Alterations in Oxygenation -- Cardiovascular

Reading:

Porth, C.M. (2007)  Essentials of Pathophysiology:  Selected portions of chapters 16-19. 

Purposes:

Review the normal anatomy and physiology of the cardiovascular system as a basis for your understanding of the pathophysiological changes that occur in disease.

Describe the etiology, pathogenesis, manifestations, and treatment of coronary artery disease.

Relate the pathophysiological consequences of various valvular diseases of the heart, including those seen in infants and children.

Describe the hemodynamic changes which result in the clinical manifestations for left- and right-sided congestive heart failure (and other cardiac mechanical dysfunctions).

Relate the etiology and pathophysiology of hypertension and its sequelae.

Reading Guide:

Again, as in the last module, to help you determine which parts of the chapters are to be emphasized, refer to the written syllabus for guidance on included topics. 

Review the textbook website at http://thePoint.LWW.com/PorthEssentials for links to chapter-related resources with animations and chapter review questions.

Terminology:

The list below contains terminology and concepts you should know:

Study Questions:

1. What are the differences between the systemic and pulmonary circulatory systems? (think pressures)
2. What are the names of the valves of the heart and where are they located? What is their function?
3. During what part of the cardiac cycle does ventricular filling occur? Know what a normal EKG looks like and know what this waves, etc. represent. (P wave—atrial depolarization, etc.). .
4. What effects do the sympathetic nerves have on the rate and contractility of the heart? What effects do the parasympathetic nerves (vagus) have on the cardiovascular system?
5. Place the following structures in order relative to the conduction system in the heart: AV node, purkinje fibers, Right and left bundle branches, Bundle of His, SA node. Which of these has the fastest intrinsic rhythm and serves as the "pacemaker" of the heart?
6. Which of the following is volume-related: preload or afterload? Which is more pressure-related?
7. How does heart rate influence the work of the heart?
8. What is the significance of an ejection fraction of 40%? Is the heart more or less effective than normal in this instance?
9. What factors define cardiac output (which is about 5 liters/minute)?
10. How do arteries and veins differ? Click here to see the answer to this question.
11. What are some of the mechanisms that affect blood pressure? Click here to see the answer to this question.
12. What are the two main factors that affect blood flow?
13. What are the two main factors that affect blood pressure?
14. What is the formula for mean arterial pressure?
15. How do you compute pulse pressure?
16. At what levels do the LDL and HDL cholesterol become cardiac risk factors? What is the upper level of normal for total cholesterol?
17. At what stage of the cardiac cycle do the coronary arteries, which perfuse the heart muscle itself, fill?
18. What are the major EKG changes during ischemic conditions of the heart? (ST segment depression and T-wave inversion). Can you draw and label a normal EKG?
19. What are the major EKG changes during myocardial infarction? (ST segment elevation and abnormal Q-waves)
20. What is probably the best serum enzyme change to look for to help confirm a diagnosis of MI?
21. What is the most important stimulus for renin secretion? Which organ secretes renin? What is the main end result of renin secretion? What hormone is stimulated by renin?
22. When thinking of congestive heart failure, what are some factors that can increase preload, adding to the work of the heart?
23. What is the main cause of right heart failure? What is another name for right heart failure, when it results from pulmonary disease? What are the main clinical manifestations of right-sided heart failure?
24. If end-diastolic volume of the left ventricle is increased, does that represent an increased preload or afterload?
25. What is the Frank-Starling law of the heart?
26. What are the clinical manifestations of pulmonary edema? (Think about what happens if the body doesn’t get enough oxygen.)
27. Which of the types of shock (cardiogenic, hypovolemic, neurogenic, anaphylactic, septic) involve problems with vasodilation?
28. Which of the following is most dangerous and why: atrial tachycardia or ventricular tachycardia?
29. Can you trace a drop of blood from the right inferior vena cava through the entire circulatory system until it gets back to the aorta?
30. What are the defects seen in Tetralogy of Fallot and what are the manifestations of these?
31. What are three examples of non-atherosclerotic peripheral vascular diseases.
32. What are the risk factors for thrombus formation? What is an embolus? From where do arterial emboli usually originate? From where do venous emboli originate? Which is likely to be the cause of a pulmonary embolus?

Exercise:

Go to the Exercise for Module 2. Remember, the exercises are in Angel.  Again, below are directions for logging in to Angel.

1) Click on the Exercise link above or go to https://elearning.kumc.edu/angel/frames.aspx

2) On the next page, login with your GroupWise username and password.

3) Once in Angel, under Courses select NURS 320 - Alterations in Physiological Functioning.

4) Once inside the course, go to Lessons from the left side menu and select Module 2.  You'll see Module Exercise 2 under Module 2. 

Discussion Group:

The deadline for participation in the discussion group for this module is midnight, Sunday, Sept. 17th.

Reminder: The material in this module will be covered in the exam on Sept. 21, 2006, 3-5 p.m. in 1050 SON!  Your target date for completing this module is Sept. 8th.  When you've finished the material in this module, move right on to Module 3.