The Cardiovascular System: The Heart سيستم قلبى وعايى: قلب

1. The Cardiovascular System: The Heartسيستم قلبى وعايى: قلب EDO 001.16 01/31/2012

2. The Heartقلب Learning Objective: The Physical Therapy Technician will gain an understanding of the anatomy and physiology of the heart and its purpose within the body. Estimated Time to Complete: 325 minutes. وقت معین شده برای تکميل این لکچر : ٣٢٥ دقيقه AFAMS

3. Lesson Overview(Insert Dari) • Insert Dari • Organization • Function • The Heart • Vessels • Disorders • In-class assignment

4. The cardiovascular system includes the heart and all the vessels that branch out from it. Insert Dari Heart (Insert Dari) Artery (Insert Dari) Vein (Insert Dari)

5. Functions of the Cardiovascular System(Insert Dari) • Transport oxygen, nutrients and waste products through the body. • Maintain body temperature • Maintain fluid balance. Insert Dari

6. The Heart(Insert Dari) Heart (Insert Dari) • The heart acts as a pump, delivering blood containing oxygen and nutrients to tissues via blood vessels. • The heart is approximately the size of a human first and is located near the centre of the chest (slightly to the left). • Insert Dari

7. Anatomy of the Heart(Insert Dari) • The human heart is a muscular organ consisting of 4 chambers: • Left atrium • Right atrium • Left ventricle • Right ventricle • Major vessels branching from the heart include: • Aorta • Pulmonary artery • Superior and inferior vena cava Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari

8. Anatomy of the Heart(Insert Dari) • Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari

9. Blood Flow through the Heart(Insert Dari) • Blood enters the right side of the heart via the superior/inferior vena cava. • It then moves from the right atrium to the right ventricle and is then pumped through the pulmonary vein to the lung tissue for oxygenation. • The pulmonary artery carries the blood back to the left atrium. • The blood is then pumped into the left ventricle and out through the aorta for delivery to body tissues.

10. Blood Flow through the Heart(Insert Dari) Insert Dari • Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari

11. Pumping Action of the Heart(Insert Dari) • The muscular ventricles of the heart contract creating the pumping action which moves blood through the vessels of the body. • The muscle tissue of the heart contracts in response to nerve stimulation. • Insert Dari

12. Heart Rate and Rhythm(Insert Dari) • A heart beat is a contraction of the heart muscle. • A normal heart rate is 60-100 beats per minute. • Heart rhythm is the coordinated contraction and relaxation of the atrium and ventricles of the heart. • Cardiac cycle: atrium will contract first, followed by the ventricle. Both the atrium and ventricle relax at the same time.

13. Vessels (Insert Dari) • Blood vessels circulate blood through the body. • There are three types of blood vessels: • Arteries – carry blood away from the heart towards the tissues. • Capillaries – which enable the exchange of fluids, nutrients and oxygen between the blood and tissues. • Veins – which carry de-oxygenated blood back to the heart. Arterial System (Insert Dari) Venous System (Insert Dari)

14. Capillaries (Insert Dari) • The smallest blood vessels of the body. • Consist of a network of small vessels between a vein and an artery. • Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari

15. Veins (Insert Dari) • The veins contain valves to assist with moving the blood back to the heart from the tissues. The valves also prevent the backflow of blood. • Insert Dari

16. Regulation of Heart Rateتنظيم ضربان قلب • کنترول عصبى از مرکز قلبى وعائى در ميديولاى دماغ • تحريک سيمپاتيتيک ضربان قلب را بيشتر و تقلص را نيرومندتر ميسازد • تحريک پاراسيمپاتيتيک ضربان قلب را کمترميسازد • آخذه هاى فشار (باروريسيپتورها) تغيرات فشار خون را کشف نموده و معلومات را به مرکز قلبى وعائى ميرساند. • واقع در قوس ابهر و شرائين کاروتيد • هورمون ها نيز بر ضربان قلب تأثير ميکنند • هورمون هاى ايپى نفرين، نورايپى نفرين و تيروئيد • ايون ها (سوديم، پتاسيم، کلسيم) • سن، جنس، آمادگى جسمانى، و درجۀ حرارت • Nervous control from the cardiovascular center in the medulla • Sympathetic impulses increase heart rate and force of contraction • parasympathetic impulses decrease heart rate. • Baroreceptors (pressure receptors) detect change in BP and send info to the cardiovascular center • located in the arch of the aorta and carotid arteries • Heart rate is also affected by hormones • epinephrine, norepinephrine, thyroid hormones • ions (Na+, K+, Ca2+) • age, gender, physical fitness, and temperature

17. Blood Pressure(Insert Dari) Insert Dari • The pressure exerted on the wall of the blood vessel by the circulating blood. • During each heartbeat blood pressure varies between systolic and diastolic pressure. • Systolic pressure = pressure in the vessels when the heart muscle is contracting. • Diastolic pressure = pressure in the vessels when the heart is resting. • Blood pressure = systolic pressure • diastolic pressure

18. Disorders of the Cardiovascular System(Insert Dari)

19. Atrial Fibrillation (Insert Dari) Insert Dari • Atrial fibrillation = an abnormal heart rhythm. • Occurs when nerve impulses, which control relaxation/contraction of cardiac muscle, become uncoordinated. • Increases a patient’s risk for having a stroke. • A stroke = disruption in blood supply to the brain, resulting in a mild to severe loss of brain function.

20. Hypertension (Insert Dari) Hypertension is a high blood pressure in the arteries. This requires the heart to work harder to move blood through the body. Insert Dari

21. Coronary Artery DiseaseInsert Dari Hyperlipidemia - elevated levels of lipids is the blood. Lipid = fat molecule Lipids can deposit in the arterial vessel wall causing a plaque to form = narrowing of the artery. When this occurs in the arteries that supply the heart muscle tissue it is called coronary artery disease. This results in decreased blood flow to the heart and can result in a heart attack.

22. Coronary Artery DiseaseInsert Dari Insert Dari Insert Dari Insert Dari Insert Dari Insert Dari

23. Heart Failure(Insert Dari) • Occurs when the heart cannot provide sufficient blood flow to meet the needs of the body. • This usually occurs after the heart has been damaged or weakened due to another disease such as: • Hypertension • Coronary artery disease

24. Heart Failure(Insert Dari) Insert Dari Insert Dari • Insert Dari

25. Congestive Heart Failureعدم کفايۀ (نارسائى) احتقانى قلب • اسباب عدم کفايۀ احتقانى قلب • امراض شرائين اکليلى، ازدياد فشار خون، ميوکارديل انفرکشن (مرگ عضلۀ قلب)، اختلالات دريچه ها، نواقص ولادى • عدم کفايۀ سمت چپ قلب • پمپ کمتر مؤثر بوده، خون بيشتر در بطیناتها باقى ميماند • قلب زياد کش شده و حتى خون بيشتر در بطینباقى ميماند • خون به شکل اديماى ريوى ، تا به ريه ها پس مى آيد • نرسيدن و کمبود اکسيجن انساج • عدم کفايۀ سمت راست قلب • مايعات در انساج بشکل اديماى محيطى جمع ميشود • Causes of CHF • coronary artery disease, hypertension, MI, valve disorders, congenital defects • Left side heart failure • less effective pump so more blood remains in ventricle • heart is overstretched & even more blood remains • blood backs up into lungs as pulmonary edema • suffocation & lack of oxygen to the tissues • Right side failure • fluid builds up in tissues as peripheral edema

26. Risk Factors for Heart Diseaseعوامل خطر امراض قلبى • Risk factors in heart disease: • high blood cholesterol level • high blood pressure • cigarette smoking • obesity & lack of regular exercise. • Other factors include: • diabetes mellitus • genetic predisposition • male gender • high blood levels of fibrinogen • left ventricular hypertrophy • عوامل خطر در امراض قلبى: • سطح بلند کولسترول خون • فشار بلند خون • سگرت کشيدن • چاقى و فقدان ورزش منظم • عوامل ديگر: • مرض شکر • زمينۀ ارثى • جنس مذکر • سطح بلند فيبرينوجن خون • کلان شدن بطینچپ

27. Plasma Lipids and Heart Diseaseشحميات پلازما و امراض قلبى • سطح بلند کولسترول خون عامل خطر انکشاف امراض قلبى ميباشد • رشد پلک هاى شحمى را ارتقا ميبخشد. • اکثر شحميات بشکل ليپو پروتين ها (پروتين هاى شحمى) انتقال ميکنند • ليپوپروتين هاى داراى تراکم کم (کولسترول بد)، يا low-density lipoproteins (LDLs) • ليپوپروتين هاى داراى تراکم زياد (کولسترول خوب)، ، يا high-density lipoproteins (HDLs) • ليپوپروتين هاى داراى تراکم بسيار کم يا very low-density lipoproteins (VLDLs) • ليپوپروتين هاى داراى تراکم زياد (HDLs) کولسترول اضافى را از دوران خون بيرون ميکشد • ليپوپروتين هاى داراى تراکم کم (LDLs)با تشکيل پلک هاى شحمى ارتباط دارد • ليپوپروتين هاى داراى تراکم بسيار کم (VLDLs) زمينۀ ازدياد تشکيل پلک هاى شحمى را مساعد ميسازد • در بدن دومنبع کولسترول وجود دارد: • از غذا گرفته ميشود و در جگر ساخته ميشود • Risk factor for developing heart disease is high blood cholesterol level. • promotes growth of fatty plaques • Most lipids are transported as lipoproteins • low-density lipoproteins (LDLs) • high-density lipoproteins (HDLs) • very low-density lipoproteins (VLDLs) • HDLs remove excess cholesterol from circulation • LDLs are associated with the formation of fatty plaques • VLDLs contribute to increased fatty plaque formation • There are two sources of cholesterol in the body: • in foods we ingest & formed by liver

28. Desirable Levels of Blood Cholesterol for Adultsسطح مطلوب کلسترول خون در کاهلان • TC (total cholesterol) under 200 mg/dl • LDL under 130 mg/dl • HDL over 40 mg/dl • Normally, triglycerides are in the range of 10-190 mg/dl. • Among the therapies used to reduce blood cholesterol level are exercise, diet, and drugs. • کولسترول مجموعى (TC) پائينتر از ٢٠٠ ملى گرام در هر ديسى ليتر • ليپوپروتين هاى داراى تراکم کم (LDL) کمتر از ١٣٠ ملى گرام در هر ديسى ليتر • ليپوپروتين هاى داراى تراکم زياد (HDL)بيشتر از ٤٠ ملى گرام در هر ديسى ليتر • بصورت نورمال، ترى گلسريد ها در حد ١٠-١٩٠ ملى گرام در هر ديسى ليتر ميباشد • در تداوى هائيکه براى کم کردن کولسترول خون مورد استفاده قرار ميگيرند، ورزش، رژيم غذائى و ادويه شامل اند

29. Clinical Problemsپرابلم هاى سريرى (کلينيکى) • MI = myocardial infarction • death of area of heart muscle from lack of O2 • replaced with scar tissue • results depend on size & location of damage • Blood clot • use clot dissolving drugs streptokinase or t-PA & heparin • balloon angioplasty • Angina pectoris----heart pain from ischemia of cardiac muscle • ميوکارديل انفارکشن (مردن عضلۀ قلبى به اثر نرسيدن خون) • مرگ يک ساحۀ از عضلۀ قلب به اثر فقدان اکسيجن • جايش را انساج ندبه (زخم) ميگيرد • نتيجه به اندازه و محل اسيب بستگى دارد • علقۀ خون • از ادويۀ منحل کنندۀ علقۀ خون ستريپتوکيناز يا تى -پى اى (t-PA) و هيپرين استفاده کنيد • انجيوپلاستى بالون • انجينا پيکتوريس---درد قلبى از کمخونى عضلۀ قلب

30. By-pass Graftپيوند باى پاس

31. PercutaneousTransluminal Coronary Angioplastyانجيوپلاستى در امتدادمجراى شريان اکليلى از طريق جلد

32. Stent in an Artery ستنت (Stent) در شريان • Maintains patency of blood vessel رگ خون را باز نگهميدارد

33. Exercise and the Heartورزش و قلب • Sustained exercise increases oxygen demand in muscles. • Benefits of aerobic exercise (any activity that works large body muscles for at least 20 minutes, preferably 3-5 times per week) are; • increased cardiac output • increased HDL and decreased triglycerides • improved lung function • decreased blood pressure • weight control. • ورزش متداوم ضرورت اکسيجن عضلات را زياد ميکند • فوائد ورزش ايروبيک (هر فعاليتى که در آن عضلات بزرگ بدن بکار افتند، ترجيحاً ٣-٥ بار در هفته) عبارتند از: • ازدياد حاصل (خروج خون) قلب • ازدياد ليپوپروتين هاى داراى تراکم زياد (کولسترول خوب) و کم شدن ترى گلسريد ها • بهبود فعاليت ريه ها • کم شدن فشار خون • کنترول وزن بدن (جلوگيرى از چاقى)

34. Venous Thromboembolism(Insert Dari) • Thrombosis • clot (thrombus) forming in an unbroken blood vessel • may dissolve spontaneously or dislodge & travel • Embolus • clot, air bubble or fat from broken bone in the blood • pulmonary embolus is found in lungs. • ترومبوز • تشکيل علقه (ترومبوز) در داخل رگ هاى سالم خون • ممکن خود بخود حل شده و يا کنده (رها) شده و سفر کند • امبولى (جسم مسدود کنندۀ جريان خون) • علقه، حباب هوا و يا چربى از استخوان شکسته در داخل خون • امبولى ريوى در شش ها يافت ميشوند

35. In-class Assignment(Insert Dari)

36. 1. The Cardiovascular System consists of the heart and blood vessels, true or false?

37. 1. The Cardiovascular System consists of the heart and blood vessels, true or false? Answer: True

38. 2.Which of the following most correctly describes the functions of the Cardiovascular System? (Insert Dari) • Transport oxygen and nutrients, control body movements, excrete waste products from the body • Absorb oxygen and nutrients, maintain body temperature, maintain fluid balance • Transport oxygen and nutrients, maintain body temperature, maintain fluid balance • Absorb oxygen and nutrients, control body movements, excrete waste products from the body • Insert Dari

39. 2.Which of the following most correctly describes the functions of the Cardiovascular System? (Insert Dari) • Transport oxygen and nutrients, control body movements, excrete waste products from the body • Absorb oxygen and nutrients, maintain body temperature, maintain fluid balance • Transport oxygen and nutrients, maintain body temperature, maintain fluid balance • Absorb oxygen and nutrients, control body movements, excrete waste products from the body • Insert Dari

40. 3. The smallest blood vessel which allows for exchange of fluids, oxygen and nutrients from blood to tissues(Insert Dari) • Arteries • Veins • Capillaries • Venules • Insert Dari

41. 3. The smallest blood vessel which allows for exchange of fluids, oxygen and nutrients from blood to tissues(Insert Dari) • Arteries • Veins • Capillaries • Venules • Insert Dari

42. 5. Match the following disorders with their description:(Insert Dari) • Anemia • Hypertension • Heart Failure • Venous Thromboembolism • Inappropriate blood clotting • Inability of the heart to supply blood to body tissues • High blood pressure • Oxygen carrying capacity of the blood is reduced. • Insert Dari

43. 5. Match the following disorders with their description:(Insert Dari) • Anemia (4) Oxygen carrying capacity of the blood is reduced. • Hypertension (3) High blood pressure • Heart Failure (2) Inability of the heart to supply blood to body tissues • Venous Thromboembolism (1) Inappropriate blood clotting • Insert Dari