Congestive heart failure (CHF) is a condition in which the hearts function as a pump to deliver oxygen rich blood to the

body is inadequate to meet the bodys needs. So any kinds of people all around the world have this kind of disease. People who are mostly at risk with this kind of disease are those who have high cholesterol and Low Density Lipoprotein (LDL) in the body, high blood pressure, diabetes mellitus and family history of heart disease. In addition to that people who are smokers and obese are also at risk. Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure. The most common cost of congestive heart failure is coronary artery disease, high blood pressure (hypertension), longstanding alcohol abuse and disorders of the heart valves. Less common causes includes viral infections of the heart muscle.

The symptoms of the congestive heart failure vary among individuals according to the particular organ system involved and depending on the degree to which the rest of the body has compensated for the heart weakness. An early symptom of CHF is fatigue. As the body becomes over loaded with fluid from congestive heart failure, swelling (edema) of ankles and legs or abdomen may be noticed. In addition fluid may accumulate in the lungs, thereby causing shortness of breath particularly during exercise or when lying flat. In some instances, patients are awakened at night, grasping for air. Some may be unable to sleep unless sitting upright. The extra fluid in the body may cause increase urination, particularly at night. Accumulation of fluid in the liver and intestines may cause nausea abdominal pain and decrease appetite. There are many diagnostic procedures for CHF this includes BNP blood test, chest X ray, coronary angiography, echocardiography, ECG and cardiac stress test.

Medications available for the treatment of CHF were frustratingly limited on controlling the symptoms. Recently, medications have been developed that both improve symptoms and importantly, prolong survival. These medications include Angiotensin Converting Enzyme (ACE) Inhibitor, Betablockers, Digoxin, and Diuretics. The number of people who have this kind of disease is continuously increasing that is why to prevent us from acquiring CHF we need exercise, proper diet, and awareness about the signs and symptoms of CHF.

NAME: AGE: GENDER: DATE OF BIRTH: PLACE OF BIRTH: NATIONALITY: CIVIL STATUS: ADDRESS: OCCUPATION: ATTENDING PHYSICIAN: CHIEF COMPLAIN: RM NO./HOSPITAL: DATE ADMITTED: TIME ADMITED: FINAL DIAGNOSIS:

JACK 76 Male February 9, 1931 Lannig Solana, Cagayan Filipino Widower Centro Solana, Cagayan Cook Dr. Reyes and Dr. Gonzales Bipedal Edema RM 212/SPH June 30, 2007 12:40 PM CHF

PAST MEDICAL HISTORY

A few years prior to admission, the patient was diagnosed of hypertension and heart disease. His vaccination is incomplete due to poverty. During his youthful days lolo Jack enumerated a number of illnesses that he experienced namely: fever, cough, body weakness and pain, headache and diarrhea. He usually experienced fatigue and weakness when he was an adolescent because of his work as a chef apprentice. He was fortunate not to have any problems with his lungs until now. In mild health alteration he usually goes to their Barangay Health Center and in worse cases he goes to CVMC or SPH.

PRESENT MEDICAL HISTORY

One week prior to admission, generalized edema was exhibited, accompanied with easy fatigue ability presented, hence consultation and after sometime without his knowing he was brought to the SPH, ICU because his condition became worse. After a day in the ICU he was transferred to a private room because of the doctors order and the harmful effects of the smell of the paint. His c/c was face and bipedal edema and the final diagnosis was CHF. In our visit he was ok with an IV of #5 PNSS 1L KVO line in his left arm, O2 inhalation running at 6LPM and his o2sat was 90%. He had no bathroom privileges. We visited lolo during our last rotation and he was still there, we ask when will he be discharged and the SO said hindi namin alam, pero sana malapit na kasi gusto na daw niyang lumabas.

FAMILY HEALTH HISTORY

The patient has family history of lung disease, hypertension and heart disease from both sides of the family. His mother died because of CVA and his father died because of salinity. He said that their family has a strong immune system when it comes to pathogenic diseases. So far his children seem to carry the same immunity.

NIGHT SWEATS FEVER

TREMOR

FALLING HAIR

CHEST PAIN SPUTUM DYSPNEA

WEAKNESS JOINT PAIN

HEALTH PERCEPTION AND Before hospitalization:

HEALTH MANAGEMENT

The patient views health as the total condition of ones body and mind. He views health as a gift from God and a gift that should not be deprived of the next generation. He said that health is for all not only for the rich but for the poor people too. The patient also verbalized kapag hindi gaano masakit sa pakiramdam e sa albularyo ako pumupunta, pero pag sobrang sakit talaga kinakailangan talaga na sa doctor ako magpachek-up. There are times when he just relies on OTC drugs in minor health alterations such as fever, cough, and headache. He believes that discipline plus faith can get you through any problem even those that concern health. During hospitalization: During his hospital days Lolo Jack considered himself weak, unhealthy, and completely different from before. He then views health as something he once had and is wanting to have now. As he verbalized lumusog lang ako hindi na ako gagalaw masyado, sayang rin lang ang buhay ko. He religiously follows his diet and the health maintenance procedures in the hospital because he believes that those are the ways on how to be well again. He said that he does his best in managing his health and he just lets God do the rest.

NUTRITIONAL-METABOLIC PATTERN
Before hospitalization: Lolo Jack prides of eating more than just the usual 3 times daily with no food preference or allergy. When he was young he liked adult food more and didnt like candy and chocolates that much. He stated kapag dumadaan yung mambabalot o fishball e kumakain ako, kapag mukhang masarap yung ulam na tinitinda sa kanto e kumakain ako. He then said that he eats as long as he has money. The patient loves to eat laoya because according to him laoya his favorite food. He has a good appetite far better than his friends and family. He does not follow any special kind of diet. He loves to eat vegetable and meat and did not develop that much liking to fish since he was young (only fishball). He likes fruits especially bananas. He drinks 8-9 glasses of water a day. He drinks coffee only once a day (in the morning usually brewed with coffee mate). He doesnt drink that much of carbonated drinks (softdrinks) but there are times when he drinks alcohol until he gets drunk. And in drinking and gambling sessions he usually eats peanuts and potato chips. In conclusion he said masarap kumain kapag sama-sama at masaya, malakas ako kumain kapag kasama ko pamilya ko.

During hospitalization: Lolo Jacks diet in the hospital is low salt and low fat. Now in the hospital, fish is often served to him. He often utters ano ba naman yan?, isda na naman? every time his meal comes. He said that the food served in the hospital do not have any appeal to him anymore. He then said nasasayangan ako sa pagkain pero buti nalang mataba na ako dati at baka mangayayat ako ng sobra dito. His usual fluid intake decreased from the usual 8-9 glasses to only about 2-4 glasses. He is completely aware that his input and output are monitored every one hour. He then decreased his craving for alcohol and coffee while confined.

SLEEP-REST PATTERN Before hospitalization: Lolo Jack has no problems with his sleep and rest pattern and he usually sleeps about 8-9 hours from 9 PM to 5 AM. He has a naptime after lunch, 2-3 hours long and he liked right side lying position. He prefers sleeping somewhere soft and well ventilated. So far he said that people do not have difficulty waking him up, kalugin mo lang ako magigising na ako. So far his sleep is always continuous and he doesnt have difficulty sleeping. During hospitalization: Since his present condition is not good, his sleep and rest pattern is altered. He was sent to the Intensive Care Unit once during his first day. He is usually disturbed of his usual sleeping pattern because of the uncomfortable environment and secondary to the medications he needs and monitoring of vital signs every hour. He lies in the semi-fowlers position. He has complains about the hospital smell and the noisy aircon.

ELIMINATION PATTERN Before hospitalization: Lolo Jacks elimination pattern depends on how much he eats and drinks daily. He urinates at least 9-10 times a day with a transparent yellow appearance about 200 to 250 mL per urination and he defecates about 2 times a day, once in the morning after breakfast and late at night before he sleeps, his stool is usually dark, also depending on what he eats, soft stool and well formed. When asked about the odor of his stool he responded lahat naman ng tae mabaho. He said that his elimination is normal except on times of loose bowel movement and on drinking sessions. During hospitalization: During his hospitalization there were times when he wasnt given bathroom privileges. He was then asked to urinate or defecate in a separate urinal or arinola. Lolo Jack now urinates about 2-3 times a day with dark yellow color about 100-200 mL per urination and he defecates at least once a day dark in color, foul smelling, and well formed. Since elimination seems difficult for him, he asks for assistance from his loved ones.

ACTIVITY-EXERCISE PATTERN Before hospitalization: Lolo Jack does not perform any kind of exercise since his work is already his exercise and he verbalized maglaro ng tong-its, yan ang pinag-aabalahan ko maghapon hindi naman ako mahilig manood ng t.v, sa sabong at makinig sa radyo pwede. He said that cooking for the people is his exercise. He further said that minsan kailangan ng rekado e ako pa ang bibili at magpapagod. He takes care himself and his family. If he does not have things to do he tries to check-up on the garden and cleans their car. He said ayaw ko kasi na pinapagod ko ang sarili ko. During hospitalization: When asked of what he does when he is awake he answered wala lang, dumudulang sa hangin, wala naman kasi magawa masyado dito para kang nakakulong. Even if confined he still plays cards and although limited in his movement he reads the newspaper and plays board games with his children minsan naririnig nalang ako sa radyo. The only exercise he does are the dee breathing exercises he needs.

COGNITIVE-PERCEPTUAL PATTERN
Before hospitalization: Lolo Jack prides of knowing and memorizing plenty of recipes and even delicacies. He said that he can compete in game shows if he likes. He is also oriented and aware of the events happening in our country. He has difficulty in hearing and his vision is poor in both eyes, he started having blurred vision by age 43 he then used eye glasses with strong grade. He cannot read small letters if he does not use his glasses. He is completely in touch with reality and sees things normally. He has no problems with his taste, smell, and touch sense. During hospitalization:

Lolo Jack then said that hindi ko alam pero kapag nagbabasa ako e bigla nalang akong nahihilo. He said that there are no apparent changes in his senses. He just blames the food for his poor appetite. He then concluded wala namang nagbago masyado sa akin, basta ngayon nasa hospital ako tapos iba na lahat.

SELF PERCEPTION PATTERN Before hospitalization: When asked about what Lolo Jack sees of himself he said syempre gwapo ako and he considers himself healthy, happy and jolly. He fears the Lord and is known on how he budgets his time and gives attention to all who are needy. He said that as long as he has strength and is healthy he is normal. He still sees himself as the head of the family even if all of his children have families of their own already, the once the sought to and breadwinner, and the source of strength for his family. During hospitalization:

Concerning his present condition, Lolo Jack views himself as a prisoner, unhealthy and not free. All he wants is to leave the hospital as healthy as before and not suffer the same condition again. He believes that plenty of people are expecting much from him. Thats why he needs to get well soon.

ROLE-RELATIONSHIP PATTERN Before hospitalization: Lolo Jack is widower and he lives with his son. He communicates well using vernacular words like Itawes, Ilocano, at Ibanag. He is independent in making decisions for himself. He is a very good father for having nine children finish their studies and become responsible citizens. He is a great grandfather, a nice neighbor, and a law-abiding citizen of the Philippines. During hospitalization: Lolo Jack viewed himself as the important and helpless one when he was admitted. He was very thankful that his friends visit him and wish him well. During hospitalization he proved how strong and important his role is as a friend and father and how important the relationships he made based on trust and love.

SEXUAL REPRODUCTIVE PATTERN Before hospitalization: Lolo Jack was circumcised by the age of 10 and his first sex experienced was when he was at the age of 20 with his wife. He verbalized that his sex life was so active. He usually performs at least 3 times and he doesnt use contraceptives because these are useless. He said that he can not see himself having sex with anyone other than his wife. During hospitalization: Because he is a widower, his sex life is now inactive and zero. He promised that he would not engage in affairs or in any sexual relations with anyone to his wife and his children.

COPING STRESS PATTERN Before hospitalization: When faced with problems Lolo Jack shares his feelings with sons and daughters. He verbalized pag kinewento ko kasi ang aking problema sa aking mga anak eh gumagaan ang aking luob. According to Lolo Jack, he thinks more clearly and makes wiser decisions after talking to his children, however before making a decision he always refer to his magic book to make him feel more confident on the possible outcomes of his actions. Aside from that he eats more foods when he is stressed. Lolo Jack claims that eating makes him feel that his problem is not that tragic. During Hospitalization: Lolo Jack shares his problems to the Student Nurses and the SO but he feels more comfortable talking to his family. To make the problems feel lighter he tends to make jokes. Lolo Jack verbalized pag may naririnig kasi ako na tumatawa e magaan sa luob.

AREA ASSESSED SKIN Color Hair distribution Moisture Texture Turgor Temperature Thickness

TECHNIQUE USED Inspection Inspection Inspection Palpation Pinching Touching Touching Inspection Inspection Palpation Inspection Inspection Blanche test

NORMAL FINDINGS

ACTUAL FINDINGS Light brown Equally distributed Slightly moist Skin rough Recedes immediately Warm to touch Uniformly thin Equally distributed Black Smooth Violet Convex Cyanotic nail beds

ANALYSIS

Light to Deep brown Equally distributed Slightly moist Smooth Recedes immediately Warm to touch Uniformly thin Equally distributed Black Smooth Pinkish Convex 2-3 second

Normal Normal Normal Normal due to age Normal Normal Normal Normal Normal Normal Normal Normal Consider cardiovascular dysfunction

HAIR
Distribution Color Texture NAIL Color of nail bed Shape contour Capillary refill and

VALUE-BELIEF PATTERN Before hospitalization: Lolo Jack is a Roman Catholic and he believes in superstitions. He believes in the existence of spirits both good and bad. He verbalized that he has a magic book he called that Planetarium and that book is helpful and important to him. Things concerning luck, health, love, and fortune can be seen in the book. He said that he got it from his ancestors. He said that God is his source of strength. Although he is not a habitual church goes he said that he prays when he wakes up, before and after he eats, and before he sleeps. He knows how to pray the rosary. He believes that what you let children see is what they will turn out to be. During hospitalization:

Lolo Jacks faith just grew stronger and he also relies on the magic book he has. He believes that a continuous, steadfast, and strong faith can get you out of everything. He believes that the people around him give him strength and that someday he will be healthy and strong again. As he concluded ang una kong gagawin paglabas ko dito ay magsimba sa Piat.

NAME: JACK DATE: July 5, 2007 VITAL SIGNS: BP: 130/90 RR:90 PR: 28 T: 36.5 O2 SAT: 90%

Texture HEAD Symmetry Shape and size Texture FACE Symmetry Facial EYES Position & alignment Skin Quality EYELASHES Hair distribution Direction of curl SCLERA Color CONJUNCTIVA Movement

Palpation Inspection Inspect and palpate Palpation Inspection Inspection

Smooth Symmetrical Normocephalic Nodules not palpable Symmetrical Symmetrical facial features Parallel to each other Skin intact Equally distributed Outward direction of curl

Smooth Symmetrical Normocephalic Nodules not palpable Symmetrical Symmetrical facial features Parallel to each other Skin intact Lost of outer 1/3 Outward direction of curl White

Normal Normal Normal Normal Normal Normal

Inspection Palpation Inspection Inspection

Normal Normal Due to decrease hair follicle Normal

Inspection

White

Normal

Color
Texture PUPILS Color Reaction to light

Inspection
Palpation Inspection Inspection

Pinkish
Smooth Black PERRLA

Pinkish
Smooth Black PERRLA

Normal
Normal Normal Normal

Shape

Inspection

Round

Round

Normal

Ocular Movement
Ability to constrict AURICLES Symmetry Position Texture AUDITORY CANAL Color Discharges EARS Size and shape

Inspection
Inspection Inspection Inspection Palpation Inspection Inspection Inspection

Equal movement
3-5 mm Symmetrical Upper part leveled to the eyes Non tender Pink None Bilaterally with no swelling and thickening Feel firm and movement should produce no pain Symmetrical Oval, symmetrical Smooth

Equal movement
3 mm Symmetrical Upper part leveled to the eyes Non tender Pink None Bilaterally with no swelling and thickening Firm and there is no pain Symmetrical Oval, symmetrical Smooth

Normal
Normal Normal Normal Normal Normal Normal Normal

Tenderness NOSE Symmetry Nares Texture

Inspection

Normal

Inspection Inspection Inspection

Normal Normal Normal

Secretions

Inspection

No presence of any type of secretions

Presence of secretions

Abnormal d/t increase tracheobronch ial secretions

NASAL CAVITY Color Inspection Red color Red color Normal

Texture
MOUTH LIPS Color Moisture Symmetry TEETH AND GUMS Color

Inspection

Smooth moist surface

Smooth moist surface

Normal

Inspection Inspection Inspection

Slightly brown Slightly moist Symmetrical

Slightly brown Slightly moist Symmetrical

Normal Normal Normal

Inspection

Whitish

No teeth

Normal due to age

Number TONGUE Color Symmetry

Mobility NECK Symmetry Position

Inspection

32

No teeth

Normal due to age

Inspection Inspection
Inspection

Pink Lies midline

Freely movable

Pink Lies midline

Freely movable

Normal Normal
Normal

Inspection Inspection

Head position in the midline Centrally positioned

Head position in the midline Centrally positioned

Normal Normal

Mobility Trachea THORAX AND LUNGS Thoracic cage Thickness chest wall Symmetry Breath sounds of the

Inspection Inspection and palpation Inspection Palpation Inspection Inspection Auscultation

Freely movable Midline at the suprasternal Straight line Thin chest wall Loud and low pitch Symmetrical Bronchovesicular

Freely movable Midline at the suprasternal Straight line Thin chest wall Loud and low pitch Symmetrical Crackles

Normal Normal

Normal Normal Normal Normal Due to secretions in the trachea and large bronchi

Pitch and intensity

HEART SOUNDS S1 S2 Presence murmurs Frequency of Auscultation Auscultation Auscultation Auscultation Loudest at apex Loudest at base No murmurs/sounds Low Sound is soft Soft is undistinguishable With murmurs Unstable Due to decreased cardiac output Due to left atrium hypertrophy Due to structural defects in valves Due to heart chamber malfunction Due to heart chamber malfunction

Intensity

Auscultation

Loud

Unstable

Duration

Auscultation

Short

Unstable

Due to heart chamber malfunction Due to heart chamber malfunction Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal

Timing

Auscultation

Systole/Diastole

Unstable

ABDOMEN Color Contour Umbilicus Tenderness UPPER EXTREMITIES Color Symmetry Respond to pain LOWER EXTREMITIES Color Symmetry Respond to pain Ability to flex and extend extremities Level of Consciousness Inspection Inspection Palpation Flexing and extending Inspection Symmetrical Present Present Able to flex and extend Conscious Symmetrical Present Present Able to flex and extend Conscious Inspection Inspection Palpation Similar to the rest of the body Symmetrical Present Similar to the rest of the body Symmetrical Present Inspection Inspection Inspections Percussion Light brown Fairly protuberant Midline and inverted None Light brown Fairly protuberant Midline and inverted None

UPPER AND LOWER EXTREMITIES

LABORATORY

RESULTS

CHEMICAL SPECIMEN EXAM REPORT

CARDIAC PANEL RESULT
TEST: TROPONIN I RESULT: NEGATIVE ( - )

NORMAL RANGE: LESS THAN 0.01 ug/L

BLOOD CHEMISTRY COUNT

RESULT
BLOOD UREA NITROGE N CREATINI NE PATASSIU M

NORMAL

ANALYSIS
Due to decreased blood flow to the kidney relative to heart failure.

10.01 131.3 4.49

2.50-8.33 mmol/L M: 65-120 mmol/L

3.6-5.5 mmol/L

Due to dehydration. NORMAL

HEMATOLOGY REPORT
RESULT NORMAL ANALYSIS

WBC HGB HTC

6.8 17.0 51

5-10 2/0 ^g/l M: 13.0-18.0 g/dl M: 39.0-54.0%

NORMAL

NORMAL

NORMAL

DIFFERENTIAL COUNT
RESULT NORMAL ANALYSIS Due to impaired cell oxygenation. NORMAL

SEGMENTERS

0.71 0.29

0.60-0.70 0.20-0.30

LYMPHOCYTES

BLOOD CHEMISTRY COUNT

RESULT
FASTING BLOOD SUGAR

NORMAL
3.87-5.84 mmol/L

ANALYSIS NORMAL NORMAL NORMAL

5.63 2.35 0.71

CHOLESTEROL

3.85-6.71 mmol/L M: 0.68-1.88 mmol/L

TRIGLYCERIGES

RESULT

NORMAL
M: >1.4 mmol/L

ANALYSIS Due to atherosclerotic heart disease. NORMAL

Due to insulin in the heart relative to congestive heart failure.

HDL-C LDL-C SGPT

0.9 1.15 42

<3.88 mmol/L M: up to 40 m/L

CHEST XRAY PA VIEW

DATE: June 30, 2007 Interstitial infiltrates, both lower lobes with haziness in the right obliteratory and its sulcus.

Heart is moderately enlarged.

Diaphragm and sinuses are normal.

Mild deviation of thoraces spin of the left.

IMPRESSION:
Interstitial pneumonitis, both lower lobes with pneumonic consolidation in the right effusion right mild leucsocoliosis thoracic spine.

CHEST XRAY PA VIEW

DATE: July 6, 2007
Follow up in comparison with the previous radiograph dated June 30, 2007, shows progression of the previous noted wedge-shaped opacity in the right lower lung field.

There is mild accent ration of the pulmonary vascular marking. The right costoohrenic sulcus remains blunted.

The rest of the findings are uncharged.

IMPRESSION:
Right lobe consolidation with progression, cordiomegaly pulmonary congestive changes. with

Artherosclerotic aorta.
Pleural reactin vs minimal pleural effusion right.

Home

Title page Introduction Structures of the heart Heart valves Mycardium Pericardium Endocardium Coronary arteries Functions of the heart Cardiac cycle Cardiac output

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ANATOMY and PHYSIOLOGY of the HEART

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INTRODUCTION

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Heart, in anatomy, hollow muscular organ that pumps blood through the body. The heart, blood, and blood vessels make up the circulatory system, which is responsible for distributing oxygen and nutrients to the body and carrying away carbon dioxide and other waste products.

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The heart is the circulatory systems power supply. It must beat ceaselessly because the bodys tissues, especially the brain and the heart itself, depend on a constant supply of oxygen and nutrients delivered by the flowing blood. If the heart stops pumping blood for more than a few minutes, death will result.

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The human heart is shaped like an upside-down pear and is located slightly to the left of center inside the chest cavity. About the size of a closed fist, it is made primarily of muscle tissue that contracts rhythmically to propel blood to all body parts.

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This rhythmic contraction begins in the developing embryo about 3 weeks after conception and continues throughout an individuals life. Over a typical life span of 76 years, the heart will beat nearly 2.8 billion times and move 169 million liters (179 million quarts) of blood.

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STRUCTURES OF the HEART

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The human heart has four chambers. The upper two chambers, the right and left atria, are receiving chambers for blood. The atria are sometimes known as auricles. They collect blood that pours in from veins, blood vessels that return blood to the heart.

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The hearts lower two chambers, the right and left ventricles, are the powerful pumping chambers. The ventricles propel blood into arteries, blood vessels that carry blood away from the heart. A wall of tissue separates the right and left sides of the heart.

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Each side pumps blood through a different circuit of blood vessels: The right side of the heart pumps oxygen-poor blood to the lungs, while the left side of the heart pumps oxygen-rich blood to the body.

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Blood returning from a trip around the body has given up most of its oxygen and picked up carbon dioxide in the bodys tissues. This oxygen-poor blood feeds into two large veins, the superior vena cava and inferior vena cava, which empty into the right atrium of the heart. The right atrium conducts blood to the right ventricle,

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and the right ventricle pumps blood into the pulmonary artery. The pulmonary artery carries the blood to the lungs, where it picks up a fresh supply of oxygen and eliminates carbon dioxide. The blood, now oxygen-rich, returns to the heart through the pulmonary veins, which empty into the

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left atrium. Blood passes from the left atrium into the left ventricle, from where it is pumped out of the heart into the aorta, the bodys largest artery. Smaller arteries that branch off the aorta distribute blood to various parts of the body.

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HEART VALVES

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Four valves within the heart prevent blood from flowing backward in the heart. The valves open easily in the direction of blood flow, but when blood pushes against the valves in the opposite direction, the valves close. Two valves, known as atrioventricular valves, are located between the atria and ventricles.

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The right atrioventricular valve is formed from three flaps of tissue and is called the tricuspid valve.The left atrioventricular valve has two flaps and is called the bicuspid or mitral valve. The other two heart valves are located between the ventricles and arteries.

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They are called semilunar valves because they each consist of three half-moon-shaped flaps of tissue. The right semilunar valve, between the right ventricle and pulmonary artery, is also called the pulmonary valve. The left semilunar valve, between the left ventricle and aorta, is also called the aortic valve.

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MYOCARDIUM

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Muscle tissue, known as myocardium or cardiac muscle wraps around a scaffolding of tough connective tissue to form the walls of the hearts chambers. The atria, the receiving chambers of the heart, have relatively thin walls compared to the ventricles, the pumping chambers.

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The left ventricle has the thickest walls nearly 1 cm (0.5 in) thick in an adultbecause it must work the hardest to propel blood to the farthest reaches of the body.

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PERICARDIUM

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Pericardium is a thin space filled with a watery fluid that helps prevent these layers from rubbing against each A tough, double-layered sac known as the pericardium surrounds the heart. The inner layer of the pericardium, known as the epicardium, rests directly on top of the heart muscle.

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The outer layer of the pericardium attaches to the breastbone and other structures in the chest cavity and helps hold the heart in place. Between the two layers of the pericardium other when the heart beats.

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ENDOCARDIUM

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The inner surfaces of the hearts chambers are lined with a thin sheet of shiny, white tissue known as the endocardium. The same type of tissue, more broadly referred to as endothelium, also lines the bodys blood vessels,

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forming one continuous lining throughout the circulatory system. This lining helps blood flow smoothly and prevents blood clots from forming inside the circulatory system.

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CORONARY ARTERIES
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The heart is nourished not by the blood passing through its chambers but by a specialized network of blood vessels. Known as the coronary arteries, these blood vessels encircle the heart like a crown.

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About 5 percent of the blood pumped to the body enters the coronary arteries, which branch from the aorta just above where it emerges from the left ventricle. Three main coronary arteriesthe right, the left circumflex, and the left anterior descendingnourish different regions of the heart muscle.

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From these three arteries arise smaller branches that enter the muscular walls of the heart to provide a constant supply of oxygen and nutrients. Veins running through the heart muscle converge to form a large channel called the coronary sinus, which returns blood to the right atrium.

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FUNCTIONS OF the HEART

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The hearts duties are much broader than simply pumping blood continuously throughout life. The heart must also respond to changes in the bodys demand for oxygen. The heart works very differently during sleep, for example, than in the middle of a 5-km (3-mi) run.

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Moreover, the heart and the rest of the circulatory system can respond almost instantaneously to shifting situationswhen a person stands up or lies down, for example, or when a person is faced with a potentially dangerous situation.

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CARDIAC

CYCLE
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Although the right and left halves of the heart are separate, they both contract in unison, producing a single heartbeat. The sequence of events from the beginning of one heartbeat to the beginning of the next is called the cardiac cycle.

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The cardiac cycle has two phases: diastole, when the hearts chambers are relaxed, and systole, when the chambers contract to move blood. The cardiac cycle has two phases: diastole, when the hearts chambers are relaxed, and systole, when the chambers contract to move blood.

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During the systolic phase, the atria contract first, followed by contraction of the ventricles. This sequential contraction ensures efficient movement of blood from atria to ventricles and then into the arteries.

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If the atria and ventricles contracted simultaneously, the heart would not be able to move as much blood with each beat. During diastole, both atria and ventricles are relaxed, and the atrioventricular valves are open. Blood pours from the veins into the atria, and from there into the ventricles.

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In fact, most of the blood that enters the ventricles simply pours in during diastole. Systole then begins as the atria contract to complete the filling of the ventricles. Next, the ventricles contract, forcing blood out through the semilunar valves and into the arteries,

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and the atrioventricular valves close to prevent blood from flowing back into the atria. As pressure rises in the arteries, the semilunar valves snap shut to prevent blood from flowing back into the ventricles. Diastole then begins again as the heart muscle relaxesthe atria first,

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followed by the ventriclesand blood begins to pour into the heart once more.

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CARDIAC OUTPUT
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To determine overall heart function, doctors measure cardiac output, the amount of blood pumped by each ventricle in one minute. Cardiac output is equal to the heart rate multiplied by the stroke volume,

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the amount of blood pumped by a ventricle with each beat. Stroke volume, in turn, depends on several factors: the rate at which blood returns to the heart through the veins; how vigorously the heart contracts; and the pressure of blood in the arteries,

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which affects how hard the heart must work to propel blood into them. Normal cardiac output in an adult is about 3 liters per minute per square meter of body surface. An increase in either heart rate or stroke volumeor bothwill increase cardiac output. During exercise, sympathetic nerve fibers increase heart rate.

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At the same time, stroke volume increases, primarily because venous blood returns to the heart more quickly and the heart contracts more vigorously. Many of the factors that increase heart rate also increase stroke volume. For example,

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impulses from sympathetic nerve fibers cause the heart to contract more vigorously as well as increasing the heart rate. The simultaneous increase in heart rate and stroke volume enables a larger and more efficient increase in cardiac output than if, say, heart rate

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alone increased during exercise. In a healthy adult during vigorous exercise, cardiac output can increase six-fold, to 18 liters per minute per square meter of body surface.

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Drug Study
I. II. III. IV. V.

Aldazide Solu-Cortef Spiriva Ansimar Vigocid

Aldazide
Generic name: Thioridazine hydrochloride Classification: Diuretic Action: o Promotes diuresis in patients with edema or ascites Indications: Essential hypertension Edema and ascites of congestive heart failure Cirrhosis of the liver Idiopathic edema

Contra-indications

Acute renal insufficiency Significant renal compromise Addisons disease Significant hypercalcaemia Hypersensitivity Thiazide diuretics

Dosage

tab OD @ 1 PM

Side effects
Gastrointestinal disorders: abdominal pain, vomiting, nausea, diarrhea Body as a whole: fever, malaise Skin and Appendages: rash, pruritis, dermatitis Nervous system disorders: dizziness, headache Psychiatris disorders: impotence

Neoplasm: breast neoplasm including malignancy Metabolic and nutritional disorders: electrolyte disturbances Reproductive disorders: breast disorders, mentrual disorders Hematological disorders: thrombocytopenia Pancreatitis Cholestatic jaundice

Solu-cortef
Generic name: Classification: Corticosteroid hormones Action: helps reduce swelling, redness, itching, and allergic reactions Treats severe allergies, skin problems, asthma, arthritis

Contra-indications: Blood clotting disorders diabetes

High blood pressure Liver disease Osteoporosis Previous heart attack Stomach or intestinal disease Seizures (convulsions)

Dosage: 100 mg/IV every eight hours

Side effects bloody or black, tarry stool Confusion Eye pain Frequent passing of urine Increased thirst Irregular heart beat Nausea, vomiting Stomach pain Swelling of feet or legs

Spiriva

Generic name: tiotropium inhilation Classification: Antiasthmatic Actions: Used to prevent bronchospasm (narrowing of the airways in the lungs)

Contra-indications: Narrow-angle glaucoma Enlarged prostate or bladder obstruction Allergic to tiotrupium Pregnant Breast feeding mothers

Dosage: 18 mg/capsule 1 capsule OD via inhalation Side effects: Dry mouth, cough, hoarseness Blurred vision Trouble swallowing Nausea, constipation Fast heart rate Drowsiness white patches around the mouth or in the throat

ansimar

Generic name: Classification: Doxofylline

Action: Treatment of bronchial asthma and pulmonary disease with spastic bronchial component.


o o

o
o o

Special Precaution: Liver disease CHF Chronic obstructive lung disease Concomitant infection pregnancy

Contra-indications: Acute MI Hypotension Lactation

o o o o o o

Dosage: 100 mg/tablet tablet BID

o
o o

Side effects: Nausea, vomiting Epigastric pain Cephalalgia Irritability Insomia Tachycardia, Tachypnea Extrasystole Hyperglycemia Albuminuria

Vigocid

Generic name: Penicillin Classification: Antibiotics

Action: Treatment of severe gm-ve infection & other susceptible bacteria; neutropenic patients; biliary tract infection; surgical infection prophylaxis

Contra-indications: History of allergic reaction to penicillins Cephalosporins Beta-lactamase inhibitors Dosage: 4.5 gm/IV every eight hours Side effects: Nausea Indigestion

Vomiting Diarrhea or constipation Rash Itchy or red skin Urticaria Sleeping difficulty Headache or dizziness Super-infection