MAIN IDEAS
MAIN IDEAS
Common Pathologies
100
What are the 2 transport systems?
Cardiovascular sys.
lymphatic sys.
100
BLOOD PRESSURE:
Measure of pressure within what?
Pressure due to what?
What will be higher when arteries have smaller diameter (arterial constriction) than when they have larger diameter?
Blood pressure highest when?
•Measure of pressure within arterial system
•Pressure due to left ventricle contraction and relative contraction/relaxation of smooth muscle in arteries
•Blood pressure will be higher when arteries have smaller diameter (arterial constriction) than when they have larger diameter.
•Blood pressure highest during systole (heart contraction)
•Lowest during diastole (heart relaxation)
•Low blood pressure: <90 systolic or <60 diastolic
100
CHF
■This decrease in delivery of oxygenated blood to active tissues limits the patient’s ability to exercise.
■Compression therapy should not be used with these patients.
■Why not?
■LE elevation should not be performed
■Why not?
■Symptoms include tachycardia, SOB, sudden weight gains (fluid retention), fatigue/weakness, persistent cough/ wheezing
■Pharmacological management
■Diuretics (water pills)- rid body of salt/water (through urination) to decrease pressure
■Vasodilators- opens arteries and veins
■ACE inhibitors- vasodilate and decrease pressure
■Beta blockers- causes heart to beat slower with less force-decreases BP
■Anticoagulants- Thins blood, decreases resistance
200
Cardiovascular System Functions
•Closed system
•Transport blood throughout the body
•Bring nutrients and oxygen to each cell
•Removal of waste from each cell
•Arteries transport blood away from heart
•Veins transport blood back to heart
200
5 main blood pressure ranges?
Hypertensive crisis?
Stage 2?
Stage 1?
Elevated?
Normal?
Low?
200
CAD
•Narrowing or blockage of coronary arteries due to atherosclerosis (plaque) resulting in diminished blood flow
•Diminished blood flow may cause angina, SOB
•Complete blockage can cause heart attack (MI)
•Pharmacologic treatment:
•Antiplatelet agents (aspirin)
•ACE inhibitors
•Statins- blocks substances body needs to make cholesterol, lowers cholesterol levels
•Surgeries:
•Angioplasty, coronary bypass graft surgery (CABG)
300
Lymphatic System Functions
•Collect excess interstitial fluid as lymph
•Transporting lymph from interstitial spaces to venous system
•Helps cardiac system maintain adequate fluid balance
•Part of immune system
•Filters lymph for harmful bacteria & viruses, initiating the immune response
300
Lymphatic System:
Linked to what other symptoms?
One way route from where to where?
4 main function of vast sys.?
•Linked to the cardiovascular system and the immune system
•One way route from periphery to venous system
•Vast system with 4 main functions
•Collect lymph from body’s interstitial spaces
•Filter lymph
•Detect and initiate response to infection
•Return lymph to cardiovascular system
300
PAD
•Stenotic, occlusive, and aneurysmal diseases of aorta and peripheral arteries
•Results in compromised circulation to the extremities.
•Usually caused by atherosclerosis and thromboembolic processes
•Symptoms: Fatigue, aching, numbness, pain in buttock, thigh, calf, or foot at rest or when walking.
•Poor healing wounds of legs and feet, trophic skin changes, hypertrophic nails
•Pharmacologic management: Beta blockers to control HTN.
•Surgery: revascularization procedures and bypass
•Resting claudication is considered a contraindication to active exercise in patients with PAD and may also indicate that the disease process is more advanced
400
Describe the 2 circuits of the cardiovascular sys.
Pulmonary Circuit
•Transports oxygen-depleted blood from venules in capillary beds through veins to Vena Cava (BLUE)
•Enters RIGHT atrium -> RIGHT ventricle of heart
•Exits to lungs via pulmonary arteries
•Returns to LEFT side of heart (RED) via pulmonary veins
Systemic Circuit
•Transports nutrients and oxygen-enriched blood from lungs to LEFT side atrium -> LEFT ventricle
•Exits left side of heart via Aorta -> arterioles -> capillaries throughout body
•Returns to heart to enter the pulmonary circuit
400
Lymphatic sys
Prevents why?
Has a major role in maintaining normal BV and BP because why?
•Has a major role in maintaining normal blood volume and blood pressure because it returns fluid to venous system
•Prevents edema by returning fluid from interstitial spaces to cardiovascular system
400
ANIEMA
■Decreased hemoglobin (Hb) level
■Hb is the iron-containing molecule of RBC’s that binds with O2
■Suggests that the oxygen carrying capacity of the blood is decreased.
■Hb may be increased when the body’s water content is decreased from dehydration, diarrhea, vomiting, excessive sweating, severe burns and the use of diuretics.
■Pharmacologic management: Iron, Vit B12, iron-rich food
500
Diffusion
What is it?
Where are the 3 distinct regions diffusion happens in?
Where is o2 exchanged for co2?
Where is waste products exchanged for nutrients?
Molecules move from high concentration to low concentration
3 distinct regions
•Lungs: Carbon dioxide (Blue) is exchanged for oxygen (red)
•Viscera: Waste products exchanged for nutrients
•Capillary beds: Oxygen (red) is exchanged for carbon dioxide (blue) & nutrients for waste products
500
Lymph Collection
The lymphatic system collects excess what and returns it to where?
Thus, it plays a vital role in maintaining normal what?
Lymph originates as what?
Approximately __ liters of lymph flow into blood circulation daily.
•The lymphatic system collects excess fluid that has leaked out of the capillaries and returns it to the venous system. Thus, it plays a vital role in maintaining normal blood volume and BP.
•Lymph originates as blood plasma – the fluid portion of blood.
•Approximately 2 liters of lymph flow into blood circulation daily.
500
Chronic Venous Insufficiency
•Condition in which veins and valves in the LE are damaged and cannot keep blood flowing toward the heart.
•Causes veins to remain filled with blood
•Due to weak or damaged valves
•Risk factors: age, obesity, pregnancy, prolonged sitting, standing
•Signs and symptoms: LE swelling, varicose veins, aching, heaviness, cramping, skin ulcers of legs and ankles
•Treatment: compression stockings, elevation of LEs, varicose vein stripping
600
Myocardium Heart Muscle
What is automaticity?
What is the mediastinum and where is it location?
What are some other organs in the thoracic cavity?
Automaticity
•Heart muscle contracts on its own, without input from CNS
Contracts about 38 million times/year
Approximately size of fist
•Mediastium
Location in middle portion of thoracic cavity, between the sternum and vertebral column
Approximately 2/3 of heart located to left of midline
L and R lungs located on either side of heart in thoracic cavity
•Other organs located in thoracic cavity:
Aorta, thymus gland, chest portion of the trachea, esophagus, lymph nodes, and vagus nerve
600
Lymph Collection
Blood enters capillary beds. Fluid portion of blood = ______, enters ________ of tissues by diffusion.
Once in interstitial spaces, termed _______?
~90% of this returns as plasma, through venules, to the _____________.
~10% of this, rich in proteins, enters _________, termed ______ which is in the lymph vessels.
The lymphatic system ends at the ________.
•Blood enters capillary beds. Fluid portion of blood = Plasma, enters interstitial spaces of tissues by diffusion.
•Once in interstitial spaces, termed interstitial fluid.
•~90% interstitial fluid returns as plasma, through venules, to cardiovascular system.
•~10% interstitial fluid, rich in proteins, enters lymphatic system, termed lymph which is in the lymph vessels.
•Lymph vessels have lymph nodes which are kidney shapes structures located along lymphatic system paths.
•The lymphatic system ends at the subclavian vein.
600
WHAT IS BUN?
•Blood Urea Nitrogen
•test measures the amount of nitrogen in the blood that comes from the waste product urea.
•Urea is made when protein is broken down in the body.
•It is performed to assess kidney function.
•An increase BUN level can be indicative of
•dehydration
•renal failure
•heart failure
•Normal adult BUN level = 10-20 mg/dL
700
HEART CHAMBERS
What are the chambers?
which chambers are thinner and why?
Which are thicker and why?
What chamber sends blood to the lungs?
What chamber sends blood to the body?
•Divided into 4 chambers:
•Right and left sides
•Upper and lower chambers
•Atria (atrium)
•Thin-walled upper chambers
•Collect blood returning to heart (via veins) from body (R atrium) and lungs (left atrium)
•Ventricles
•Thick-walled lower chambers, L > R
•Why thicker?
•R ventricle: Heart -> lungs
•L ventricle: Heart -> body
700
Filtration and Protection
Lymph passes through _______ on its path to the subclavian vein, where lymph enters the ________ system.
Lymph passes through lymph node where ______ and _____ particles are intercepted, engulfed, and digested by white blood cells.
When infection is present, lymph nodes _____ and become TTP due to accumulating bacteria and lymphocytes (white blood cells)
•Lymph passes through lymph nodes on its path to the subclavian vein, where lymph enters the cardiovascular system
•Lymph passes through lymph node where bacteria and foreign particles are intercepted, engulfed, and digested by white blood cells.
•When infection is present, lymph nodes enlarge and become TTP due to accumulating bacteria and lymphocytes (white blood cells)
•When nodes are damaged or removed, they cannot regenerate, leading to difficulty draining lymph
700
Coagulation Time
•Prothrombin time and partial prothrombin time
•Measures how much time it takes for your blood to clot.
•Increased coagulation time indicates and increased time to form a clot.
•Why does this matter?
•Neither test is affected by hydration status.
800
Heart Valves
How many are there?
which one is L atrium -> ventricle?
Which one is R atrium -> ventricle?
Which lead away from the heart?
•Ensures blood flows through heart in one direction only
•Increases efficiency
•2 Atrioventricular valves (AV)
•Between atrium and ventricle
•Tricuspid valve - R atrium -> ventricle
•Bicuspid valve - L atrium -> ventricle
•Aka mitral valve
•2 Semilunar valves (SL)
•Between ventricle and artery leading away from heart
•Pulmonic or pulmonary - R ventricle and pulmonary artery
•Aortic valve - L ventricle and aorta
800
Drainage Patterns
Why isnt it considered circulation?
T/F: Lymph drains in predictable patterns
When interstitial fluid is not ________ in cardiovascular system, edema (swelling) results
•Since lymph is transported only from the periphery to the subclavian veins, we will think about lymph drainage rather than its circulation.
•Lymph drains in predictable patterns
•When interstitial fluid is not reabsorbed in cardiovascular system, edema (swelling) results
800
Hematocrit
•Blood is made up of red blood cells, white blood cells and platelets, suspended in plasma
•Hematocrit measures the percentage of RBCs in a volume of blood.
•Red blood cells are important because they carry oxygen throughout your body.
•May be increased when the body’s water content is decreased from dehydration, diarrhea, vomiting excessive sweating, severe burns and the use of diuretics.
•May be decreased with anemia
Aka packed cell volume test - PCV Test
900
Heart Sounds
When are the sounds made?
How can we hear the sounds?
What is LUB?
What is DUB?
•Result when the heart valves close.
•Can be heard with a stethoscope.
•Lub-Dub
•First sound LUB:
•When the ventricles are full, the AV valves (between atria & ventricles) close
•Second sound DUB:
•When the SL valves (located in pulmonary and aortic arteries) close to prevent blood from flowing back into the ventricles
900
EXERCISE CONSIDERATIONS
•Unstable angina
•Symptomatic heart failure
•Moderate to severe aortic stenosis
•Uncontrolled diabetes
•Acute systemic illness or fever
•Uncontrolled tachycardia
•Resting systolic BP > 180 mm Hg
•Resting diastolic BP > 110 mm Hg
Thrombophlebitis
1000
Cardiac Cycle
R and L _____ contract simultaneously, followed closely by simultaneous contraction of R and L______.
What is diastole?
What is systole?
What causes AV valves to close?
§R and L atria contract simultaneously, followed closely by simultaneous contraction of R and L ventricles
§Diastole: Resting phase of cardiac cycle
§Blood from superior & inferior vena cava flows into R atrium and ventricle
§SL valves close
§Systole:
§Active phase of cardiac cycle
§Electrical system of the heart stimulates contraction of the cardiac muscle
§Pressure causes AV valves to close
1100
Blood vessels:
What are the 3 types?
Which carry blood away from the heart?
What carry blood to the heart?
Where do they merge?
What do they exchange?
•3 types of blood vessels
•Arteries
•Carries blood away from heart
•Start with aorta (largest)
•End with arterioles (smallest) in capillary beds
•Veins:
•Carry blood toward heart
•Start with venules (smallest) in capillary beds
•To superior and inferior vena cava (largest)
•Capillaries:
•arterioles and venules, termed capillaries.
•Where they merge = capillary beds
•All exchange of oxygen and nutrients with carbon dioxide and waste happens in walls of capillaries
1200
Blood vessels:
Which are larger in diameter, with thinner, less elastic walls?
Since veins are moving blood against gravity, they contain valves to prevent what?
__s have more valves than __s since they pump against gravity more. Prevents pooling of blood in legs
Contraction of large _____ _____ assists with blood pumping, especially in Les
•Veins are larger in diameter, with thinner, less elastic walls
•Since veins are moving blood against gravity, they contain valves to prevent backflow of blood away from heart
•LEs have more valves than UEs since they pump against gravity more. Prevents pooling of blood in legs
•Contraction of large skeletal muscle assists with blood pumping, especially in Les
•Arteries, veins, and nerves usually share same path and are named together
•Exception -carotid artery with jugular vein in neck
1300
Circle of Willis
What does it do?
Design ensures continuous blood/oxygen to brain should one of the three major arteries fail.....
•Design ensures continuous blood/oxygen to brain should one of the three major arteries fail
•2 internal carotid arteries (anterior)
•Basilar artery (posterior)
1400
Anastomoses
What is it?
Where does it usually form?
Where do small anastomoses form?
•The joining of arteries, providing multiple pathways for blood to supply tissues
•Usually form in tissues where blood flow is critical to survival
•Brain
•Heart
•Small anastomoses are also common around joints
1500
•Normal: beats per minute (bpm)
•Adults (age > 13): ? bpm
•Athletes: ? bpm
•Children: ? bpm
varies by age
•Normal: beats per minute (bpm)
•Adults (age > 13): 60-100 bpm
•Athletes: 40-60 bpm
•Children: 70-130 bpm
varies by age