The Cardiovascular System

1. The Cardiovascular System How your Heart and Blood Vessels Work

2. LearningPoints Overview of the heart and the circulatory system Coronary artery disease (CAD) and peripheral arterial disease (PAD) Atrial Fib and Heart Failure Treatment Options

3. The Heart • is a muscle the size of your fist located between the breastbone and the spine just to the left of the midline inside your rib cage • A women’s heart is smaller in size than a man’s

4. The Heart Our bodies need oxygen to survive Blood carries oxygen to the whole body The heart pumps the blood (oxygen) through the arteries to the body tissues

5. The Heart • Has four chambers • two upper chambers called Atria • two lower chambers called Ventricles • The left ventricular wall is thicker to be able to pump with more force 5

6. The Heart • The grade of the left ventricleindicates the amount of damage to the heart muscle: • Grade 1 - normal • Grade 2 - some damage • Grade 3 - more damage • Grade 4 - weakened heart 6

7. There are four valves: • Tricuspid • Pulmonic • Mitral - Bicuspid • Aortic • valves are strong and flexible • allow blood to flow in one direction • may be injured or diseased requiring repair or replacement

8. Circulation of Blood to the Heart Muscle • Through the Coronary Arteries • right coronary artery • left coronary artery • circumflex • left anterior descending artery

9. Collateral circulation develops in later age arteries grow to make a natural bypass towards an area of reduced blood flow Collateral Circulation

10. Heart’s Electrical Conduction • The Sinoatrial node or pacemaker beats 60-100 times per minute • Atrioventricular node can beat 40-60 times per minute as a backup • Bundle of His and Ventricles can beat 20-40 times per minute as a further backup

11. Artery disease = Atherosclerosis • Process can start before birth • Gradual buildup of plaque in the arteries • Narrows the inside diameter of the arteries • Causes the artery walls to become less elastic

12. Where can blockages occur? • Any artery in the body • Occurs more often in areas where arteries branch • Most common in arteries to the: • head - carotid artery disease • heart - coronary artery disease • legs - peripheral artery disease • organs - eg. kidneys, male sex organs

13. Angina-reduced blood flow to the heart muscle • Temporary lack of oxygen to the heart muscle • is caused by a narrowing in one or more of the coronary arteries • Treated with Nitrospray and rest

14. Angina Symptoms Men and Women: • chest pain • pain into throat and jaw • pain down one or both arms • shortness of breath More common in women: • fatigue • shortness of breath • pain in back between shoulder blades • nausea and vomiting

15. Claudication-reduced blood flow to the muscles in the lower extremities • Temporary lack of oxygen to one or both of your legs • is caused by a narrowing in one or more of the arteries • Treated with rest

16. Reduced blood flow to the brain: signs and symptoms TIA and Stroke • Headache • Blurred vision • Slurred speech • Dizziness • Difficulty swallowing • Weakness on one side • Difficulty with balance

17. How does a Heart Attack occur? • A sudden severe blockage in a coronary artery • caused by plaque rupture and blood clotting • Coronary artery spasm • An involuntary closing of the walls of the artery. Usually occurs for a short period of time but can cause severe blockage • Coronary artery spasm and blood clot occurring together

18. Heart Attack Occurs

19. OtherMedicalConditions • Atrial Fibrillation • Heart Failure

20. AtrialFibrillation • A rapid and irregular heart beat • Most common causes are • Damage to the heart’s structure • Diseases affecting the heart’s valves or pumping system • Long term high blood pressure • Undetermined cause

21. Atrial Fibrillation • Signs and symptoms • Fast, irregular heart beat • Weak, lightheaded, confused • Shortness of breath, chest pain • Treatment • Medication – slow down the heart rate • Pacemaker – to control the heart rate • Surgical – ablation/maze procedure to change the electrical pathway • Blood thinner medication - to prevent blood clots

22. Heart failure • The heart is not strong enough to pump enough blood through the body to meet the demands • Causes – most common • Heart attack • Long term high blood pressure • Heart valve problems

23. Heart failure • Symptoms • Shortness of breath • Difficulty sleeping laying flat • Cough • Fluid retention causing swelling • Sudden weight gain • Fatigue, confusion, impaired memory

24. Heart failure • Treatment goal is to manage the problem • Medications • Exercise • Heart devices eg. Pacemaker, ICD • Surgery - transplant

25. Diagnostic Tests

26. Diagnostic Testing – for the heart • Resting ECG - looking at the heart’s electrical system from 12 different views • Holter Monitor/Loop recorders - longer term ECG monitoring • Exercise stress test - checking ECG changes while increasing the work of the heart • Echocardiogram - heart ultrasound • Stress Thallium - nuclear dye test with or without a stress test • Angiogram - dye test of the heart’s arteries

27. Diagnostic testing – for the legs and head • Doppler studies • Angiograms

28. Treatments

29. Interventions • Angioplasty • Stent

30. Stent – Coronary Artery • A wire mesh tube used to prop open an artery after angioplasty • The stent is placed over the angioplasty balloon catheter • When the balloon is inflated the stent expands

31. Drug Eluting Stent • The stent slowly releases a drug to reduce the chance of a clot forming • Used at doctors’ discretion

32. Angioplasty and stent

33. Surgical Procedures

34. Surgical Procedures • Pacemakers • Implantable Defibrillators • Endarterectomy • Artery Bypass Grafting (coronary, carotid, leg arteries) • Valve Replacement or repair • Heart Transplantation

35. Pacemaker • Stimulates the heart to beat regularly • The generator is the size of a silver dollar and is implanted just beneath the skin. • The leads are threaded into position through veins leading back to the heart.

36. Pacemaker • Battery life is up to 10 years depending on the usage • Has the ability to slow down or speed up the heart rate • In some models, the heart rate can be increased with activity Indications: • heart rate too slow • heart rate too fast

37. Implantable defibrillators (ICD) • A pacemaker with the ability to deliver an electrical shock to correct a life threatening heart rhythm • Indications: • life threatening irregular heart rhythm • heart failure

38. Endarterectomy • Surgical removal of plaque from the inner lining of an artery

39. Coronary Artery Bypass Graft (CABG) • Provides a new supply of blood beyond the site(s) of the blockage • Indications • unstable angina that does not respond to medical treatment • stable angina with severe left-main or significant three-vessel coronary artery disease

40. Leg Artery Bypass • Vein from leg or arm, or synthetic graft is used to bypass a blockage in legs • For severe blockage when there is a risk of losing your limb

41. Valve Replacement and Repair • Valves must flex, stretch, and hold back pressure to function normally • Aortic and Mitral valves are the most commonly repaired or replaced valves • 2 types of valves used • tissue valves from pigs; do not need to take blood thinners • mechanical valves; need to take blood thinners for life

42. Heart Transplantation • People who require heart transplants suffer from severe heart failure • 2 major causes of heart failure are coronary artery disease (CAD) and cardiomyopathy

43. Any Questions?