Cardiovascular A

1
Cardiovascular AP and Patho-physiology

• Irene Mueller, EdD, RHIA
• Montana Hospital Association
• May 26, 2010

2
Objectives First Hour

• Functions of Circulatory System
• Heart Vessels
• Anatomy
• Normal physiology

• Congenital ?
• VSD
• PDA
• Coarctation of Aorta
• ASD
• Tetralogy of Fallot
• Transposition of Great Arteries
• ? Pathologies
• HTN

3
Objectives - 2nd hour

• ? Pathologies
• CAD
• MIs
• Anginas
• Arrhythmias
• CHF
• Cor Pulmonale
• Emboli

• Vessel Pathologies
• Congenital
• AV Malformations
• Pathologies
• Phlebitis
• Thrombophlebitis
• Emboli
• Arteriosclerosis
• Resources

http//www.alleganynutrition.com/images/upload/blo
od-vessels-an.jpg
4
Functions of Circulatory System

• 2 primary functions
• Delivery of oxygen, nutrients, hormones, other
  essential body substances to body cells
• Removal of waste products from cells
• CO2 waste product of respiration
• Metabolism wastes carried to kidneys, skin,
  intestines
• Nitrogenous
• RBCs carry O2 to cells CO2 away from cells to
  lungs

5
3 sub-circulation systems

• Pulmonary
• Exchange of O2 and CO2
• Carries blood to lungs
• to receive O2 and remove CO2
• Coronary
• Nutrition and health of heart muscle
• Systemic
• Delivers blood and components to all tissues
• Except lungs and myocardium

6
? AP

• Pericardium
• Muscle (myocardium)
• Chambers
• Valves
• Arteries
• Veins
• Flow of Blood
• Systole
• Diastole

• Coronary Arteries

7
? Enclosure

• Pericardium
• 2 layers
• Inner serous
• Visceral pericardium OR epicardium
• Outer fibrous
• Parietal
• Between layers
• Serous fluid
• Reduces friction during heartbeat (function)

8
? Facts

• The heart is about the size of your fist
• Usu pumps about 50 of blood present in chamber
  at beginning of contraction (ejection fraction)
• Pumps about 5 quarts/minute
• Up to 5 gallons/min during exercise
• Pumps about 4,000 gallons/day

9
? Chambers

• ? is 4-chambered hollow organ of strong muscle
  tissue
• Located in thorax between lungs
• 2 pumps side-by-side
• R atrium and R ventricle
• Blood from body pumped to lungs (pulmonary circ)
• L atrium and L ventricle
• Blood from lungs to body (systemic circulation)

10
? Valves

• 4 valves prevent backflow of blood in ?
• AV Valve (Tricuspid)
• Between R atrium and R ventricle
• Pulmonic/Pulmonary valve
• Between R ventricle and pulmonary arteries
• Bicuspid (Mitral)
• Between L atrium and L ventricle
• Aortic Valve
• Between L ventricle and Aorta

11
? Chambers

• Atria (upper chambers)
• Thin-walled
• Receive and hold blood before ventricles
• Ventricles
• Thick-walled
• Main pumps
• Septa walls between chambers
• Atrial septum
• Ventricular septum

Where else do you have a septum?
12
Flow of Blood through ? (Cardiac cycle)

• http//kidshealth.org/misc/movie/parent/ASD_rev/AS
  D_rev.html

13
Cardiac Cycle

• Cardiac muscle contraction cycle
• One sequence of conduction pathway
• One heartbeat
• PQRST segment on EKG
• Electrical stimulation triggers contractions
• Sinoatrial (SA) node
• Atrioventricular (AV) node
• Bundle of His, R L Bundle Branches
• Purkinje fibers

14
PQRST

• http//cygnus.et.put.poznan.pl/piotrw/nauka/fibon
  acci/heartelec2.gif

15
? AP
http//www.nhlbi.nih.gov/health/dci/Diseases/shock
/shock_heartworks.html
16
Coronary Arteries

• 1st vessels to branch from the aorta
• Right Coronary Artery supplies posterior ?
• Left Main Coronary Artery divides into
• Left Anterior Descending
• Supplies front of ?
• Left Circumflex
• Wraps around the left and posterior ?
• http//myhealth.ucsd.edu/library/healthguide/en-us
  /images/media/medical/hw/h9991261_001.jpg

17
Great Vessels

• the large arteries and veins entering and
  leaving the heart. They include
• the aorta, (3 cm diameter as leaves ?)
• the pulmonary arteries and veins, and
• the superior and inferior vena cava.
• Superior drains upper body (about size of thumb)
• Inferior drains lower body

http//medical-dictionary.thefreedictionary.com/gr
eatvessel
18
Greys Anatomy. Figure 489
19
Vessel AP

• Arteries
• Carry Oxygenated Blood
• Exception
• Pulmonary Arteries
• Very high pressure
• Elastic, muscular
• Thick Walls
• Tunica adventitia/externa
• Tunica media (sm. muscle)
• Tunica intima

http//www2.merriam-webster.com/mw/art/med/artery.
htm
20
Vessel A P

• Arterioles
• Arteries branch into smaller and smaller sizes
• Smallest arteries branch into arterioles
• Less smooth muscle in walls
• Arterioles branch into metarterioles
• Loss of connective tissue/muscle layers
• Give rise to Capillaries

21
Vessel AP

• Capillaries
• Smallest vessels
• Microscopic
• Connect metarterioles
• to venules
• Endothelial layer only
• Very thin walls
• Selective permeability
• O2/CO2
• Nutrition
• WBCs/Plasma

http//www2.merriam-webster.com/mw/art/med/circula
t.htm
22
Artery Anatomy
http//www.kidney-hypertension.com/arteries.gif
23
Vessel A P

• Venules
• Little larger than capillary, then larger, etc.
• Have muscular layer also

24
Vessel AP

• Veins
• Carry de-oxygenated blood
• 3 layers
• Tunica Externa, Media, Intima
• Much Less elastic/muscular
• Thinner walls/less pressure
• Valves
• One-way flow to heart
• More in lower body

http//www2.merriam-webster.com/mw/art/med/vein.ht
m
25
Vessel A P

• Venous Return
• Contraction of skeletal muscles help
• Breathing pressure changes help
• http//www.youtube.com/watch?vHNuPWdfjDoc
• 62,000 miles of blood vessels in a human body

26
Vessel Anatomy
http//umanitoba.ca/faculties/medicine/units/anato
my/images/ArtVeincopy.JPG
27
Circulatory Physiology

• Blood pressure
• Systolic (Top Number)
• Moment of contraction in heart
• Pressure against vessel walls/resistance
• Diastolic (Bottom Number)
• Moment of relaxation of the heart
• Less pressure against vessel walls
• Pulse pressure systolic - diastolic

28
Pulse

• Pulse is usu. same as ? rate
• Alternating, beating throbs at body points
• Brachial
• Carotid (common)
• Femoral
• Dorsalis pedis
• Popliteal
• Radial
• Temporal

• Where is each of these points on your body?

29
Congenital ? Disease
30
Congenital ? Disease

• Congenital Heart Defects (CHD) are the most
  common birth defect in the United States. About
  35,000 children (1 of 120) are born with a CHD
  every year. ACHA
• Can be diagnosed at any age
• 10 of cases dx as adults
• 2008 - 1 million people w/congenital heart
  disease have survived to adulthood

31
Etiologies of Congenital ? disease

• Genetic
• Other risk factors
• Maternal rubella (German measles)
• Poor maternal nutrition
• Alcoholism/Drug abuse
• Some medications during pregnancy

32
Congenital ? Conditions

• VSD (Ventricular Septal Defect)
• PDA (Patent Ductus Arteriosus)
• ASD (Atrial Septal Defect)
• Tetralogy of Fallot
• Coarctation of Aorta
• Transposition of Great Arteries

33
Fetal Heart

• Fetal lungs not used for breathing
• Blood enters R atrium, most of blood flows to L
  atrium through a special fetal opening - foramen
  ovale
• Fetal circulation shunts (bypasses lungs) from
  pulmonary artery to aorta through a connecting
  blood vessel - ductus arteriosus
• After Birth, normally both close

34
VSD (Ventricular Septal Defect)

• Opening in the ventricular septum remains
• Most common heart defect (25)
• "Hole in the heart
• If small, often "heals"  (closes) on its own
• Blood flows from L ventricle to R ventricle at
  high pressure, often a loud "murmur"
• Larger VSD requires surgery as baby
• Smaller may be watched for years
• http//www.med.ucla.edu/wilkes/Systolic.htm

35
PDA

• Ductus Arteriosus
• Connection between pulmonary artery and aorta
  Normal in fetal ?
• Patent does NOT close after birth
• Oxygenated blood goes back to lungs instead of to
  body increases workload
• 2x more common in girls

36
ASD

• Opening between R and L atria
• Usu. Due to foramen ovale NOT closing
• Oxygenated blood goes from L to R atria
• Never leaves lungs and heart
• More common in girls

37
Tetralogy of Fallot

• Tetra Four in Greek
• Very serious heart defect Blue Baby
• Combination in varying degrees of
• Pulmonary valve stenosis
• R ventricle Hypertrophy
• Ventricle Septal Defect
• Abnormal placement of Aorta

38
SS of Tetralogy of Fallot

• Cyanosis increases with age
• Clubbing of fingers/toes
• Resting in squatting position
• Breathe easier, improves venous return
• Growth retardation
• Severe dyspnea with exercise
• Frequent Respiratory infections

39
Coarctation of Aorta

• Stricture (Varying degrees) of
• Descending or thoracic aorta
• High blood pressure proximal to narrowing
• Lower blood pressure distal
• May cause bl press in arms, in legs
• Increases workload on heart
• May NOT be dx until adulthood

40
Transposition of Great Arteries

• Aorta and Pulmonary artery are "transposed" from
  normal position
• Aorta arises from the R ventricle
• Pulmonary artery arises from the L ventricle
• Oxygen-poor ("blue") blood from body is sent back
  to body
• Oxygen-rich ("red") blood from lungs is sent back
  to lungs
• Untreated, 50 of infants die in 1st month ,
  90 percent in 1st year
• If no unusual risk factors, surgery successful
  for 95 of NBs
• http//www.cincinnatichildrens.org/health/heart-en
  cyclopedia/anomalies/graphicsummaries/transwf.htm

41
? Pathologies

• HTN
• CAD
• MIs
• Anginas
• Arrhythmias
• CHF
• Cor Pulmonale
• Emboli

42
Common SS of ? Disease

• Chest Pain
• Dyspnea
• Fatigue
• Tachycardia

• Cardiac palpitations
• Strong, rapid, irregular heartbeats that pt feels
• Diaphoresis
• Edema of extremities
• NV

43
HTN

• Silent Killer no symptoms
• Leading cause of stroke/heart failure
• Reduced life expectancy
• When Diastolic is 90
• Can be primary OR
• 2nd (due to other disease)
• Cerebrovascular
• Cardiovascular
• Kidney

• 20 of Americans w/HTN
• Higher in
• Blacks
• Postmenopausal women
• South (Stroke Belt)
• Diet variation
• More salt
• More cholesterol
• Less micronutrients

44
HTN

• Normal LESS than 120/80
• Pre-HTN 120-130/80-89
• Stage 1 HTN 140-159/90-99
• Stage 2 HTN 160/100
• Determined by action of heart and/or blood vessel
  resistance
• Kidney also has role

45
Primary/Essential HTN

• 90 of cases
• Idiopathic, but risk factors
• Heredity (Black, Family Hx)
• Diet High salt and fat
• Age
• Obesity increased heart workload
• Smoking - vasoconstriction
• Stress - vasoconstriction
• Type A personality

46
Salt and HTN

• Action of salt in body
• Kidneys excrete if too much, stays in blood
• Excess salt holds water, increases volume
• high blood pressure
• Excess salt increases ouabain (hormone)
• Keeps calcium in artery muscle cells
• Triggers constriction and HTN
• Salt-sensitivity (50 of Americans)
• African-Americans, elderly, diabetics

47
Salt in American Diet

• 3,436 mg sodium daily (Average)
• Many experts now (2010)
• Lowering daily consumption to 1,500 mg of sodium
  daily
• Prevent/lower high blood pressure
• Most dietary sodium in processed foods

• 1/4 teaspoon salt 
• 600 mg sodium
• 1/2 teaspoon salt
• 1,200 mg sodium
• 3/4 teaspoon salt
• 1,800 mg sodium
• 1 teaspoon salt
• 2,300 mg sodium
• 1 teaspoon baking soda 1,000 mg sodium

48
Complications of HTN

• Arteriosclerosis and atherosclerosis
• Aneurysm
• CAD/Angina/MIs
• Enlarged L heart
• Heart Failure
• TIAs/Stroke/Dementia

• Kidney failure/scarring
• Retinopathy
• Optic neuropathy
• Sexual Dysfunction ?
• Osteoporosis
• Sleep Apnea, but
• Sleep apnea increases blood pressure

49
Malignant HTN

• SS
• Severe headache, blurred vision, dyspnea
• Organ damage
• Sudden onset
• Risk factor for CVA, renal damage, MI
• Etiology unknown, but stress may contribute
• 200/120

50
Break Time
51
Coronary Artery Disease(CAD)

• Narrowing of arteries that supply ? muscle
• 1cause of death in US (men and women)
• Usu due to atherosclerosis
• Ischemia, necrosis of muscle tissue
• Causes CHF
• Blocked artery (occlusion)
• Slow plaque (may have collateral arteries)
• Fast thrombus/embolus
• Infarct (MI)
• AKA CHD and arteriosclerotic ? disease

52
Risk Factors for CAD

• Atherosclerotic risk factors
• Heredity
• Age
• Sex (more in males until menopause in women)

• Diabetes
• Diet (more fat and carbs more athero)
• Sedentary lifestyle
• Smoking
• NOT smoking 10 X more effective than
  diet/exercise control
• Stress
• HTN

53
Anginas

• Types of angina (an-JI-nuh or AN-juh-nuh) stable
• unstable
• variant (Prinzmetal)
• microvascular
• Have different symptoms and require different
  treatments

54
Stable Angina

• AKA Angina Pectoris, Cardiac Angina, Exertion
  Angina, Vasomotor Angina, Angina Syndrome, Angina
  Attack, Chest Pain
• Caused by lack of oxygen to ? muscle
• Myocardial ischemia
• Symptom of impending MI
• Triggered by exercise, stress, large meal
• Consistent pattern of events that trigger

55
Unstable Angina

• Doesn't follow a pattern
• Can occur w/wo physical exertion
• May not be relieved by rest or medicine
• Very dangerous
• Requires emergency treatment
• Sign that MI may happen soon

56
Variant (Prinzmetal) Angina

• Rare
• Usually occurs at rest, between midnight and
  early morning
• Pain can be severe
• Medicine can relieve this type of angina

57
Microvascular angina

• Can be more severe and last longer than other
  types of angina
• Medicine may not relieve it
• May be a symptom of coronary MVD
• Also called cardiac syndrome X and nonobstructive
  CHD
• More common in women

58
Myocardial Infarction (MI)

• Infarct necrosis
• Decrease in blood supply to muscle
• CAD plaque
• Thrombus, Embolus
• Mortality from MI
• About 35

• Anything that increases oxygen need may lead to
  MI
• Physical exertion
• Shock
• Hemorrhage
• Stress

59
Risk Factors for MI

• HTN
• Smoking
• Sedentary lifestyle
• Burn fewer calories watching TV than sleeping
• Obesity
• High-cholesterol diet

60
SS of MI

• Severe chest pain
• Diaphoresis
• Nausea
• Referred pain
• L arm, neck, jaw
• Feeling of indigestion
• Cardiogenic shock

61
Areas of Referred Pain

• Pain sites can be helpful, but require more
  evaluation to eliminate differential dx
• http//images.emedicinehealth.com/images/4453/4453
  -4478-10907-25156.jpg

62
SS of MI in Women

• Frequently no chest pain silent MI
• Can begin up to a month before MI occurs

• SS BEFORE MI
• Unusual fatigue - 70
• Sleep disturbance - 48
• Shortness of breath - 42
• Indigestion - 39
• Anxiety - 35
• SS DURING MI
• Shortness of breath - 58
• Weakness - 55
• Unusual fatigue - 43
• Cold sweat - 39
• Dizziness - 39

63

• http//www.womenshealth.gov/heart-stroke/heart-att
  ack-signs/heart-attack-signs.gif

64
Arrhythmias (Irregular Heartbeats)

• Any deviation from normal
• Abnormalities due to problem in conduction system
• Often idiopathic

http//www.spike.com/video/ekgecg-intrpretation/31
82500?cmpnid790ptsrrefsite7118
65
SS of Arrhythmias

• Palpitations
• Tachycardia
• Skipped beats
• Bradycardia
• Syncope
• Fatigue

66
Etiologies of Arrhythmias

• Disturbance of
• SA node (slow impulse)
• AV node
• Bundle branches
• Purkinje fibers
• Block between SA and AV nodes (conduction)
• Ischemia
• Meds

67
Normal ? Rhythm

• Normal sinus rhythm
• Between 60 and 100 beats/minute
• Normally, women have slightly higher in range
• Regular
• Normal conduction
• Originating in SA node

68
Fast Arrhythmias

• Flutter
• Up to 350 beats/minute
• Regular
• Fibrillation (Irregularly Irregular)
• Uncoordinated, Irregular
• Atrial usually not serious
• Ventricular (vfib) life-threatening/emergency

http//filer.case.edu/dck3/heart/sounds/af.wav
69
Fast Arrhythmias

• Atrial Tachycardia
• 150-250 bpm
• Normal rhythm
• Sudden onset
• Irritable atrium
• Normal conduction

• Atrial Fibrillation
• gt350 bpm
• Ectopic discharging
• AV node blocks some impulses
• Ventricle responds irregularly
• No P waves

70
Fast Arrhythmias

• Ventricular Tachycardia
• 150-250 bpm
• Usu regular
• 4 PVCs at rapid rate
• Advanced irritability of myocardium
• P wave buried in QRS complex
• Often forerunner of vfib

• Ventricular Fibrillation
• Lethal
• Loss of consciousness immediately
• No peripheral pulses
• No heart sounds
• No blood pressure
• Fibers twitch

71
Slow Arrhythmia

• Sinus Bradycardia
• Less than 60 bpm
• Regular
• P wave unform
• Slow impulse in SA node
• Normal Conduction

72
Heart Block Arrhythmias

• Interrupted conduction system
• 1st Delay at AV node
• 2nd AV node blocks impulse intermittantly
• 3rd SA impluse is completely blocked
• Atria and ventricles beat independently
• Requires pacemaker

73
Premature ? Contractions

• Can affect atria or ventricles
• Ectopic beat starts in irritable ventricle
• Followed by compensatory pause
• AKA - "extrasystoles"

74
Multifocal Arrhythmia

• Regularly irregular PVCs
• Ectopic beat(s) no prior P wave
• Coupling two beats in a row
• regular occurrence of a premature beat
• Bigeminy every other beat
• Trigeminy every third beat
• 2 normal QRS complexes are followed by a PVC
• Quadrigeminy every fourth beat
• heartbeats are grouped in fours
• usually one sinus beat followed by three
  extrasystoles
• a repetitive group of four of any composition is
  quadrigeminal

75
CHF

• ? cant pump enough blood for body
• Failure of ventricles
• Develops slowly
• Usu. Follows cardiac condition increasing
  workload
• Acute CHF after MI
• Chronic CHF after HTN, CAD, COPD, valve,
  arrhythmias, cardiomyopathy
• Other - thyroid disease, kidney disease,
  diabetes, or congenital heart defects
• R-sided congestion of liver and spleen
• L-sided lung congestion
• http//www.health-res.com/EX/08-03-22/HeartFailure
  Zones.gif

76
Progression of CHF

• Decreased Cardiac Output (many etiologies)
• Compensation mechanisms
• Vasoconstriction, increased resistance in L V
• Increased rate and force, incr. work
• Incr. sodium and water retentioin, incr volume,
  increased work for heart
• L CHF - LV weakens pulmonary congestion
• Increased resistance for RV
• R CHF increased blood in systemic circ
• Edema in legs and Digestive system

77
SS of CHF

• Depend on which ventricle fails
• Dyspnea - L
• Tachycardia
• Tachypnea
• Neck vein distention R
• Ascites - R
• Pedal edema - R (CHF)
• Pitting edema (fluid is forced into interstitial
  spaces)
• pitting is an assessment using grading scale of
  1 for mild and up to 4 for deep pitting.
• http//www.health-res.com/EX/07-28-04/55PJ35JA.jpg

78
Assessment of pitting edema

• 1 2mm or less
• Slight pitting
• Disappears rapidly
• No visible distortion
• 2 2-4mm
• Somewhat deeper pit
• Disappears in 10-15 secs
• No easily detected distortion
• Assessment Chart for Pitting Edema adapted from
  the Guelph General Hospital Congestive Heart
  Failure Pathway

• 3 4-6mm
• Pit noticeably deep
• May last more than 1 minute
• Dependent extremity looksfuller and swollen
  (4-6mm)
• 4 Edema 6-8mm
• Pit is very deep
• Lasts as long as 2-5 minutes
• Dependent extremity isgrossly distorted
  (6-8mm)

79
Cor Pulmonale

• Right-sided heart disease
• R ventricle enlarges due to lung disease
• Acute pulmonary emboli
• Chronic - pulmonary HTN, emphysema, lesions
• Hypoxia More RBCs thicker blood
• SS
• Dyspnea, distended neck veins, edema of
  extremities, enlarged/tender liver

80
Vessel Pathologies

• Congenital
• Arteriovenous Malformations
• Pathologies
• Phlebitis
• Thrombophlebitis
• Emboli
• Arteriosclerosis

http//www2.merriam-webster.com/mw/art/med/vein.ht
m
81
Common SS of Vessel Disease

• Pain
• Edema
• Cyanosis

82
Arteriovenous Malformations

• Formed in fetus
• Usu. NOT discovered before age 20
• Usu. in brain, but can occur anywhere
• Abnormal connection (no capillaries)
• Fragile, tend to bleed/hemorrhage
• When in brain, bleed can lead to SS similar to
  stroke
• Cerebral AVMs have 10 mortality rate

83
Phlebitis

• Inflammation of vein
• Usu in lower legs, but can occur anywhere
• Superficial
• Swelling, redness, warmth, cordlike mass
• Deep
• Affects tunica intima, can cause clots
• Thrombophlebitis

84
Thrombophlebitis

• Formation of a thrombus on vein wall due to
  inflammation (phlebitis)
• Interferes with blood flow, causes edema
• SS - Pain, swelling, warmth, tender, chills
  fever
• Causes
• Venous stasis (sitting in car/plane for long
  time, etc.), Hypercoagulability, blood disorders,
  injury to wall

85
Embolus

• Material transported by blood stream, sticks in
  small vessel, impedes circulation
• Thrombus - blood clot breaks loose and travels
  (DVTs, cardiac arrhythmias)
• Cholesterol -often from atherosclerotic plaque in
  vessel
• Fat bone fracture or fat droplets
• Air (Gas) air bubbles surgery, injury,
  central cath, diving

86
Embolus

• Material transported by blood stream, sticks in
  small vessel, impedes circulation
• Septic pus-containing bacteria, bacterial
  clumps
• Tissue of small fragments of tissue (placenta,
  etc)
• FB foreign materials such as talc and other
  small objects
• Amniotic fluid amniotic fluid, fetal cells,
  hair, or other debris enters mother's bloodstream
  via placenta and triggers allergic reaction

87
SS of Emboli

• Depend on Location and amount of tissue served by
  vessel
• Severe pain
• Pale, numb, cold extremities
• Arterial pulses absent beyond occlusion
• NV, Fainting, Shock IF large artery

88
Causes of Emboli

• Bed rest
• Physical Inactivity
• Heart failure
• Arrhythmias
• Pressure on veins
• Decreased flow in veins

89
Arteriosclerosis

• Group of diseases - hardening of arteries
• 3 forms
• Atherosclerosis
• Plaque w/in arterial tunica intima
• Monchebergs arteriosclerosis
• Medial calcific sclerosis, tunica media
• Destruction of muscle/fibers w/calcium deposits
• Arteriosclerosis
• Arteriole walls thicken, lose elasticity/contracti
  lity

90
Homework

• Please access these two case studies and identify
  ALL (not just Cardiovascular) narrative dx
  statements that you would code. (DO NOT code
  yet)
• N.B.The second case covers several encounters
• Congestive Heart Failure Case Study. VHCT.
  School of Health Professions. University of
  Missouri Columbia.
• http//www.vhct.org/case1899/phys_exam.htm
• Lifestyle Issues in Cardiac Health. Robert L.
  Blake, Jr., MD. VHCT. School of Health
  Professions. University of Missouri Columbia.
• http//www.vhct.org/case2800/index.htm

91
15 leading causes of death 2006

• Diseases of heart (heart disease) (CV,
  Lifestyle)
• Malignant neoplasms (cancer)
• Cerebrovascular diseases (stroke) (CV,
  Lifestyle)
• Chronic lower respiratory diseases
• Accidents (unintentional injuries)
• Diabetes mellitus (diabetes) (CV, Lifestyle)
• Alzheimers disease
• Influenza and pneumonia
• Nephritis, nephrotic syndrome and nephrosis
  (kidney disease)
• Septicemia (CV)
• Intentional self-harm (suicide)
• Chronic liver disease and cirrhosis
• Essential hypertension and hypertensive renal
  disease (hypertension)
• (CV, Lifestyle)
• Parkinsons disease
• Assault (homicide)

92
Questions ? ? ?
imueller_at_email.wcu.edu
Thank You !
93
AP/Pathophys Resources

• American Heart Association/American Stroke
  Association. Cardiovascular media library.
  http//www.medmovie.com/mmdatabase/mediaplayer.as
  px?MessageVG9waWNpZD0wO0NsaWVudElEPTY1O1Zlcm5hY3V
  sYXJJRD0x2DP83bCzVaVLA3D
• American Heart Assoc. Adults With Congenital
  Heart Defects. 12/14/09. http//www.americanheart
  .org/presenter.jhtml?identifier11062
• American Heart Assoc. Blood Pressure.
  (n.d.) http//www.americanheart.org/presenter.jhtm
  l?identifier4473.
• Cable, C. MD. Auscultation Assistant. 1997.
• http//www.med.ucla.edu/wilkes/intro.html
• The Cardiac Exam Auscultation
• http//filer.case.edu/dck3/heart/listen.html
• Cincinnati Children's Hospital Medical Center.
  Cardiac Anomalies / Congenital Heart Defects
• http//www.cincinnatichildrens.org/health/heart-en
  cyclopedia/anomalies/default.htm
• EKG/ECG Interpretation (4 minute video).
• http//www.spike.com/video/ekgecg-intrpretation/31
  82500?cmpnid790ptsrrefsite7118

94
AP/Patho Resources

• Frazier, M. S. and Drzymkowski, J. W. 2009.
  Essentials of Human Diseases and Conditions, 4th
  ed. Saunders.
• Fulcher, E.M., Soto, C.D., Fulcher, R.M.
  Pharmacology Principles Applications. A
  worktext for Allied Health Professionals,
  Saunders, 2003.
• Grays Anatomy. 1918. At Bartleby.com Great Books
  Online.
• http//www.bartleby.com/cgi-bin/texis/webinator/si
  tesearch?FILTERcol107queryx12y10
• Health Resources. Heart Failure Zones.
• http//www.health-res.com/EX/08-03-22/HeartFailure
  Zones.gif
• Heartpoint Gallery. http//www.heartpoint.com/gall
  ery.html

95
AP/Patho Resources

• KidsHealth For Parents
• http//kidshealth.org/misc/movie/parent/ASD_rev/AS
  D_rev.html
• Maryland Heart Center. About the Heart.
  University of Maryland Medical Center.
• http//www.umm.edu/heart/anatomy.htm
• Mayo Clinic. High Blood Pressure (Hypertension).
• http//www.mayoclinic.com/health/high-blood-pressu
  re/HI00062
• Mayo Clinic. Coarctation of the Aorta.
• http//www.mayoclinic.com/health/coarctation-of-th
  e-aorta/DS00616/DSECTIONsymptoms
• MedlinePlus. U.S. National Library of Medicine
  and the National Institutes of Health.
• http//medlineplus.gov/

96
AP/Patho Resources

• Moisio M. A. E. W. Moisio, Understanding
  Laboratory and Diagnostic Tests, Delmar, 1998
  (2nd ed? later)
• National Heart Lung and Blood Institute. What Is
  Angina?
• http//www.nhlbi.nih.gov/health/dci/Diseases/Angin
  a/Angina_WhatIs.html
• National Institute of Nursing Research. Womens
  symptoms are new or different Prior to heart
  attack.
• http//www.ninr.nih.gov/NR/rdonlyres/C76323E9-822F
  -47D9-853F-61032685AC9E/4820/WomensSymptomsAreNewo
  rDifferentPriortoHeartAttack.pdf
• Neighbors and Tannehill-Jones. Human Diseases.
  2000. Delmar
• PQRST graphic
• http//cygnus.et.put.poznan.pl/piotrw/nauka/fibon
  acci/heartelec2.gif

97
AP/Patho Resources

• Robert Wood Johnson University Hospital. Heart
  Illustrations - Fetal Circulation
• http//www.rwjuh.edu/health_information/ce
  nters_heart_fetlcirc.html
• Scott, A. S. Fong, E. Body Structures and
  Functions, 11th ed., Delmar, 2009
• St. Jude Medical. Heart Library.
• http//www.heartlibrary.com/site-map.aspx
  (medical technology and services vendor)
• Tetralogy of Fallot. American Heart Assoc.
• http//www.americanheart.org/presenter.jhtml?ident
  ifier11071
• WebMD. Congenital Heart Disease.
• http//www.webmd.com/heart-disease/guide/congenita
  l-heart-disease

98
VHCT Cases

• Congestive Heart Failure Case Study. VHCT.
  School of Health Professions. University of
  Missouri Columbia.
• http//www.vhct.org/case1899/phys_exam.htm
• Lifestyle Issues in Cardiac Health. Robert L.
  Blake, Jr., MD. VHCT. School of Health
  Professions. University of Missouri Columbia.
• http//www.vhct.org/case2800/index.htm