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Phase 1a Miles Benjamin Daniel Bradbury

Cardio. Phase 1a Miles Benjamin Daniel Bradbury. The Peer Teaching Society is not liable for false or misleading information…. Outline. Physiology Mechanical activity of heart Regulation of Mean Arterial Pressure (MAP) Pathology Atherosclerosis Thromboembolism Shock Heart Failure

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Phase 1a Miles Benjamin Daniel Bradbury

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  1. Cardio Phase 1a Miles Benjamin Daniel Bradbury The Peer Teaching Society is not liable for false or misleading information…

  2. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  3. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  4. Muscle • Action potential arrives at sarcomere. • Opening of Ca2+ channels. • Influx of calcium ions. • Initiates muscle contraction. The Peer Teaching Society is not liable for false or misleading information…

  5. Troponin • Three types of troponin: • Troponin C – calcium binds to cause a conformational change in Troponin I. • Troponin T – binds to tropomyosin, forming a tropomyosin – troponin complex. • Troponin I – inhibtory binds to actin, to hold the tropomyosin – troponin complexes in place. The Peer Teaching Society is not liable for false or misleading information…

  6. Cardiac Contraction • Contraction of involuntary striated muscle. • Controlled by Ca2+ • Increase in concentration causes contraction • Sliding filament theory The Peer Teaching Society is not liable for false or misleading information…

  7. So … The Peer Teaching Society is not liable for false or misleading information…

  8. The Cardiac Cycle The Peer Teaching Society is not liable for false or misleading information…

  9. Atrial Systole • Contraction of the left and right atria. • blood pressure in atria increases forcing blood into the ventricles. • begins with the onset of the ‘P’ wave on ECG The Peer Teaching Society is not liable for false or misleading information…

  10. Ventricular Systole • Ventricular systole is the contraction of the left and right ventricles. • Blood is forced out of the pulmonary and aortic valves • “Lubb – Dub” • Lubb is the closure of AV valves at beginning of ventricular systole. • Dub is the closure of aortic and pulmonary at end of ventricular systole. • QRS complex The Peer Teaching Society is not liable for false or misleading information…

  11. Diastole • When do coronary arteries perfuse heart tissue with blood? • Diastole! • In diastole the heart is in an mostly un-contracted state • As pressure drops in ventricles, AV valves open. Blood begins filling chambers again. The Peer Teaching Society is not liable for false or misleading information…

  12. Leaving the heart • Cardiac Output CO = SV x HR • SV = Stroke Volume • HR = Heart Rate • 5+ litres a minute • Are ventricles pumping effectively? The Peer Teaching Society is not liable for false or misleading information…

  13. Electro Cardiography The Peer Teaching Society is not liable for false or misleading information…

  14. Main waves • P wave • Atrial depolarization, SA node towards the AV node, spreads from the right to left atrium. • QRS complex •  Rapid depolarization of the right and left ventricles. Larger muscle so larger amplitude. • T wave • Repolarisation of the ventricles. The Peer Teaching Society is not liable for false or misleading information…

  15. The Peer Teaching Society is not liable for false or misleading information…

  16. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  17. Mean Arterial Pressure • Definition • The average arterial blood pressure over the entire cardiac cycle • Formula? The Peer Teaching Society is not liable for false or misleading information…

  18. Physiology • Definition • The average arterial blood pressure over the entire cardiac cycle • Formula? Mean Arterial Pressure (MAP) Total Peripheral Resistance (TPR) Cardiac Output (CO) = x The Peer Teaching Society is not liable for false or misleading information…

  19. Cardiac Output • Definition • Volume of blood ejected by each ventricle per minute • Formula? The Peer Teaching Society is not liable for false or misleading information…

  20. Physiology • Definition • Volume of blood ejected by each ventricle per minute • Formula? Cardiac Output (CO) Heart Rate (HR) Stroke Volume (SV) x = The Peer Teaching Society is not liable for false or misleading information…

  21. Physiology • Definition • Total resistance to flow of blood by all systemic blood vessels • Which level of blood vessel offers the most resistance? • Arterioles offer the most resistance to vascular flow as they can be changed by vasoconstriction or vasodilation The Peer Teaching Society is not liable for false or misleading information…

  22. Physiology • Controlling TPR • Locally • Active hyperaemia ↑ demand by organ = vasodilation • Flow autoregulation  ↓ supply to organ = vasoconstriction • Extrinsic • Autonomic nervous system • Hormones  whole host of vasodilators/constrictors • NO The Peer Teaching Society is not liable for false or misleading information…

  23. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  24. Atherosclerosis • Definition - Formation of plaques in the intimal layer of medium to large sized arteries. HARDENING OF THE ARTERIES The Peer Teaching Society is not liable for false or misleading information…

  25. Atherosclerosis • Pathophysiology LDL oxidation → macrophages & lymphocytes to absorb oxidised LDL → foam cells. White cells cannot process oxidised LDLs → inflammation & continuation of cycle. Fatty streak → fibrous plaque → atherosclerotic plaque The Peer Teaching Society is not liable for false or misleading information…

  26. The Peer Teaching Society is not liable for false or misleading information…

  27. Atherosclerosis • Risk Factors • Age • FH • Obesity • Male • Smoking • Diabetes Mellitus • Hyperlipidaemia • Hypertension The Peer Teaching Society is not liable for false or misleading information…

  28. Outcomes of Atherosclerosis • Angina • Claudication • MI • Aneurysm The Peer Teaching Society is not liable for false or misleading information…

  29. Angina • Atherosclerosis of coronaryarteries • Pathophysiology • Increaseddemandwithoutproportionalincrease in oxygensupply • ClincalFeatures • SOB, Nausea, Fatigue, ChestPain • Stable vs. Unstable The Peer Teaching Society is not liable for false or misleading information…

  30. Angina • Diagnosis • ECG (ST depression), exercisetolerance, coronaryangiogram • Treatment • Immediate= GTN Spray • Long Term= ???????? The Peer Teaching Society is not liable for false or misleading information…

  31. Atherosclerosis – Angina • Diagnosis • ECG (ST depression), exercisetolerance, coronaryangiogram • Treatment • Immediate= GTN Spray • Long Term= Statins, Beta Blockers, Antiplatelets:ACE inhibitors, Calcium Channel blockers The Peer Teaching Society is not liable for false or misleading information…

  32. Atherosclerosis – MI • Complete blockage of coronaryartery • ClinicalFeatures • Severecrushingchestpain, Dyspnoea, Nausea, Sweating, Feeling of terror • Diagnosis • ECG, Bloods, RaisedCardiomyocyte • Treatment • Antiplatelet, BB,Statins, PCI The Peer Teaching Society is not liable for false or misleading information…

  33. Intermittent Claudication Ischaemia, usually do to atherosclerosis Typically presents as elderly person who gets leg pain when walking After they rest for a few minutes the pain goes away and they can start walking again The Peer Teaching Society is not liable for false or misleading information…

  34. Aneurysm • Localised, permanent dilation of artery • Can be asymptomatic until it ruptures • Ruptured abdominal aneurysm causes sudden severe abdominal pain – surgical emergency • Aortic dissection – blood between layers of aorta The Peer Teaching Society is not liable for false or misleading information…

  35. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  36. Thromboembolism • Deep vein thrombosis • Pulmonary embolism The Peer Teaching Society is not liable for false or misleading information…

  37. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  38. Shock An acute failure of the CVS to perfuse the tissues Hypovolaemic – blood loss Anaphylactic – type I hypersensitivity Septic – vasodilation caused by bacterial toxins Cardiogenic – heart failure The Peer Teaching Society is not liable for false or misleading information…

  39. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  40. Heart Failure • Where the heart is unable to pump enough blood to satisfy the needs of the metabolising tissues. • Breathlessness, tiredness and fatigue are associated with a cardiac abnormality that reduces cardiac output. The Peer Teaching Society is not liable for false or misleading information…

  41. Left Heart Failure • Fatigue and weakness • Exertional breathlessness • Orthopnoea • paroxysmal nocturnal dyspnoea • Cough / pulmonary oedema – crackles in ;lung bases. The Peer Teaching Society is not liable for false or misleading information…

  42. Right Heart Failure • Swollen ankles • Fatigue • Raised jugular venous pressure • Abdominal swelling/hepatomegaly • Pitting oedema • Ascites • Could be corpulmonale – query PE, COPD etc. The Peer Teaching Society is not liable for false or misleading information…

  43. Congestive Heart Failure • Both! • Very often a case of right heart failure due to severe left failure. The Peer Teaching Society is not liable for false or misleading information…

  44. Outline • Physiology • Mechanical activity of heart • Regulation of Mean Arterial Pressure (MAP) • Pathology • Atherosclerosis • Thromboembolism • Shock • Heart Failure • Arrhythmias • Clinical Problems • Chest Pain • Leg Pain • Murmurs The Peer Teaching Society is not liable for false or misleading information…

  45. Arrhythmias • Abnormal electrical activity in the heart. • Too fast? • Too slow? • Uncoordinated? The Peer Teaching Society is not liable for false or misleading information…

  46. Normal ECG The Peer Teaching Society is not liable for false or misleading information…

  47. Bradycardia • Slow heart rate (< 60bpm) • Sinus node disease, AV block, MI, beta blockers. • non-cardiac • e.g.raised ICP • hypothermia • hypothyroidism The Peer Teaching Society is not liable for false or misleading information…

  48. Bradycardia • AV Block • First degree – delayed conductance, prolongation of PR interval. • Second degree – when one or more impulses fail to reach ventricles. • Mobitz 1: progressive lengthening of PR interval each successive complex until a P wave is not conducted. • Mobitz 2: PR interval constant, QRS complexes dropped intermittently or in fixed ratio to P wave rate. • Third degree – No conductance from atria to ventricles. Complete dissociation of P Waves and QRS complexes. Rate 30-40 / min The Peer Teaching Society is not liable for false or misleading information…

  49. Tachycardia • Sinus tachycardia. Rate > 100/min • Causes • Exercise • Thyrotoxicosis • Catecholamine stimulation (emotion) • Fever • Anaemia • Cardiac failure • Hypovolaemia The Peer Teaching Society is not liable for false or misleading information…

  50. Supra Ventricular Tachycardia • Symptoms include palpitations - sudden onset • sudden offset or gradually tails away • few seconds to hours/days • Precipitating factors • Tea, coffee, tobacco, alcohol, exercise, • emotional upset • Rate 120-260/min • P-waves may or may not be present The Peer Teaching Society is not liable for false or misleading information…

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