Transcript Diseases of the Cardiovascular System

Human Diseases
A Systemic Approach
Sixth Edition
Mary Lou Mulvihill
Mark Zelman
Paul Holdaway
Elaine Tompary
Jill Raymond
Chapter 7
Diseases of the
Cardiovascular System
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Chapter 7
Diseases of the Cardiovascular System
Multimedia Asset Directory
Slide 4
Slide 6
Slide 13
Slide 21
Slide 22
Slide 24
Slide 26
Slide 34
Slide 35
Slide 36
Slide 37
The Heart
The Cardiovascular System
Chambers of the Heart
Atrial Blood Flow
Atrial Contraction
Systole and Diastole
Ventricular Contraction
Aneurysm
Congestive Heart Failure
Acute Myocardial Infarction
Heart Attacks
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Slide 38
Slide 39
Slide 55
Slide 59
Slide 70
Slide 76
Slide 125
Slide 126
Slide 134
Slide 137
Slide 138
Electrocardiogram
Arrhythmia
Coronary Artery Disease
Angina
Coronary Heart Disease
Congenital Heart Disease
Vital Signs
Vital Signs (Continued)
Dysrhythmias
Hypovolemic Shock
Shock
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Organs of the Cardiovascular
System
 Blood vessels
– Arteries
– Veins
– Capillaries
 Heart
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation showing the
heart.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiovascular (CV) System
 Also called circulatory system
 Maintains the distribution of blood
throughout the body
 Is composed of:
– Heart
– Blood vessels
– Arteries
– Capillaries
– Veins
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation showing the
cardiovascular system.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Circulatory System Composed
of Two Parts
 Pulmonary circulation
– Between heart and lungs
– Transports deoxygenated blood to the lungs to get
oxygen
– Then back to the heart
 Systemic circulation
– Carries oxygenated blood away from the heart to
tissues and cells
– Then back to the heart
– All the body cells receive blood and oxygen.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart
 Muscular pump
 Made up of cardiac muscle




fibers
Could be called a muscle
instead of an organ
Has 4 chambers or cavities
Beats an average of 60 – 100
beats a minute (bpm), or about
100,000 times a day
Each time the muscle
contracts, blood is ejected,
pushed throughout the body
within blood vessels
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
 Located in the mediastinum, in





center of chest cavity
More to the left side of the
mediastinum
Is about the size of a fist
Is shaped like an upside-down
pear
The tip of the heart at the lower
edge is called the apex
The sternum is located directly
in front of the heart
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart Layers
Endocardium
Myocardium
Epicardium
Inner layer
Thick, muscular,
Outer layer of heart
Lines the heart
middle layer of heart
Visceral pericardium,
Contraction of this
inner layer of the
muscular layer
pericardium (pleural
develops the pressure sac)
required to pump
Fluid between the 2
blood through the
layers of the sac
blood vessels
reduces friction as the
heart beats
chambers
Smooth, thin layer
that reduces friction
as the blood passes
through the heart
chambers
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-1: Heart covering and layers of the heart.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart Chambers
 Divided into 4 chambers or cavities
– 2 atria (upper chambers)
– 2 ventricles (lower chambers)
 These are divided into right and left sides by
walls called the interatrial septum and the
interventricular septum.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart Chambers (continued)
 The atria are receiving chambers of the heart.
– Blood returning to the heart in veins collects in the
atria.
 The ventricles are pumping chambers.
– They have a much thicker myocardium.
– Contraction of the ventricles ejects blood out of the
heart and into the great arteries.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on the
chambers of the human heart.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart Valves
 4 valves: tricuspid, pulmonary, mitral, aortic
 Act as restraining gates to control the direction
of blood flow
 Situated at the entrances and exits to the
ventricles
 When properly functioning, valves allow blood to
flow only in the forward direction by blocking it
from returning to the previous chamber
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-2: Heart valves in closed position viewed from the
top.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Tricuspid Valve
 Is an atrioventricular valve
– It controls the opening between the right
atrium and right ventricle
– Once the blood enters the right ventricle, it
cannot back up into the atrium again.
– The prefix tri-, meaning three, indicates that
this valve has 3 leaflets or cusps.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pulmonary Valve
 Semilunar valve
 Semi means half
 Lunar means moon
 Semilunar means this valve looks like a half
moon
 Located between right ventricle and pulmonary
artery
 Allows blood to flow from right ventricle into
pulmonary artery
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Mitral Valve
 Also called bicuspid valve
– 2 cusps
 Blood flows through this atrioventricular
valve to the left ventricle
 Cannot back up into left atrium
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Aortic Valve
 Blood leaves left ventricle through this
semilunar valve between the left ventricle
and into aorta
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Flow of Blood through
the Heart
1.
2.
3.
Deoxygenated blood from all
the tissues, except lung,
enters a relaxed right atrium
via two large veins called the
superior vena cava and
inferior vena cava.
The right atrium contracts
and blood flows through the
tricuspid valve into the
relaxed right ventricle.
The right ventricle then
contracts and blood is
pumped through the
pulmonary valve into the
pulmonary artery, which
carries it to the lungs.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
4.
5.
6.
The left atrium receives
blood that has been
oxygenated by the lungs.
This blood enters the relaxed
left atrium from the four
pulmonary veins.
The left atrium contracts and
blood flows through the mitral
valve into the relaxed left
ventricle.
When the left ventricle
contracts, the blood is
pumped through the aortic
valve and into the aorta, the
largest artery in the body.
The aorta carries blood to all
parts of the body except the
lungs.
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on atrial blood
flow.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on atrial
contraction.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart Chambers
 Alternate between relaxing in order to fill
and contracting to push blood forward
 Relaxation phase is diastole.
 Contraction phase is systole.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation showing
systole and diastole.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Conduction System of the Heart
 Autonomic nervous system controls the
heart rate
 No voluntary control over our heart
 Special tissue conducts electrical impulses
that stimulate different chambers to
contract in correct order.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on ventricular
contraction.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
The path that the impulses
travel is as follows:
1. The sinoatrial (SA) node, or
pacemaker, is where the
electrical impulse begins.
From the sinoatrial node a
wave of electricity travels
through the atria, causing them
to contract, or go into systole.
2. Next, the atrioventricular node
is stimulated.
3. This node transfers the
stimulation wave to the bundle
of His.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
4. The electrical signal next
travels down the bundle
branches within the
interventricular septum.
5. Finally, the Purkinje’s fibers
out in the ventricular
myocardium are stimulated
which results in ventricular
systole.
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Three Types of Blood Vessels
 Arteries: large, thick-walled vessels that
carry blood away from the heart
 Veins: carry blood back to the heart
 Capillaries: connecting units between the
arteries and veins. They are very thin and
carry oxygen-rich blood from the arteries
to the body cells.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-3: Coronary arteries and major blood vessels.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Blood Pressure
 A measurement of the force exerted by blood
against the walls of a vessel
 During ventricular systole, blood is under a lot of
pressure from ventricular contraction.
– Gives highest pressure – systolic
 During ventricular diastole, blood isn’t being
pushed from the heart at all.
– Blood pressure drops to lowest point – diastolic
 Both numbers are required to see full range.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-4: Venous return to the heart and blood flow to the
lungs.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-5: Return of oxygenated blood to heart and entry into aorta
(red=oxygenated blood, blue=deoxygenated blood).
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-7: The blood flow through the heart.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the image to view an animation on heart
conditions: aneurysm.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the image to view an animation on congestive
heart failure (CHF).
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on heart
conditions: acute myocardial infarction.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view a video on the topic of
heart attacks.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view a video on the
electrocardiogram.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view an animation on
arrhythmia.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-6: Conducting system of the heart.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Major Diseases within the
Cardiovascular System
 Congenital heart disease which affects the infant
or child
 Inflammatory heart disease, especially of an
infectious nature, but also the peripheral or
metabolic forms.
 Ischemic vascular disease as found in blood
clots or occlusion of vessels
 Hypertension related disease involving high
blood pressure or hypertensive heart or lung
 Metabolic diseases, associated with diet,
diabetes, and kidney-related problems
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Control of the Heart and the Influence of the
Autonomic Nervous System
 The cardiac muscle can contract continuously
and rhythmically without nerve stimulation
 The sinoatrial node, the pacemaker of the heart,
initiates the heartbeat.
 The impulse for contraction spreads over the
atria and the ventricles via the (AV) – bundle of
His.
 The impulse terminates in the Purkinje’s fibers,
which further branch through the ventricles
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Autonomic Influence
 Parasympathetic: vagus nerve secretes
acetylcholine, slows the heart
 Sympathetic: stimulates the release of
epinephrine into the bloodstream
– Speeds up the heart during periods of stress
and physical activity when the body needs
greater blood flow
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Structure of Blood Vessels
 The walls of arteries are thick and strong with
considerable elastic tissue and are lined with
endothelium, which comprises the intima.
 Arterioles are not only smaller in diameter but
their walls are thin, consisting mostly of smooth
muscle fibers arranged circularly; arterioles are
also lined with endothelium.
 Capillaries are minute vessels about 1/2 to 1 mm
long with a lumen as wide as a red blood cell.
Their walls consist of a layer of endothelium.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Structure of Blood Vessels
(continued)
 Capillaries, the thinnest-walled vessels, allow for
the exchange of oxygen and carbon dioxide
between the blood and tissues. Nutrients and
waste products of cellular metabolism are also
exchanged through capillary walls by diffusion.
 Veins have walls that are much thinner than their
companion arteries, but the lumen is
considerably larger. Veins tend to collapse when
empty.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Arteriosclerosis
 Arteriosclerosis is caused by several
conditions in which the wall of an artery
becomes thicker and less elastic. The
most common of these diseases is
atherosclerosis, in which fatty material
accumulates under the inner lining or
intima of the arterial wall, forming an
atheroma.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-8: An atherosclerotic artery.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-9: Blood vessels: (a) Normal artery. (b)
Constriction. ( c ) Arteriosclerosis and atherosclerosis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Atherosclerosis
 Begins with inflammatory processes such as a slight tear in
the artery wall. Monocytes or white blood cells then
accumulate under the inner lining or intima of the arterial wall
forming an atheroma.
 These white blood cells, in turn, transform into cells that
accumulate fat. Fatty deposits, called plaques, narrow the
lumen of the blood vessels and, in some instances,
completely occlude it.
 Plaque may also consist of complex carbohydrates, blood and
blood products, fibrous tissue, and calcium deposits.
 The aorta and its branches can be affected as well as smaller
coronary and cerebral arteries. Occlusion of these vessels
interferes with blood flow to the heart muscle, causing a
myocardial infarction, and to the brain, causing a stroke or
cerebral vascular accident (CVA). Lack of blood to any organ
is called ischemia and causes tissue damage.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
The Cause of Atherosclerosis
 Not completely known
 But it does have a hereditary basis
 Atherosclerosis is a common complication
of diabetes, also a disease with a
hereditary tendency.
 A low-cholesterol diet and regular exercise
should reduce the risk of developing
atherosclerosis.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Arteriosclerosis
 Arteriosclerosis is caused by several conditions in which
the wall of an artery becomes thicker and less elastic.
 The most common underlying cause of this condition is
atherosclerosis as previously described.
 With time, calcium may accumulate and the vessel is
less resilient or flexible and therefore is unable to
rebound with the pressurized blood rushing through it
during the contraction phases of the heart.
 Arteriosclerosis is the resultant (due to atherosclerosis)
basis of hypertension or high blood pressure.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Table 7-1: Risk Factors for Heart Disease
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Coronary Artery Disease
 The heart muscle itself receives a fraction (about 5%) of the





large volume of blood flowing through the atria and the
ventricles.
Coronary circulation supplies the heart with oxygen-rich blood
and returns oxygen-depleted blood to the right atrium.
Vessels can become occluded (blocked).
Narrowing of the lumen is due to that same condition termed
atherosclerosis.
Ischemia is a deficiency of blood supply (and therefore
oxygen supply) to an area or organ.
Continued ischemia to the heart muscle results in a heart
attack. When an area of the myocardium is suddenly deprived
of blood due to occlusion of the coronary artery, that tissue
dies and the dead muscle is called an infarct. This situation is
a true heart attack or myocardial infarction (MI).
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-10: Blockage of coronary arteries.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view a video on the topic of
coronary artery disease.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Angina pectoris
 Temporary chest pain or sensation of chest pressure




that is caused by transient oxygen insufficiency
Pressure and pain below the breastbone, may radiate to
the neck, jaw, and arms.
Feeling of tightness and suffocation
Triggered by physical activity, heavy meals, exposure to
cold, or emotional stress, it lasts no more than a few
minutes, and subsides with rest.
Medication such as nitroglycerin (a pill under the tongue)
is administered to dilate coronary arteries, permitting
adequate blood flow.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Chronic Unstable Angina
 Recurring attacks of angina is called chronic
unstable angina.
 Control of exercise and physical activity is
necessary for all cases of angina.
 Severe chest pains generally accompany an MI,
but the pain may be referred to the neck or left
arm, and the person may feel nauseous, and
have symptoms confused with heartburn
sensations.
 Additional symptoms are restlessness, cold
sweats, vomiting, lightheadedness, and clammy
skin.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Table 7-2: Signs and Symptoms of Heartburn and
Heart Attack
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view a video on the topic of
angina.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-11: Outcome of myocardial infarction. 40% of 1 week survivors
have late complications resulting in death. Ten year survival is about
25%.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Prognosis
 Depends on many factors
– The speed with which medical attention is given is
very important. Thus, cardiopulmonary resuscitation
(CPR) can be of great assistance while waiting for an
emergency care unit to arrive.
– If one is alone or awaiting emergency care it is
suggested that coughing helps create pressure to
assist the heart.
 Women need to take special precautions
following an MI, because within one year 38%
will die, compared to 25% of deaths in men
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnosis and Severity of MI
 Size of occlusion and distance from its origin
impacts the extent of heart damage
 The diagnosis and severity of an MI is also
indicated by the type and level of certain
enzymes found in the blood.
 These enzymes, which are additional factors,
relate closely to the prognosis.
 If a collateral circulation has been established,
that is, if blood vessels from the surrounding
area have channeled into the damaged tissue,
recovery will be faster and better.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 7-12: Serum enzyme level patterns used to
diagnose myocardial infarction. AST=aspartate
aminotransferase, CPK=creatine phosphokinase, and
LDH=lactate dehydrogenase.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Myocardial Repair
 Scar tissue
– Limited function
– Potential site for clot formation
 Controlled exercise to maintain circulation
 Strength may be limited
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Risks for Coronary Artery Disease
 Obesity
 Hypertension
 Smoking
 Sedentary lifestyle
 High-cholesterol diet
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treatment of Heart Disease
 Severe damage to heart muscle after a heart
attack has been greatly reduced by early
administration of thrombolytic (blood clotdissolving) drugs. TPA (tissue plasminogen
activator), preferably used within 3 hours of the
attack, applied in about 20% of the cases, and
streptokinase are commonly used.
 Other anticoagulants, aspirin (81 mg), and
Coumadin are used depending on the person
having had an MI or bypass surgery, age, or
health status.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Treatment of Heart Disease
(continued)
 During coronary bypass surgery, a portion of the
patient’s vein, usually the saphenous vein, is
used to reroute blood around the occlusion.
When obstruction to blood flow is less severe,
angioplasty may be performed.
 Inserting a balloon-tipped catheter, usually from
the femoral artery, and guiding it up to the heart
into a narrowed coronary artery, in order to
dilate it, the balloon expands and opens up the
vessel. This process is called percutaneous
transluminal coronary angioplasty (PTCA).
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cor Pulmonale
 A serious heart condition in which the right side of the
heart fails as a result of long-standing chronic lung
disease
 As respiratory failure develops, pressure in the blood
vessels to the lung increases, a condition termed
pulmonary hypertension.
 This hypertension overworks the right ventricle, which
pumps blood into the pulmonary artery, causing dilation
and hypertrophy of the right ventricle.
 Treatment is aimed at relieving the causative lung
disease by administration of bronchodilator medication
(e.g., Albuterol) and the use of a ventilator.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Congestive Heart Failure
 Progressive heart condition in which the quantity of blood




pumped by the heart is insufficient to meet the needs of the
body.
Coronary heart disease impairs blood flow to the heart and
can cause a heart attack, as previously described, that
permanently damages the heart.
An infection of the heart caused by viruses, bacteria, and
other microorganisms may damage the heart muscle and
heart valves to cause heart failure.
Heart valve disorders and hypertension increase the size of
the heart muscle and cause it to work harder initially.
Over time, the enlarged heart weakens and fails to pump
adequately. The heart’s conduction system may fail, resulting
in slow, fast, or irregular heartbeats that cannot pump blood
effectively.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Click on the screenshot to view a video on the topic of
coronary heart disease.
Mulvihill, Zelman, Holdaway, Tompary, and Raymond
Human Diseases: A Systemic Approach, 6e
Return to Directory
Copyright ©2006 by Prentice-Hall, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.