Anatomy and Treatment of Cardiovascular Conditions

Chapter 26 The Cardiovascular, Circulatory, and Lymph Systems

Figure 26.1 The heart.

Anatomy of the Heart • Composed of four chambers: two upper and two lower • Atria—top two chambers • Ventricles—bottom two chambers • Septum—divides heart into right and left sides

Valves of the Heart • Tricuspid valve—located between the right atrium and the right ventricle • Pulmonary valve—located between the right ventricle and the pulmonary artery • Mitral or bicuspid valve—located between the left atrium and the left ventricle • Aortic valve—located between the left ventricle and the aorta

Layers of the Heart • Pericardium—fluid-filled sac that surrounds and protects the heart • Permits free movement of the heart during contraction • Endocardium—innermost wall layer; covers the inside surface of the heart • Myocardium—surrounds heart and causes chamber contractions

Figure 26.2 Blood flow through the heart.

Function of the Heart • Provides oxygenated blood throughout the body by a pumping mechanism • Oxygenated blood deposits materials necessary for growth and nourishment • Receives from tissues the waste products resulting from metabolism

Hypertension • Sustained elevation of systemic arterial blood pressure • Symptoms include: • Severe headache • Chest pain • Irregular heartbeat • Fatigue

Hypertension (cont.) • Pharmaceutical treatment includes diuretics, vasodilators, ACE inhibitors, beta blockers, and calcium channel blockers

Congestive Heart Failure • Heart pumps out less blood than it receives • Results in weakened and enlarged heart

Congestive Heart Failure (cont.) • Symptoms of CHF include: • Upright posture or leaning forward • Anxiety and restlessness • Cyanotic and clammy skin • Persistent cough • Rapid breathing • Fast heart rate • Edema of the lower limbs

Congestive Heart Failure (cont.) • Pharmaceutical treatment includes cardiac glycosides, diuretics, vasodilators, ACE inhibitors, beta-adrenergic blockers, and phosphodiesterase inhibitors

Coronary Artery Disease • Occurs when there is insufficient blood flow to the heart • Can lead to: • Angina • Heart attack • Arrythmias • Stroke • Pulmonary embolism • Heart failure

Coronary Artery Disease (cont.) • Pharmaceutical treatment includes platelet aggregation inhibitors, anticoagulants, tissue plasminogen activators, and thrombin inhibitors

Cardiovascular Pharmaceuticals • Antiarrhythmic drugs—restore normal rhythm patterns but do not cure the cause of the irregular heartbeat • Cardiac glycosides—used to increase the force of myocardial contraction, without causing an increase in the consumption of oxygen

Cardiovascular Pharmaceuticals (cont.) • Diuretics—used to eliminate excess sodium and water via the urinary tract • Vasodilators—allow more blood to exit the heart, preventing or mitigating congestion; lower blood pressure

Cardiovascular Pharmaceuticals (cont.) • Angiotensin-converting enzyme inhibitors (ACE inhibitors)—lower high blood pressure; thought to reshape the heart; prevent the body from producing natural vasodilators • Angiotensin II receptor blockers—similar to ACE inhibitors; block the body’s natural vasodilators

Cardiovascular Pharmaceuticals (cont.) • Beta-adrenergic blockers—used to block cells from receiving natural vasoconstrictors • Antiadrenergic agents—interfere with the manufacture of vasoconstrictors at nerve endings • Platelet aggregation inhibitors—reduce the ability of the blood to coagulate

Cardiovascular Pharmaceuticals (cont.) • Anticoagulants—prevent clots from forming or existing clots from getting bigger • Tissue plasminogen activators—break down blood clots by reversing the clotting order and interfering with the synthesis of various clotting factors

Cardiovascular Pharmaceuticals (cont.) • Thrombin inhibitors—inactivate bound thrombin by binding to the enzyme and blocking its interaction with its substrates of fibrin • Antihyperlipidemics—help prevent the progression of coronary artery disease by lowering plasma lipid levels

Anticoagulants • Do not thin out the blood • Prevent clots from forming • Prevent existing clots from getting bigger • Cannot dissolve existing blood clots

Warfarin • Oral drug of choice • Works by preventing the synthesis of clotting factors II, VII, IX, and X

Warfarin (cont.) • Used in the long-term prevention or management of venous thromboembolic disorders, including: • Deep vein thrombosis • Pulmonary embolism • Clotting associated with atrial fibrillation and prosthetic heart valves • Vitamin K may be used as an antidote when too much warfarin has been given

Heparin • Parenterally administered drug of choice • Works by inactivating clotting factors IX, X, XI, and XII • Used prophylactically to: • Prevent and treat deep vein thrombosis • Prevent and treat pulmonary embolism • Treat thrombophlebitis • Prevent clotting during cardiac and vascular surgery

Heparin (cont.) • The only antidote for heparin overdose is protamine sulfate

Table 26.2 Antiarrhythmic Agents

Table 26.2 (continued) Antiarrhythmic Agents

Table 26.3 Thiazide Diuretics

Table 26.4 Loop Diuretics

Table 26.5 Potassium Sparing Diuretics

Table 26.7 Peripheral Vasodilators

Table 26.8 Coronary Vasodilators

Table 26.9 Angiotensin-Converting Enzyme Inhibitors

Table 26.9 (continued) Angiotensin-Converting Enzyme Inhibitors

Table 26.10 Angiotensin II Receptor Blockers (Angiotensin II Antagonists)

Table 26.11 Nonselective Beta-Adrenergic Blocking Agents

Table 26.12 Selective Beta-Adrenergic Blocking Agents

Table 26.13 Antiadrenergic Agents

Table 26.14 Antiplatelet Agents

Table 26.15 Comparison of Antiplatelet Agents

Table 26.15 (continued) Comparison of Antiplatelet Agents

Table 26.16 Anticoagulants

Table 26.17 Thrombolytics and Tissue Plasminogen Activators

Table 26.18 Thrombin Inhibitors

Cholesterol and Triglycerides • HDL—high-density lipoproteins or “good” cholesterol • LDL—low-density lipoproteins or “bad” cholesterol • Triglycerides—a form of energy stored in adipose and muscle tissues • Often measured to depict fat ingestion and metabolism • Can be used to assess CAD risk factors

Table 26.19 Total Cholesterol Levels

Table 26.20 High-Density Lipid (HDL) Levels (Good Cholesterol)

Anatomy and Treatment of Cardiovascular Conditions