Pulmonary Heart Disease
Otherwise Known as Cor Pulmonale
Before we move on...
Here is some background information on the function and structure of the heart:
- Heart Chambers: The heart contains 4 hollow chambers. The two upper chambers are called the atria. Atria are often called receiving chambers because blood enters the heart through veins that open into these upper cavities. The two lower chambers and called ventricles. Ventricles are often called discharging chambers because blood is pumped from the heart into the arteries that exit from the ventricles.
- Heart Valves: The two valves that separate the atrial chambers above from the ventricle below and called atrioventricular (AV) valves. The left AV valve is the bicuspid valve, or mitral, valve, located between the left atrium and ventricle. The left AV valve is the tricuspid valve located between the right atrium and ventricle. The semilunar (SL) valves are located between the two ventricular chambers and large arteries that carry blood away from the heart when contraction occurs.
- Pericardium: The covering of the heart is called the pericardium. The inner layer of the pericardium is called the visceral pericardium, or epicardium. It covers the heart the way an apple skin covers an apple. The outer layer of the pericardium is called the parietal pericardium. It fits around the heart like a loose-fitting sack, allowing enough room for the heart to beat.
- Major Blood Vessels and Blood Flow: Blood enters the right atrium through two large veins called the superior vena cava and interior vena cava. The heart pump receives oxygen-poor blood from the veins. After entering the right atrium, it is pumped through the right AV and enters the right ventricle. When the ventricles contract, blood in the right ventricle is pumped through the pulmonary SL valve into the pulmonary artery and eventually to the lungs, where oxygen is added and carbon dioxide is lost. Blood rich in oxygen returns to the left atrium of the heart through four pulmonary veins. It then passes through the left AV into the left ventricle. When the left ventricle contracts, blood is forced through the aortic SL valve into the aorta and is distributed as a whole.
- Conduction System: Cardiac muscle fibers must be coordinated by electrical signals if the heart is to pump efficiently. The heart has its own conduction system for coordinating contractions during the cardiac cycle. All of the cardiac muscle fibers are electrically linked together. The intercalated disks are connections that electrically join muscle fibers into a single unit that can conduct an impulse through the wall of the heart chamber without stopping. Thus, both atrial walls will contract at about the same time because of all their fibers are electrically linked. There are four structures in the wall of the heart specialized for making strong impulses and conducting them rapidly to certain regions of the heart wall: sinoatrial node, atrioventricular node, AV bundle, and Purkinje fibers.
- Arteries, Veins, and Capillaries: Arteries are vessels carrying blood away from the heart and to the rest of the body. Veins do the opposite; they are vessels that carry blood towards the heart. Lastly, capillaries are tiny vessels that connect atrioles and venules.
- Cardiac Cycle: The beating of the heart is a rhythmic and systematic process. Each complete heartbeat is called a cardiac cycle and includes the contraction and relaxation of atria and ventricles. The stroke volume refers to the volume of blood ejected from the ventricles during each beat.
- ECG: An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of your heart. An EKG translates the heart's electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves. An ECG is done to: Check the heart's electrical activity, find the cause of unexplained chest pain, find the cause of symptoms of heart disease, find out if the walls of the heart chambers are too thick (hypertrophied), check how well medicines are working and whether they are causing side effects that affect the heart, check how well mechanical devices that are implanted in the heart, and check the health of the heart when other diseases or conditions are present.
- Blood Pressure: Blood pressure is measured in millimeters of mercury (mmHg) and recorded as two numbers systolic pressure "over" diastolic pressure. Both numbers in a blood pressure reading are important. As we grow older, systolic blood pressure is especially important. To test your blood pressure, your doctor will use a familiar device with a long name. It is called a sphygmomanometer (pronounced sfig’-mo-ma-nom-e-ter). There are five factors that influence blood pressure: blood volume (the amount of blood in the vessels), strength of heart contractions ( strength and rate the heartbeat), heart rate (rate of the heartbeat), blood viscosity (blood thickness), and resistance to blood flow (strength of the blood flow).
- Pulse: What you feel when you take your pulse is an artery expanding and then recoiling. To feel your pulse you must place your fingertips over an artery that is towards the surface of the body. The pulse is very useful in that it can provide information about the rate, strength, and rhythm of the heartbeat.
- Sound of Heartbeat: When listening to the heartbeat with a stethoscope two distinct sounds can be heard. They are often described as lub dup. The first sound is caused by the vibration and abrupt closure of the AV valves as the ventricles contract. The second heart sound is caused by the closing of the SL valve when the ventricles undergo diastole.
- Blood Tests: The hematocrit blood test measures the proportion, by volume, of the blood that consists of red blood cells. The white blood cell count is the number of white blood cells per volume of blood and can tell if there is any inflammation in the body. Lastly, the platelet count is a test to measure how many platelets you have in your blood. This is important because platelets help the blood clot.
On to the Real Topic..
- The ECG, shown it the first picture below, shows the presence of right ventricular hypertrophy, RV strain, and the underlying pulmonary disease.
- When taking his pulse I noticed it was abnormally fast, which isn't suprising because of his labored breathing due to the low blood oxygen levels.
- His blood pressure was extremely high because the heart has a harder time pumping the blood.
- The patient's stroke volume, pictured as the second picture below, is very high due to his high blood pressure. It will stay high as long as the blood pressure stays elevated.
- The results of the cardiac output, in the third picture below, show that his blood is pumping from the heart at a high volume.
- After listening to his heartbeat I have concluded that his heart sounds are rather abnormal, especially in the second heart sound.
- The three blood tests came back normal.
The treatment for this patient's Pulmonary Heart Disease first starts with quiting smoking. I will perscribe my patient with Chantix to help end this habit. He will also do daily oxygen therapy to help oxidize his lungs and eventually the blood going to the right side of his heart. Finally, he will eat a low fat, low cholestorol, and low sodium diet and follow an exercise plan that I will develop for him. There is no cure for Pulmonary Heart Disease, but these simply changes will reduce discomfort and stop futher damage.
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