Heart: RAA,

Implications of short stay on 4E. Short.
Endothelial lining of heart.
Critical role for nursing.
Valves
1. Tricuspid
2. Plutonic
3. Aortic
4.
Superior inferior vena cava out plutonic to pulmonary artery to lungs.
Left corroded/ left subclavians. Which get more blood flow? Subclavians do the arms and are pretty active, also the brain which is the most needy organ in the body. So if you have a problem in your heart.
Brachiocephalic.
Coronary circulation. First branches off the aorta. Right off the aortic valve. Two main arteries: L branches into l anterior descending and L circumflex. LAD= left antioer decending, Left Cirq, RCA= right circulating artery,
Athroschlerosis: coronary arteries of particular concern. Starts at SA node.

WILL NOT HAVE TO LEARN ABOUT ACTION POTENTIALS. Automoticity= will beat on its own. Major two influences on heart rate with relation to the nervous system. Driven by the autonomic nervous system. Three major hormnes of the autonomic : epinephrine, norephinephrine, and Ach. Speed up will epi/norepi. AcH will slow the heart down.
Marjor cause of death in heart disease: dysrhythmias. May have end state heart disease, valvular disease, but that last even that happens one day is usually a dysrythmia. ECG is relied on. Won’t show us picture on exam, but we should be able to recognize the verbal description.
S1: blood ejected through pumonic and ventricular ejection: systole.
When 2/3 ejected mitral and tricuscpid open and that’s S2, dubb.
Then blood flows from atria into ventriacals called diastole, and when the ventrals are full again, that’s SI again.
Early diastolic filiing: high volume, high rate
Gallop: S3, a gallopy knocking noise. Early in diastoly and indicated ventricular dialation. Heart failure. Kentrucky.
Atrium contracts to get last bit of blood out of antriam an dinto ventrical. IF walls are stiff then atrial ejectio will make a very succato sound called an S4. Hypertrophy. Bigger cells, thicker muscle. S4. Tennesee.

Other thing that’s key is murmers.
Bruie: peripheral artery swishing noise, turbulent blood flow.
Murmer: turbulent bloof flow in the heart. Adults: muermers almost always caused by valvular heart disease.
Systole: ventricular ejection. Ventrical is contracting.
Stenosis: valve is too small. Which valve being steno tic is going to giv eyou a systolic murmer. Ventricular ejection Pushing blood through aortic valve. Systeolic ejection murmer due to stenosis is ogiong to be aortic stenosis
Mitral stenosis: blood mvoes through during diastole.
Regurgitation.
Systolic murmer due to narrowing of aortic valve.
Loud systolic murmer to second intercostal space radiating to neck you would thin aortic stenosis.
Slow rumibing during diastole heard beat at base: mitrl stenosis.
Think about where blood is moving.
Pge 28. Cardiac output. Extremely important.
Heart rate times stroke volume Number of berats per minute times the amount of blood per beat. So you come out with liters per minute.
Contractility: how good is the muscle.
Myocardial infartion: #1 way to mess with contractiiity.
What is peripheral resistance swhcih increaes our blood pressure. If vessels are really clamped down pushing it into a smaller container that’s called after load. Third component has todo with how much blood it has to work with when it starts contracting.
Preload: determines how hard it can pump. Not enough blood with which to work before contraction, like if the blood is not in the cardiovascular system but on the floor
Too mch fluid: heart stretched tooo big. Give them too much volume or kidneys don’t work.
Vaso dialators: beta blockers, calcium channel inhibitors
EF: ejection fraction
LVEDV: preload;
Veins dialate and accept volume.
Arteries are much stiffer; low compliance and low capacitance much higher pressure system. Can constrict.
Pressure in whole system related to how much volume.
Increase blood volume to increase BP or resistance.
Diuretics and vasodialtors: manage high BP
Sympathetic nervus system/ renin-angiotensin.
Pulse pressure: difference between systolic and diastolic. Higher in elderly people. Indicate stif fvessels.
Peripheral resistance:
Ace inhibitors:
Kidney: decided its in charge of BP. Sense renal blood flow t hrough JGA Juxa glomerular apparatus. Tells CVS to increae blood pressure. Renin: interacts with angiotensinin to make angiogenesis 1 Goes to lungs, where there is an enzyme called ACE: Angiotensin converting enzyme from 1 to 2, which is a powerful vasco constrtictoer of arteriorles. Stimulates adrenal cortext to make aldosterone which tell sthe kidney to hang ont o salt and water. So ace inhibitor is vasodialtor and a diuretic becase it prevents salt and water retention Improves ability to get rid of it if youdind’t have mechanism having you hang onto it.
RAA:
-bock ace
-block angiotensin receptors
-block aldosterone
This is more or less the endocrine system: effects all over the body, acting like hormones. Paracrine system in our tissues. The cardiovascular tissues themselves make angiotensin II. Endothelial and myocardial cells can do this. A growth factor and vascoconstirctor.
Remodeling.
-scarring. Not just from fibroblasts but growth of certain tissues. Disruption of norma tisssue sctrcuture. Angiotensin II constributes ot myocardial and vascular remodeling. Funcional problems of basco cnstriction and long term s structural problems that actually damage bood vesses.
Statins, Ace inhibitors: nmot ony prevenitn g but reversing. Ischemic heart disease and heart fialure. Must use ace inhibitors for people With DM, etc… more expensive.
Popurri of pt evaluations:

Pg. 130. Chest pain of heart diesease tends to be substernal and tends to be dull vs. sharp . Innervation that tells you that your heart hurts runs through the vagus nerve and the sympathetic as well. Also runs through arm and jaw. Classic symptom of heart diesase: dyspnea and dethrone (when laying down). PND


Pt; sense of impending doom. Tachycardia, tachypnea, BP elevated, murmers, gallops, Ralls, edema
Pg. 145:
ST depression or elevation: myocardial ischema.

This will become my friend:
Physiologic drawing:
L ventrical not enough blood getting out. Increase in LEVDV? Which will stretch the heart