1. Essentials of Human Diseases and Conditions 4 th edition Margaret Schell Frazier Jeanette Wist Drzymkowski

2. Chapter 10 Diseases and Conditions of the Circulatory System

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives  Name the common presenting symptoms in patients with cardiovascular disease  Describe the pathology of coronary artery disease.  Name the contributing factors for coronary heart disease.  Explain what causes the pain of angina pectoris.

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the difference between myocardial infarction and angina pectoris.  Describe the treatment of myocardial infarction.  Name and describe the symptoms of the most prevalent cardiovascular disorder in the United States.  Explain what happens when the pumping action of the heart fails.  Compare right-sided heart failure with left-sided heart failure.

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Name some causes of cardiomyopathy.  Distinguish among pericarditis, myocarditis, and endocarditis.  Explain why rheumatic fever is considered a systemic disease.  Recall the cardiac manifestations of rheumatic heart disease.  Explain the pathophysiology of valvular heart disease.

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Name the causes of cardiac arrhythmias.  Describe the signs and symptoms of shock.  Explain the possible consequences of emboli.  Compare arteriosclerosis with atherosclerosis.  Describe an aneurysm and explain how it is diagnosed.

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Explain the treatment for (a) thrombophlebitis and (b) varicose veins.  Describe the vascular pathology of Raynaud disease.  Define anemia and list the presenting symptoms.  Describe how anemias are classified and state some examples.

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  State the causes of agranulocytosis.  Describe the typical symptoms in all types of leukemias.  Distinguish between lymphedema and lymphangitis.  Explain the diagnostic significance of Reed- Sternberg cells in lymphoma.

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Name the signs and symptoms of transfusion incompatibility reaction.  Explain the cause of classic hemophilia.

10. CHAPTER 10 Lesson 10.1

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Circulatory System

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Orderly Function of the Circulatory System (cont’d.)

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cardiac Cycle  Diastole - atria fill, all valves closed  Diastole - valves open, ventricles fill  Systole - atria contract and empty, ventricles are full  Systole - ventricles begin to contract, valves close  Systole - ventricles contract, aortic and pulmonary valves open, blood to aorta  Diastole - ventricles empty, valves close

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Coronary Artery Disease Coronary artery disease: A condition involving the arteries that supply the myocardium, in which the arteries become narrowed due to atherosclerotic deposits over time, causing temporary cardiac ischemia and eventually heart attack

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Coronary Artery Disease (cont’d.) Angina pectoris: A condition of chest pain after exertion that is the result of reduced oxygen supply to the myocardium

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Coronary Artery Disease (cont’d.) Myocardial infarction: (MI) - Death of myocardial tissue caused by the development of ischemia  Most common cause is coronary thrombosis.

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Administer oxygen, give morphine for pain.  Administer aspirin.  Induce vasodilation by nitroglycerin drip.  Administer lidocaine by intravenous drip.  Administer thrombolytic drugs.  Restore blood flow by angioplasty. Treatment Options for Myocardial Infarction

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hypertensive Heart Disease Hypertensive heart disease: A condition caused by chronically elevated pressure throughout the vascular system.  Most prevalent cardiovascular disorder in the U.S.

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Treatment of Hypertension  Diuretics to reduce circulating blood volume  Beta-adrenergic blockers to slow heartbeat  Vasodilators to dilate vessels  Angiotensin-converting enzyme (ACE) inhibitors to produce vasodilation and increase renal blood flow

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Hypertensive Heart Disease  Essential hypertension  Malignant hypertension

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Congestive Heart Failure Congestive heart failure (CHF): An acute or chronic inability of the heart to pump enough blood throughout the body

22. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  gradually increasing dyspnea  cardiac and respiratory rates increase  neck veins distend  edema in ankles  liver and spleen enlarge Signs of Congestive Heart Failure

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Congestive Heart Failure (cont’d.)  left-sided congestive heart failure  left ventricle does not empty  blood backs up in pulmonary circulation  pulmonary congestion  right-sided congestive heart failure  right ventricle cannot empty  blood backs up in systemic circulation  edema in legs and digestive system

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Congestive Heart Failure (cont’d.) Cor pulmonale (right-sided heart disease): Enlargement of the right ventricle as a sequela to primary lung disease  Symptoms:  dyspnea  distended neck veins  edema of the extremities  enlarged, tender liver

25. CHAPTER 10 Lesson 10.2

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cardiomyopathy Cardiomyopathy: A noninflammatory disease of the cardiac muscle resulting in enlargement of myocardium and ventricular dysfunction  three groups:  dilated - degeneration of myocardial fibers  hypertrophic - small left ventricle  restrictive - thickening of myocardium

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Inflammatory Heart Diseases Pericarditis: acute or chronic inflammation of the pericardium, the sac enclosing and protecting the heart Myocarditis: inflammation of the muscular walls of the heart Endocarditis: inflammation of the lining and valves of the heart

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Rheumatic Fever Rheumatic fever: a systemic inflammatory and autoimmune disease involving the joints and cardiac tissue  generally preceded by sore throat caused by group A beta-hemolytic streptococcus

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Rheumatic Fever (cont’d.) Rheumatic heart disease: the cardiac manifestations that follow rheumatic fever  usually affects mitral and aortic valves

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Valvular Heart Disease Valvular heart disease: an acquired or congenital disorder that can involve any of the four valves of the heart (pulmonary, tricuspid, aortic, or mitral) Mitral valve prolapse (MVP): occurs when the valve cusps do not close completely

31. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Valve Insufficiency and Stenosis  Valve insufficiency: failure of valves to close completely, allows blood to be forced back into heart  Stenosis: hardening of cusps of valves that prevents complete opening of valves, impedes blood flow into next chamber

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cardiac Arrhythmias Cardiac arrhythmias (irregular heartbeats): any deviation from the normal heartbeat, i.e., the normal sinus rhythm

33. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes of Irregular Heartbeat  Irregular heartbeat reflects disturbances in normal conduction system, including:  the pacemaker (sinoatrial node)  atrioventricular node  bundle branches  Purkinje fibers

34. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Shock Shock: collapse of the cardiovascular system, including vasodilation and fluid shift accompanied by inefficient cardiac output Cardiogenic shock: inadequate output of blood by the heart when the myocardium fails to pump effectively

35. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Causes of Shock  anaphylaxis  hemorrhage  sepsis  respiratory distress  heart failure  neurologic failure  emotional catastrophe  severe metabolic insult

36. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. The Vascular System

37. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Functions of Vascular System  transport system responsible for supplying blood tissues with blood containing oxygen and nutrients  conveys waste products and carbon dioxide to organs for excretion  arteries - carry blood away from heart  veins - carry blood back to heart  capillaries - exchange blood at cellular level

38. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Functions of Vascular System (cont’d.)  blood vessel walls composed of three coats:  tunica intima - smooth, thin endothelium  tunica media - smooth muscle and elastic tissue  tunica externa - outermost layer composed of connective tissue

39. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Conditions Emboli: clots of aggregated material (usually blood) that can lodge in a blood vessel and inhibit the blood flow Venous thrombosis: blood clot that has formed in the deep veins of the legs  most common type of embolus

40. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Conditions (cont’d.) Arteriosclerosis: a condition that occurs when the walls of the arterioles thicken, with loss of elasticity and contractility Atherosclerosis: a thickening and hardening of the arteries that occurs when plaques of cholesterol and lipids form in the arterial tunica intima

41. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Risk Factors of Atherosclerosis  heredity  sedentary lifestyle  diet rich in lipids and cholesterol-producing foods  smoking  diabetes mellitus  hypertension  obesity

42. Chapter 10 Lesson 10.3

43. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Conditions (cont’d.) Aneurysm: a weakening and resulting local dilation of the wall of an artery

44. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Conditions (cont’d.) Phlebitis: an inflammation of a vein that occurs most often in the lower legs, but any vein may be affected Thrombophlebitis: The result of an inflammation of a vein with the formation of a thrombus on the vessel wall Varicose veins: Swollen, tortuous, and knotted veins that usually occur in the lower legs

45. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Conditions (cont’d.) Raynaud disease: a vasospastic condition of the fingers, hands, or feet, causing pain, numbness, and sometimes discoloration

46. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  elements  red blood cells  white blood cells  platelets  plasma  functions  transports elements to body cells  removes waste products  helps to maintain homeostasis Elements and Functions of Blood

47. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Blood Dyscrasias  Sites of blood cell formation

48. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Blood Dyscrasias (cont’d.) Anemia: a condition in which there is a reduction in the quantity of either red blood cells or hemoglobin, reducing the blood’s ability to carry oxygen to the cells  Symptoms: fatigue, pale appearance  Diagnostic factors: reduced red blood cell numbers, reduced hemoglobin levels, changes in morphology of corpuscles

49. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Blood Dyscrasias (cont’d.) Classifications of Anemia  Iron-deficiency anemia: Insufficient iron intake due to hemorrhage or condition of slow bleeding such as bleeding hemorrhoids  Folic acid deficiency anemia: A condition in which insufficient amounts of folic acid are available for DNA synthesis, preventing maturation of blood cells  Aplastic anemia: A condition resulting from an insult to the hematopoietic or stem cells in the bone marrow  Sickle cell anemia: Chronic hereditary hemolytic form of anemia, in the U.S. found primarily in African-Americans

50. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Blood Dyscrasias (cont’d.) Agranulocytosis (neutropenia): a blood dyscrasia in which leukocyte levels become extremely low, drastically reducing the body’s response to bacterial infection  most common causes are drug toxicity and hypersensitivity

51. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Leukemias Leukemias: malignant neoplasms of the blood-forming organs that produce an abnormal, uncontrolled clonal proliferation of one specific type of blood cell in the lymphoid or myeloid cell lines

52. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Leukemias (cont’d.) Acute lymphomatic leukemia (ALL): an overproduction of immature lymphoid cells in the bone marrow and lymph nodes Chronic lymphocytic leukemia (CLL): slow progressing neoplasm that usually involves B lymphocytes

53. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Leukemias (cont’d.) Acute myelogenous leukemia (AML): rapidly progressing neoplasm of cells committed to the myeloid line of development Chronic myelogenous leukemia (CML): slow progressing neoplasm resulting in excess of mature-appearing but hypofunctional neutrophils

54. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lymphatic Diseases Lymphedema: an abnormal collection of lymph, usually in the extremities Lymphagitis: an inflammation of the lymph vessels

55. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Lymphatic Diseases (cont’d.) Lymphoma: malignant neoplasms that arise from uncontrolled proliferation of the cellular components of the lymph system Hodgkin disease: cancer of the body’s lymphatic system Non-Hodgkin lymphoma (NHL): describes a number of heterogeneous neoplasms of the lymphoid cells

56. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Non-Hodgkin Lymphoma (NHL)  Three classifications  Indolent lymphomas (35%-40% of NHLs) follicular lymphoma (grades I and II) follicular lymphoma (grades I and II)  Aggressive lymphomas (50% of NHLs) large B-cell lymphoma and peripheral T-cell lymphoma large B-cell lymphoma and peripheral T-cell lymphoma  Highly aggressive lymphomas (5% of NHLs) Burkitt’s lymphoma and adult T-cell lymphoma Burkitt’s lymphoma and adult T-cell lymphoma

57. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transfusion incompatibility reaction: a condition that results when the blood or blood product transfused has antibodies to the recipient red blood cells or the recipient has antibodies to the donor’s red blood cells  Characteristics of the most severe transfusion reactions are hemolysis and agglutenation. Transfusion Incompatibility Reaction

58. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Clotting Disorders Classic hemophilia: a hereditary bleeding disorder resulting from a deficiency of clotting factors

59. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Early Signs of Hemophilia  male child with:  unexplained prolonged bleeding  noticeable hematomas  easy bruising  excessive nose bleeds