TONI ROSE JOY U.

HONOR BSN-4B

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Cardiovascular System is consist of the heart, associated vasculature, and blood. The heart and Vasculature deliver the blood to every organ system in the body maintaining oxygen levels, supplying nutrients, and carrying toxins away to be filtered by the spleen and liver. The structural and functional abilities of the cardiovascular system are crucial to sustaining the human body. Age-related changes to the cardiovascular structure and function will be evaluated in this section.

The Heart The heart is a muscle about the size of an adult fist. It is composed of two sides and four chambers: the left and right atria and the left and right ventricles. The two atria are located on the top of the heart and receive blood from various parts of the body. The two ventricles are located on the bottom of the heart and pump blood away from the heart, to the body. The right ventricle is responsible for pumping deoxygentated blood to the lungs. The left ventricle pumps oxygenated blood to the rest of the body. Between the chambers are valves. Valves control the flow of blood, insuring that it flows in one direction.

ATRIA of the HEART

The atria of the heart receive blood returning to the heart from other areas of the body. Right Atrium: Receives blood returning to the heart from the superior and inferior venae cavae . The superior vena cava returns de-oxygenated blood from the head, neck, arm and chest regions of the body to the right atrium. The inferior vena cava returns de-oxygenated blood from the lower body regions (legs, back, abdomen and pelvis) to the right atrium.

Left Atrium: Receives blood returning to the heart from the pulmonary veins . The pulmonary veins extend from the left atrium to the lungs and bring oxygen-rich blood back to the heart.

The ventricles do most of the "work" and move most of the blood. As such, they are bigger, thicker, and more muscular. The right ventricle pumps blood from the heart to the lungs and back to the heart. The left ventricle pumps blood from the heart to the rest of the body - your brain, liver, kidneys, and other organs, as well as your arms, legs, face, etc. - and back to the heart.

The atria are "helpers" which help the ventricles to pump more effectively by making sure the ventricles are filled completely before they contract. there are 4 chambers of the heart. 2 on top and two below. they are called the right and left atruims (the 2 upper ones) and the right and left ventricles (2 lower ones). In order to appreciate how they work, you must go thru the process of oxygenation/circulation of the blood thru the cardio pulmonary system. first, lets say the blood from the body has been depleted with oxygen, it goes in the right atrium thru the superior or inferior vena cava (theyre like hiways which carry the blood to the heart....SVC carries the blood from the upper body and the IVC carries the blood from the lower body) so, from the right atrum (which is like a containing area for all unoxygenated blod, it pumps it to the right ventricle thru the tricuspid valve (like a door to the right ventricle). when it gets to the right ventricle, it gets pumped again thru the pulmonic valve (which is also like another door) where it gets carried by the pulmonic artery to the lungs for oxygenation.

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being oxygenated by the lungs, there are 4 pulmonary veins that brings the blood back to the heart and the blood enters the left atrium (sort of like a holding area for oxygenated blood) where it gets pumped thru themitral valve (again, like a door) to the left ventricle wherein it gets pumped (yet again) this time thru the aortic valve (again like a door) to the aorta (which is the largest vessel of the body) that will carry the oxygenated blood to the various parts of the body.

 Enlargement

of heart chamber and coronary cells occurs with age, as does increased thickening of heart walls, especially in the left ventricle production of collagen. In addition, there is a decline the number of myocardial cells and subsequent enlargement of the remaining cells.

 Aging

does not appear to change the overall maximum capacity, the maximum vasodilation, or the perfusion of coronary vessels. However, resistance increases with age in the aorta, arterial wall, and vascular periphery. In addition, blood viscosity increases between the ages of 20 to 70 years. Cardiovascular symptoms of hypertension parallel the unusual aging changes seen in older adults.

few of the age-related changes in the cardiovascular system. Orthostatic hypotension has a prevalence as high 30% in individuals over 75 years of age. Changes related to orthostatic hypotension include decreased reaction of the entire system, both myocardial and vascular, Badregenic stimulus as well as reduced BARORE reflex activity relating to an imbalance in neurodocrine conrol.

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cardiovascular response is different from the response of younger individuals. Cardiovascular condition during exercise is usually measured using maximum oxygen consumption, which deals the sum of cardiac output and systemic

is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD). CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.

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major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments.

 Stable

Angina Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (Pattern refers to how often the angina occurs, how severe it is, and what factors trigger it.) If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine. Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain. Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Variant (Prinzmetal's) Angina Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina. Microvascular Angina Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina.

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

 Hypertension

is a major risk factor for stroke myocardial infarction (heart attacks), heart failure, aneurysms of the arteries Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in people for whom lifestyle changes prove ineffective or insufficient.

is an inability of the heart to provide sufficient pump action to distribute blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications. Sometimes it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure. Heart failure is a common, costly, disabling, and potentially deadly condition. In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 610%

commonly known as a heart attack, results from the interruption of blood supply to a part of the heart causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque which is an unstable collection of lipid (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).

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symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweat ing, and anxiety (often described as a sense of impending doom). Women may experience fewer typical symptoms than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue. A sizeable proportion of myocardial infarctions (2264%) are "silent", that is without chest pain or other symptoms.

Transmural: associated with atherosclerosis involving a major coronary artery. It can be subclassified into anterior, posterior, inferior, lateral or septal. Transmural infarcts extend through the whole thickness of the heart muscle and are usually a result of complete occlusion of the area's blood supply. In addition, on ECG, ST elevation and Q waves are seen.
Subendocardial: involving a small area in the subendocardial wall of the left ventricle, ventricular septum, or papillary muscles. The subendocardial area is particularly susceptible to ischemia. In addition, ST depression is seen on ECG.

 classifies

myocardial infarction into five main

types:
Type

1 Spontaneous myocardial infarction related to ischaemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection. 2 Myocardial infarction secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension, or hypotension

Type

Type 3 Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood

Type

4 Associated with coronary angioplasty or stents:

Type 4a Myocardial infarction associated with PCI Type 4b Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy

Type

5 Myocardial infarction associated with CABG

Coronary heart disease (CHD) is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. Atherosclerosis (sometimes called hardening or clogging of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery tone and function. Without an adequate blood supply, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. If blood supply to a portion of the heart muscle is cut off entirely, or if the energy demands of the heart become much greater than its blood supply, a heart attack (injury to the heart muscle) may occur.

is total paralysis of the arm, leg, and trunk on the same side of the body. Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked weakness. Hemiplegia may be congenital or acquired from an illness or stroke. Hemiplegia is not an uncommon medical disorder. In elderly individuals, strokes are the most common cause of hemiplegia. In children, the majority of cases of hemiplegia have no identifiable cause and occur with a frequency of about one in every thousand births. Experts indicate that the majority of cases of hemiplegia that occur up to the age of two should be considered to be cerebral palsy until proven otherwise.

Difficulty with gait Difficulty with balance while standing or walking Having difficulty with motor activities like holding, grasping or pinching Increasing stiffness of muscles Muscle spasms Difficulty with speech Difficulty swallowing food Significant delay in achieving developmental milestones like standing, smiling, crawling or speaking The majority of children who develop hemiplegia also have abnormal mental development Behavior problems like anxiety, anger, irritability, lack of concentration or comprehension Emotions depression Shoulder pain Often associated with a loss of external rotation of the glenohumeral joint, commonly due to the increased tone of the Subscapularis muscle and Pectoralis major muscle Shoulder Subluxation

Hemiparesis is weakness on one side of the body. It is less severe than hemiplegia the total paralysis of the arm, leg, and trunk on one side of the body. Thus, the patient can move the impaired side of his body, but with reduced muscular strength.
Hemiparesis can be caused by a number of medical conditions, most related to the brain or spinal cord. Some of the conditions that have hemiparesis as either an indicative symptom or as a result of the condition itself include migraine, head trauma, muscular dystrophy, stroke, brain tumors, or cerebral palsy.

 EFFECT
Loss

of motor skills Loss of using or understanding speech Loss of ability to distinguish left from right Loss of short-term memory and/or attention span

is a recently identified clinical disorder following left or right brain damage in which patients actively push their weight away from the nonhemiparetic side to the hemiparetic side. In contrast to most stroke patients, who typically prefer more weight-bearing on their nonhemiparetic side, this abnormal condition can vary in severity and leads to a loss of postural balance. The lesion involved in this syndrome is thought to be in the posterior thalamus on either side, or multiple areas of the right cerebral hemisphere.

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a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.

THE CARDIOVASCULAR SYSTEM AND ITS DISEASE