CARDIOVASCULAR FUNCTION {CC2 ENDTERMS

ANATOMY OF THE HEART

- Hollow muscular organ that is approximately

the size of a fist
- 325 g in men; 275 g in females; 12 cm in length
- located in the middle section of the chest cavity
between the lower lobes of each lung and slightly to the
left of the sternum

Cardiac-specific contractile proteins of the muscle fibers:

1. actin
2. myosin
3. troponins (regulatory protein)
*In addition, these fibers also contain a number of
enzymes such as myoglobin, creatine kinase (CK),
and lactate dehydrogenase (LDH) that have been
used as markers of cardiac injury.
FUNCTIONS OF THE HEART:
1. Pump blood to the organs of the body
2. Deliver oxygen and nutrients
3. Remove waste products from the tissues
BLOOD FLOW:

~pericardium- double-layered fibrous membrane (sac)

that encloses the heart
- visceral pericardium- inner layer
- parietal pericardium- outer layer
- pericardial fluid- separates the and prevents
friction between two layers when the heart
moves as it beats
Divided into two upper and two lower chambers:
1. Upper chambers- right and left atria
2. Two lower chambers- right and left ventricles

~septum.- separates the heart between left and right

interatrial septum- portion of the septum
that separates the two upper chambers of the
heart
interventricular septum- separates the two
lower chambers
~mitral valve- atrioventicular valve connecting the
upper and lower chamber on the left side
~tricuspid valve- connects the upper and lower
chambers on the right
three layers of the wall of the heart:
1. epicardium (outer layer)
2. myocardium (middle layer)
3. endocardium (inner layer)

~myocardium- contains striated muscle fibers that

alternate between contraction and relaxation, which
allows the heart to do its work.
JFGB

right pump:
a. right atrium- receives and holds oxygen poor
blood from circulation
b. tricuspid valve- opens and allows the blood to
pump into the right ventricle
c. right ventricle- hold the blood until it contracts
d. pulmonary valve- opens and allows blood into
the pulmonary artery
e. pulmonary artery- delivers blood to the lungs
for reoxygenation
left pump:
a. left atrium- receives oxygen-rich blood from the
lungs and stores it until it contracts
b. mitral valve- opens and allows blood to enter
the left ventricle
c. left ventricle- holds the blood until it contracts
d. aortic valve- opens and allows blood to enter
the aorta
e. aorta- holds blood to be circulated throughout
the body
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CARDIOVASCULAR FUNCTION {CC2 ENDTERMS

PATHOLOGIC CONDITIONS OF THE HEART
Heart muscle depends on constant nutrition through a
system of coronary arteries, which are highly vulnerable
to the process of atherosclerosis.. In the early stages of
atherosclerosis, as coronary blood flow is gradually
reduced, there are typically no symptoms or laboratory
evidence of cardiac injury. Once the diameter of a
coronary artery is reduced to less than 10%20% of its
original size, chest pain (angina pectoris) often develops
when demand for oxygen increases, particularly during
exercise (exertional angina). More rapid reduction in
blood flow can occur when plaque stimulates formation
of a thrombus in a coronary artery, leading to an acute
coronary syndrome (ACS). When a thrombus completely
cuts off blood flow, the supplied muscle will develop
irreversible ischemic damage, and the syndrome is a
myocardial infarction (MI). When the blockage is not
complete, irreversible muscle damage may be avoided,
but the patient will experience severe angina, even at
rest, and this syndrome is known as unstable angina.
The broad spectrum of heart disease resulting from
impaired coronary blood flow is referred to as coronary
heart disease (CHD).

HEART OR CARDIOVASCULAR DISEASE (CVD)

1. Congenital Heart Disease (CHF)/ Congenital
cardiovascular defects (CCVDs)
2. Congestive Heart Failure
3. Acute Coronary Syndromes
4. Hypertensive Heart Disease
5. Infective Heart Disease
SYMPTOMS OF HEART DISEASE
7 Classic Symptoms:
1. Dyspnea
2. Chest pain
3. Palpitations
4. Syncope
5. Edema
6. Cyanosis
7. Fatigue

JFGB

~Dyspnea- earliest and most common symptom of

heart disease; experienced during a low- or no-exertion
activity only
three basic types of dyspnea:
1. Cardiac dyspnea
2. Pulmonary dyspnea
3. Psychological dyspnea

~Angina pectoris/Angina
- chest pain due to coronary artery disease and
it is often a symptom of ischemia (restriction of
blood supply to the heart)
- occurs when the heart is not supplied with an
adequate amount of blood due to a blockage in
one or more arteries that supply blood to the
heart, worsened by exercise and relieved by
rest
- manifests itself as uncomfortable pressure,
squeezing in the center of the chest
two types of angina:
1. stable (reversible)
- pain and discomfort in
the chest only when
engaged in moderate
activity. Once the activity
is removed, the pain
subsides
-formed plaque enclosed
in a fibrous cap may be
seen
2. unstable (progressive)
- pain and discomfort
angina
unpredictably at rest
- plaque ruptures, allowing
blood clots to precipitate
and further decrease the
lumen of the coronary
vessel
~ Palpitation- one has of their own heartbeat

~ Syncope- sudden loss of consciousness due to

deprivation of oxygen and blood to the brain most often
caused by arrhythmia (irregular heartbeat)
~Edema- edema associated with heart disease is often
absent in the morning (as fluid is reabsorbed while lying
down) and is progressively worse during the day
~Two types of cyanosis:
a. Central- due to inherited form of heart
disease
b. Peripheral- caused by exposure to cold
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CARDIOVASCULAR FUNCTION {CC2 ENDTERMS

Unusual symptoms:
a. Cough
b. Abdominal pain
c. Hemoplysis
d. Headache
e. Sweating
f. Vision and Speech disturbances
g. Weakness of extremities
h. Weight loss
i. Nausea and vomiting
j. Fever

1. Congestive Heart Disease/ Congenital Cardiovascular

Defects (CCVDs)
- Abnormalities arising from the abnormal formation of
the heart or its major blood vessels
- All defects develop before week 10 of pregnancy
(heart develops early in embryonic life and is
completely formed and functioning by week 10 of
gestation)
- Signs and symptoms of many CCVDs include cyanosis,
pulmonary hypertension, clubbing of the fingers,
embolism, reduced growth, and syncope
Factors associated with the development of CCVDs:
a. Maternal rubella infections
b. maternal alcohol abuse
c. drug treatment and radiation
d. certain genetic and chromosomal abnormalities
CCVDs include:
a. Ventricular Septal Defects- Most common type of CCVD encountered
- hole in the heart
- There is a large opening between the
ventricles of the heart, resulting in increased
blood flow to the lungs and decrease cardiac
output
- Results in hypertrophy
- Compensatory mechanisms: increased
catecholamine secretion and salt and water
retention by means of the RAAS
b. Atrial Septal Defects
- abnormally causes left to right shunting of
blood between the atria
c. Coarctation Of The Aorta
- the aorta narrows in the area where the
ductus arteriosus inserts
d. Congenital Valve Problems
- stenosis or valvular incompetence
- Mitral valve prelapse
`
~Tetralogy of Fallot- most common cyanotic
congenital heart abnormality
JFGB

- VSD: right ventricular outflow obstruction,

abnormal positioning of the aorta above the
vsd, right ventricular hypertrophy

2. Congestive Heart Failure (CHF)

- Results from any structural or functional cardiac
disorder that impairs the ability of the ventricle to fill
with or eject blood
ineffective pumping of the ineffective pumping of the
left side of the heart
right side of the heart
- pulmonary edema and
- excess fluid accumulates
reduced output of blood
in systemic circulation and
to systemic circulation
generalized edema
- Kidneys respond by retaining excess fluid, making the
CHF worse
- may result from disorders of the walls of the heart or
from disorders of the great vessels
*most HF cases are due to left ventricular
dysfunction
Causes of heart failure:
Coronary artery disease
Cardiomyopathies
Inflammatory Heart disease
Cardiac conduction dysfunctions/arrhythmias
Congenital cardiovascular disease

3. Acute Coronary Syndrome

- Continuum of events:
1. Angina
2. reversible tissue injury
3. unstable angina
4. myocardial infarction (MI)
5. extensive tissue necrosis
- Progression of pathologic events:
1. rupture and erosion of coronary artery plaques
2. activation of platelets
3. thrombi
- Symptoms of ACS include chest pain, referred pain
(pain referred to the arm, jaw, neck, back, or abdomen),
nausea, vomiting, dyspnea, diaphoresis, and
lightheadedness.
- Major cause of ACS is atherosclerosis
~Atherosclerosis
- An inflammatory disorder
- thickening and hardening of the artery walls caused
by deposits of cholesterol-lipid-calcium plaque
(vessel occluding lesions) in the
lining of the arteries
- Results in the narrowing of the arteries
and a tendency for plaque disruption and thrombus
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CARDIOVASCULAR FUNCTION {CC2 ENDTERMS

formation leading to ischemia

Three things may result from ischemia to the heart:

CHF, angina pectoris, and MI

Myocardial infarction
- myocardial necrosis due to prolonged ischemia
Acute MI- polymorphonuclear leukocytes
Healing MI- mononuclear cells and fibroblasts in
the absence of polymorphonuclear leukocytes
Healed MI- scar tissue without cellular
infiltration
mechanisms that lead to the cellular injury in
atherosclerosis:
bacterial infection
hyperlipidemia
glycosylated products seen in diabetes mellitus
proinflammatory cytokines

Predisposing factors to atherosclerosis:

age (more common in 40 years old)
sex
family history
dyslipidemia (triglycerides and LDL; HDL)
smoking (men only)
hypertension
sedentary lifestyle
diabetes mellitus
*Premenopausal women- appear to be less at risk for
the development of atherosclerosis compared to men
due to higher levels of HDL cholesterol. However, when
estrogen levels drop at menopause, the difference
between men and women disappears

5. Infective Heart Disease

- serious complication of rheumatic fever
- result from an autoimmune response

most common heart diseases caused by infectious

agents:
rheumatic heart disease, infective endocarditis, and
pericarditis

4. Hypertensive Heart Disease

- general term used to describe heart diseases, such as
left ventricular hypertrophy, coronary artery disease,
cardiac arrhythmias, and CHF, caused by direct or
indirect effects of elevated BP
~Hypertension- defined as persistent systolic blood
pressure (BP) of at least 140 mm Hg and/or diastolic
pressure of at least 90 mm Hg, or BP that is controlled
to guideline-recommended levels using
antihypertensive medication
* for every 20 mm Hg systolic or 10 mm
Hg diastolic increase in BP, there is a doubling of
mortality from ischemic heart disease and stroke
Peripheral resistance- most important factor that
determines BP (peripheral resistance= heart disease)

JFGB

CARDIOVASCULAR FUNCTION {CC2 ENDTERMS

DIAGNOSIS OF HEART DISEASE
History- typical acute, severe and prolonged
chest pain is present
ECG- Unequivocal changes are the development
of abnormal, persistent Q waves
Serum Cardiac Markers

- demonstrates prognostic capacity in those who do not

yet have a diagnosis of vascular disease

Serum Cardiac Markers

Enzymes
CK-MB,
AST, LDH (not currently recommended
for routine use)
Cardiac proteins
Myoglobin, cardiac troponins, cardiac
myosin
light chains Inflammatory and Coagulation
Disorder Markers
CRP, Fibrinogen, D-Dimer

CK-MB- highly specific for myocardial damage

Rise
peak
return to normal
46 hours
1224 hours
23 days
Myoglobin- not cardiac specific
Rise
peak
14 hours
69 hours

return to normal
1824 hours

Troponin
- definitive markers for AMI (due to sustained elevation)
- complex of three proteins that bind to the thin
filament (actin) of cardiac and skeletal muscle
- high sensitivity and specificity for myocardial
Damage
Rise
peak
return to normal
410 hours
1248 hours
410 hours
1. Troponin T (TnT)- extremely useful in patients
who do not seek medical attention in the 2- to
3-day window when CK-MB is elevated; helpful
in monitoring patients after reperfusion
treatment
2. Troponin I (TnI)- cardiac specific
Rise
peak
return to normal
46 hours
1218 hours
6 days
3. Troponin C (TnC)

Myosin light chains- first thought to be unique

myocardial proteins

High-Sensitivity C-Reactive Protein

- useful in its high predictive value for coronary artery
disease
JFGB