Anatomy and physiology of CVS

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Anatomy and physiology of CVS The heart is the main organ of the cardiovascular system and is located in the left side of the mediastinum. There are three layers in the heart: the epicardium, the myocardium and the endocardium. The epicardium covers...



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Anatomy and physiology of CVS

The heart is the main organ of the cardiovascular system and is located in the left side of the mediastinum. There are three layers in the heart: the epicardium, the myocardium and the endocardium. The epicardium covers the outer surface of the heart. The myocardium is the middle layer and is the actual contracting muscle of the heart. The endocardium is the innermost layer and lines the inner chambers and heart valves.

There are four chambers in the heart: the right atrium, the right ventricle, the left atrium, and the left ventricle. The right atrium receives deoxygenated blood from the body via the superior and inferior vena cava. The right ventricle receives the blood from the right atrium and pumps it to the lungs via the pulmonary artery. The left atrium receives oxygenated blood from the lungs via four pulmonary veins. The left ventricle is the largest and the most muscular chamber; it receives oxygenated blood from the lungs via the left atrium and pumps blood into the systemic circulation via the aorta.

There are four valves in the heart. The atrioventricular valves lie between the atria and the ventricles. The bicuspid or mitral valve is located on the left side of the heart. The tricuspid valve is located on the right side of the heart. The pulmonic semilunar valve lies between the right ventricle and the pulmonary artery. The aortic semilunar valve lies between the left ventricle and the aorta.

The conductive system of the heart includes the sinoatrial node, the atrioventricular node, the bundle of His, and Purkinje fibers. All these structures are connected with each other consequently. The system spreads the waves of depolarization through the atria and the ventricles.

Two main heart sounds are usually heard in the fifth intercostal space at the left midclavicular line. They are called the first heart sound and the second heart sound. The first heart sound (S1) is heard as the atrioventricular valves close. The second heart sound (S2) is heard when the semilunar valves close.    

The normal heart rate is 60 to 100 beats per minute. The normal blood pressure is 120/80 mm Hg. The first figure signifies the systolic blood pressure. The second figure signifies the diastolic blood pressure. The difference between the systolic and diastolic blood pressure is called pulse pressure and accounts for approximately 40 mm Hg. Heart rate (HR) and blood pressure (BP) are regulated by the autonomic nervous system, e.g. sympathetic and parasympathetic nervous system.

The vascular system consists of different types of vessels, such as arteries, arterioles, capillaries, venules, and veins. Arteries are vessels through which the blood passes away from the heart to various parts of the body. They convey highly oxygenated blood from the left side of the heart to the tissues. Arterioles control the blood flow from the capillaries. Capillaries allow the exchange of fluid and nutrients between the blood and the interstitial spaces. Venules receive blood from the capillary bed and move blood into the veins. Veins transport deoxygenated blood from the tissues back to the heart and lungs for oxygenation.

Text 2. Hypertension

Hypertension is a persistent elevation of the systolic blood pressure above 140 mm Hg and the diastolic blood pressure above 90 mm Hg It can be classified as primary (or essential) and secondary. Primary hypertension indicates that no specific medical cause can be found. Secondary hypertension indicates that the high blood pressure is the result of another condition, such as kidney disease or certain tumors.

High blood pressure is the major risk factor for coronary, cerebral, renal, and peripheral vascular disease. The disease is initially asymptomatic. But later the patient may complain of headache, visual disturbances, dizziness, chest pain, tinnitus, etc.

One of the serious complications of hypertension is hypertensive crisis. It refers to any clinical condition requiring immediate reduction in blood pressure. It is acute and life-threatening. The accelerated hypertension requires emergency treatment, since target organ damage (brain, heart, kidneys, retina of the eye) can occur quickly. Death can be caused by stroke, renal failure, or cardiac disease.

Diagnosis of hypertension is generally made on the basis of a persistent high blood pressure. It usually requires three separate measurements at least one week apart. If an elevation is extreme, or end-organ damage is present, the diagnosis may be applied immediately.  

The treatment includes reduction of blood pressure and prevention or lessening of the extent of organ damage. Nonpharmacological methods, such as lifestyle changes, may be initially prescribed. If blood pressure cannot be decreased, the patient may require pharmacological treatment.

It is evident that our health mostly depends on us. If you want to be healthy, people should keep to a diet, be active, even-tempered, and never smoke or use any substances, such as drugs or alcohol.

Text 3. Angina

“Angina” is the term used to describe discomfort in the chest due to myocardial ischemia. It may occur when there is an imbalance between myocardial oxygen supply and demand.

The main causes of angina include obstruction of coronary blood flow because of atherosclerosis, coronary artery spasm, and conditions increasing myocardial oxygen consumption. Angina occurs most often between ages 30 and 50, men are affected more often than women. Risk factors include family history of angina, elevated serum lipoproteins, cigarette smoking, diabetes mellitus, hypertension, obesity, sedentary, stressful or competitive lifestyle.

The most important symptom of angina is chest pain. Stable angina is characterized by left-sided or central chest pain. Pain is precipitated on exertion and relieved at rest or sublingual nitrate.

Most patients describe a sense of apprehension or tightness in the chest but the pain may be denied at all. The pain may radiate to the neck or jaw. It is often accompanied by discomfort in the arms, particularly left, the wrists, and sometimes the hands. The patient may also describe a feeling of heaviness or uselessness in the arms. The pain occasionally is epigastric or interscapular.

Besides, the patient will experience dyspnea, sweating, palpitations, tachycardia, dizziness, and faintness. Symptoms tend to be worse after meal, in the cold, and when walking.

The history is the most important factor in making a diagnosis. Electrocardiogram can also be useful if taken in the period of acute attack.

The goal of treatment is to provide relief of an acute attack, and prevent progression of the disease and further attacks to reduce the risk of myocardial infarction. The patient should be given a tablet of nitroglycerin. Nitroglycerin produces vasodilation of coronary arteries. It should be placed under the tongue until fully dissolved, not swallowed. Instruct the patient to take one tablet for pain, and repeat every five minutes for a total of three doses. The patient should seek medical help immediately if the pain is not relieved in 15 minutes following the three doses.


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