1. Cardiovascular System
1.1. Function of Heart
1.1.1. circulates blood to and from cells in body
1.1.2. transports nutrients to body cells & removes waste from body --> cell metabolic processes
1.2. Heartbeat Pumping Cycle
1.2.1. heart contracts & relaxes
1.2.2. systole: contracts & ejects blood from ventricles
1.2.3. diastole: relaxes & refills with blood
2. Respiratory System
2.1. Upper Respiratory System
2.1.1. warm & humidify incoming air
2.2. Pleural cavity (parietal & visceral)
2.2.1. secretes fluid in cavity so lungs can move freely
2.3. Breathing mechanisms
2.3.1. inhaling
2.3.1.1. diaphragm contracts & moves downward
2.3.1.2. increases space in chest cavity and expands lungs
2.3.1.3. intercostal muscles assist with enlarging cavity by contracting to pull rib cage upward & outward
2.3.1.4. oxygen enters body
2.3.2. exhaling
2.3.2.1. diaphragm relaxes & moves upward
2.3.2.2. intercostal muscles relax to reduce space in chest cavity
2.3.2.3. body getting rid of metabolic waste produce CO2
2.4. Airways of Lung
2.4.1. terminal bronchiole
2.4.1.1. all smooth muscle
2.4.1.2. no cilia or mucus glands
3. Circulatory System
3.1. Circulatory Pathways
3.1.1. Pulmonary
3.1.1.1. Right side
3.1.1.2. pumps deoxygenated blood to lungs
3.1.2. Systemic
3.1.2.1. Left side
3.1.2.2. pumps oxygenated blood throughout body
3.2. Amount of blood typically traveling throughout circulatory system
3.2.1. 5 liters
3.2.2. Average lifetime: pumps 1 million barrels of blood
4. Congestive Heart Failure (CHF)
4.1. inability to pump blood to body efficiently
4.2. heart unable to provide adequate amounts of nutrients to body organs (brain, liver, kidneys) to meet metabolic demands
4.3. Results in fluid backup in tissues & lung, possibly leading to organ failure
4.4. 5.7 million adults in US (2019 stats)
4.5. prevalence increases with increasing age
4.6. 1 in 9 deaths include heart failure as contributer
4.7. ~50% of individuals who are diagnosed with CHF die within 5 years
4.8. Pathophysiology
4.8.1. cardiac injury= multiple heart attacks, HTN
4.8.2. CO: amt of blood heart pumps throughout circulatory system in a minute
4.8.3. SV: amt of blood put out by L ventricle in one contraction
4.8.4. CO=SV x HR
4.8.5. Ejection fraction: ant of blood pumped out of ventricle/ total amt of blood in ventricle
4.8.6. Heart Failure Symptoms
4.8.6.1. CHF --> heart overload, fluid overload, Na retention & water reabsorption= symptoms of CHF
4.8.6.2. CHF --> decreased mm contraction, heart output, & kidney perfusion= lung congestion
4.8.6.3. OVERALL SUMMARY: SOB, pulmonary congestion, peripheral edema
4.8.7. Systolic Heart Failure
4.8.7.1. pumping problem involving inability of contraction & ejection of blood
4.8.8. Diastolic Heart Failure
4.8.8.1. filling problem involving fluid backup into lungs & inability of heart to relax
4.9. Types of Heart Failure
4.9.1. L sided ventricular heart failure
4.9.1.1. MOST common
4.9.1.2. inability of L ventricle to pump enough blood= fluid backup in lungs & R sided heart failure
4.9.1.3. ischemic heart disease, systemic HTN, mitral or aortic valve disease, primary diseases of myocardium, pulmonary congestion/edema, systemic hypoperfusion (secondary renal & cerebral dyysfunction)
4.9.2. R sided ventricular heart failure
4.9.2.1. inefficient pumping of R side= congestion/fluid buildup of abdomen, legs, & feet
4.9.2.2. isolated failure= cor pulmonale
4.9.2.3. mostly d/t L heart failure
4.9.2.4. peripheral edema & visceral congestion (ex: liver)
4.9.3. Acute Heart Failure
4.9.3.1. emergency situation: individual completely asymptomatic before onset
4.9.3.2. acute injury to heart (heart attack) impairing ability to function
4.9.3.3. seen after heart attack or with significant illness
4.9.4. Chronic Heart Failure
4.9.4.1. more common
4.9.4.2. long term syndrome
4.9.4.3. results of pre-existing cardiac condition (HTN or MI)
4.9.5. High output failure
4.9.5.1. condition causing heart to work harder to meet metabolic demands of body
4.9.5.1.1. sepsis, anemia, thyrotoxicosis, pregnancy
4.9.6. Low output failure
4.9.6.1. unable to pump blood out of L ventricle to meet demands of body (L sided heart failure)
4.10. Individuals @ risk
4.10.1. EVERYONE
4.10.2. more common in >65 years
4.10.2.1. aging weakens heart
4.10.2.2. leading cause of hospital stays among people on Medicare
4.10.3. Hx of heart attacks
4.10.3.1. damaged heart mm can weaken heart (remodeling)
4.10.4. African Americans ^ risk for heart failure than other races
4.10.5. Individuals who are overweight
4.10.5.1. put strain on heart
4.10.5.2. leads to type II diabetes
4.10.6. Children & adults with congenital heart abnormalities (valvular heart disease)
4.11. Primary Risk Factors
4.11.1. Coronary Artery Disease
4.11.2. Advancing age
4.12. Contributing Risk Factors
4.12.1. HTN, diabetes, tobacco use, obesity, ^ serum cholesterol
4.13. Symptoms/Signs of Heart Failure
4.13.1. L side
4.13.1.1. dyspnea/SOB
4.13.1.2. dyspnea on exertion
4.13.1.3. paroxysmal nocturnal dyspnea
4.13.1.4. orthopnea (SOB when lying flat)
4.13.1.5. fatigue/weakness
4.13.1.6. lung crackles
4.13.1.7. cough/productive sputum
4.13.2. R side
4.13.2.1. SOB/fatigue
4.13.2.2. jugular venous distension
4.13.2.3. pitting edema of extremities (commonly seen in LE)
4.13.2.4. ascites/accumulation of fluid in abdomen
4.13.2.5. hepatomegaly
4.13.3. Biventricular Failure
4.13.3.1. L side: DOE, PND, lung crackles
4.13.3.2. R side: JVD, pitting edema of LE
4.14. Diagnosis
4.14.1. BNP (brain-type natriuretic peptide)
4.14.1.1. substance secreted from heart in response to excessive stretching of heart muscle cells (promote diuresis & naturesis)
4.14.1.2. BNP blood levels ^ when heart symptoms worsen & decrease when heart failure condition is stable
4.15. Classifications of Heart Failure
4.15.1. Stage A: high risk for developing heart disease
4.15.1.1. HTN, DM, CAD, FH heart disease
4.15.2. Stage B: asymptomatic heart failure
4.15.2.1. Previous MI, L ventricular dysfunction, valvular heart disease
4.15.3. Stage C: symptomatic heart failure
4.15.3.1. structural heart disease, dsypnea/fatigue, impaired exercise tolerance
4.15.4. Stage D: refractory end-stage heart failure
4.15.4.1. marked symptoms at rest despite maximal medical therapy
5. Lung Diseases
5.1. obstructive lung disease
5.2. narrowing of pulmonary airways that hinders person to expel air (waste CO2) from lungs, so air remains in lungs
5.3. difficulty breathing during increased activity/exertion
5.4. exhalations take longer with obstructive lung disease so rate of breathing increases as lungs work harder
5.5. EXAMPLES: pneumonia, bronchitis, asthma, emhysema
5.5.1. Pneumonia: alveoli fill with thick fluid, difficult gas exchange
5.5.2. Bronchitis: infection (acute) or irritant (chronic), coughing expels mucus out of system
5.5.3. Asthma: inflammation of airways d/t irritation, constriction of bronchioles d/t mm spasms
5.5.3.1. reversible bronchoconstriction/bronchospasm of small airways of smooth muscle
5.5.3.2. Types
5.5.3.2.1. Allergic
5.5.3.2.2. Non-allergic
5.5.3.3. Symptoms: wheezing, coughing, SOB, chest tightness
5.5.3.4. Cause
5.5.3.4.1. genetic predilection (intrinsic & non allergic)
5.5.3.4.2. allergic (atopic), environmental, acute lung infection can set off asthma
5.5.3.5. Pathophysiology
5.5.3.5.1. triggers of airway hyper-responsiveness
5.5.3.5.2. histamine release --> bronchospasm --> edema of bronchial mucosa --> increased bronchial secretions --> gases trapped in alveoli & reduced ventilation --> coughing, SOB, & wheezing
5.5.3.5.3. Treatment
5.5.4. Emphysema: alveoli burst & fuse into enlarged air spaces, SA reduced for gas exchange
5.5.4.1. obstructive lung disease= emphysema & chronic bronchitis
5.5.4.1.1. alpha-1 antitrypsin (AAT)
5.5.4.1.2. CB
5.5.4.2. symptoms: cough, SOB, sputum production
5.5.4.3. cause: tobacco, air pollutants, genetics, other body organ illness
5.5.5. Restrictive lung disease hinders ability to fill lungs with enough air for O2 gas exchange
5.5.5.1. restricted from fulling expanding when tissue in chest wall becomes stiffened d/t weakened mm or damaged nerves (extrinsic)
5.5.5.2. lung tissue disease restricting O2 gas exchange (instrinsic)
5.5.5.3. EXAMPLES
5.5.5.3.1. Intrinsic: asbestosis, radiation fibrosis, certain drugs such as amiodarone, bleomycin, and methitrexate, RA, hypersensitivity pneomonitis, ARDS, idiopathic pulmonary fibrosis/interstitial pneumonia, sarcoidosis, eosinophillic pneumonia
5.5.5.3.2. Extrinsic: neuromuscular diseases (myasthenia gravis & GBS), nonmuscular diseases of upper thorax (kyphosis & chest wall deformities), restricting lower thoracic/abdominal volume, pleural thickening
6. OBSTRUCTIVE VS RESTRICTIVE
6.1. OBSTRUCTIVE
6.1.1. reduction in airflow (SOB)
6.1.2. air remains inside lung after full expiration--> difficulty exhaling air
6.1.3. COPD, Asthma, bronchiectasis
6.2. RESTRICTIVE
6.2.1. reduction in lung volume
6.2.2. difficulty in taking air inside of lung
6.2.3. stiffness inside lung tissue or chest wall cavity
6.2.4. interstitial lung disease, scoliosis, neuromuscular cause, marked obesity