood throughout the body.

    Beta Receptors: Lecture pg 5. Aderenergic receptors that control heart


    rate. They are in the heart, the lungs, and peripheral vasulator,
    Stimulating beta receptors causes dilation or excitation, increasing the
    rate and the strength of the heart beat. Beta 1= heart Beta 2 = lungs.
    Beta stimulation of lungs produces dilation of the bronchioles/bronchi
    and increases the ability for air to pass through these airways.

    Epinephrine is a catecholamine that’s most effective Beta 2


    agonist/stimulant for lungs while Norepinephrine is most effective
    agonist/stimulant for Beta 1/heart.

    Beta blockers are prescribed for tachychardia, lower heart rate, lower
    blood pressure, decrease strength of contraction of heart muscle. Must
    be careful with non selective beta blockades that block both beta 1 and
    beta 2 receptors because even though it will help with heart, a beta 2
    blocker will cause bronchiole constriction, which causes higher
    resistance to airway flow in the lungs. This can result in asthma,
    difficulty breathing. Beta blockers are usually not safe for those with
    asthma, chronic bronchitis, emphysyma. In these cases blood pressure
    is better controlled with alpha adrenergic receptors rather than beta
    blockers,. See lecture pg 7

    Baimbridge Reflex Lecture pg 8: As blood pressure increases, heart rate


    will often decrease and cardiac output decreases.

    Sympathetic nervous system increases strength and rate of heart


    contraction when stimulated, it is stimulated by Beta agonists
    epinephrine and norepinephrine,.
    Parasympathetic nervous system innervation of the heart comes from
    10th cranial nerve, vagus nerve. Acetycholine facilitates this,

    Heart rate can be controlled by volume control of heart see pg 8


    paragraph above Bainbridge reflex.

    Preload and Afterload Affect Cardiac Output pgs 8-10

    Preload is volume returning from the systemic circulation to the heart


    and determines the volume of the right ventricle. As preload increases
    and afterload decreases, cardiac output increases. Preload can be
    reduced by administering diuretic which decreases circulating volume
    and return to right heart.

    Afterload is the pressure against which the left ventricle is forced to


    pump to empty itself, Controls systemic blood pressure.

    Risk factors of coronary heart disease lecture pg 11

    Hypertension pg 12 and 13

    Deborah Corey’s DSQ Module 2

    1. Factors influencing systemic blood pressure: Systemic blood


    pressure is the function of cardiac output, or the volume of blood
    that is expelled from the ventricle of the heart, and systemic
    vascular resistance, the pressure that the blood needs to be in order
    to be successfully expelled from the ventricle. Systemic blood
    pressure is positively correlated with the amount of afterload. The
    higher the systemic blood pressure, the harder the heart has to
    work. Untreated high blood pressure often eventually results in the
    heart enlarging and becoming less efficient due to hypertrophy. As
    the heart enlarges, the muscle mass increases, and the ventricle
    stiffens. The heart’s ability to perfuse itself decreases
    (McDonough, 2024).
    Blood pressure process: Blood it making its way from the heart and as it
    squeezes the veins the force that is being put on the walls is increasing,.
    This is during the squeezing part of the cycle called Systole which is
    when the heart is squeezing down. Next the heart begins to relax and the
    pressure begins to fall, this process is Diastole. The heart is taking a
    break from squeezing and is now refilling.

    2. Hypertension: Blood pressure is greater than 140/90 on two


    separate clinical readings.
    A: Causes: Genetic predisposition to insulin sensitivity or renal
    sodium excretion, stress, poor diet, lack of exercise. obesity,
    smoking, and other disease. For example, pheochromocytoma is
    caused by a tumor that secretes excess norepinephrine, causing
    increased heart rate and extremely high blood pressure. Another
    disease that causes high blood pressure is atherosclerosis, which
    causes the blood vessels to narrow, which decreases blood flow.
    The decrease in blood flow results in rapidly increasing blood
    pressure.
    B: Treatment: A common treatment for hypertension is beta
    blocking drugs such as Propranolol, Esmolol, Metoprolol, and
    Atenolol. These drugs block the beta receptors resulting in
    decreasing the heart rate, the strength of heart contractions, and
    cardiac output which in turn decreases blood pressure.
    C: Complications: When blood pressure is lowered by beta blockers,
    orthostatic hypotension may occur as a side effect. Symptoms of
    orthostatic hypotension include feeling dizzy and lightheaded when
    arising from lying down or from a seated position because their blood
    pressure is too low. Complications of hypertension itself include
    myocardial infarction, kidney disease and stroke. Metabolic syndrome
    is a combination of hypertension, dyslipidemia, and glucose intolerance
    (McCance & Huether, 2019, McDonough, 2024).

    3. Arteriosclerosis risk factors: Include dyslipidemia, hypertension,


    smoking, and obesity. (McCance & Huether, 2019).
    4. Cardiomyopathies: Are diseases of the heart muscle and have 3
    categories.
    A. Dilated Myocardiopathy: The heart muscle becomes diseased
    or infected due to exposure to toxins or malnutrition. Chronic
    alcohol use is a common cause due to the exposure of the toxin
    ethanol that is contained in alcoholic beverages. Acute ethanol
    poisoning can result in transient dilated myocardiopathy, which
    is potentially reversible if the ethanol exposure due to alcohol
    drinking is discontinued.
    B. Hypertrophic Cardiomyopathy/Idiopathic Hypertrophic
    Subaortic Stenosis: Usually results from a congenital disorder.
    Occurs when the outflow tract that carries blood from the left
    ventricle to the aorta becomes enlarged, or hypertrophic,
    resulting in an enlarged aorta. The heart itself becomes
    hypertrophic and obstructs the left ventricle, consequently
    decreasing cardiac output.
    C. Restrictive Cardiomyopathy: An infiltrative disease process that
    results in pathogenic changes in the myocardium and space
    occupying lesions that impairs the heart’s ability to expand as it
    fills with blood and pump out the blood. (Heaney, 2024,
    McDonough, 2024).

    5. Arrhythmia: Is a disturbance of heart rhythm and often the first


    presenting symptom of coronary heart disease followed by sudden
    death (McDonough, 2024). Arrhythmias can be minor such as
    occasional skipped or rapid heartbeats or severe impairments that
    interfere with the heart’s ability to pump, resulting in heart failure
    and death. They are caused by an abnormal rate of impulse
    generation by the heart’s natural pacemaker, the SA node, or
    another pacemaker. (McCance & Huether, 2019).

    References
    Heaney, R. (2024). Cardiovascular system; lecture for Fairleigh
    Dickenson University Psychopharmacology program.

    McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The


    Biologic Basis for Disease in Adults and Children (8th ed.). Elsevier.

    McDonough, J. (2024). Cardiovascular System.

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