Atherosclerosis

Atherosclerosis is very similar to Coronary Artery Disease. It is a thickening of the artery walls due to build up of plaque along the interior walls. The build up of cholesterol causes the arteries to become inflamed and thickened. Arteries that have atherosclerosis have three layers of plaque build up called atheromateous plaque. The inner most layer is called the atheroma, which is an accumulation of soft, flaky material. Underlying the atheroma is a build up of cholesterol followed by a calcification directly along the arterial walls of older accumulations. Atherosclerosis leads to a build of clots that can rupture and break off of the build up which cause stroke or heart attack. If the clots do pass through the heart safely, they will generally shrink but will cause stenosis, or narrowing of the artery, elsewhere in the body. By the clot shrinking, it allows it to become capable of passing through even smaller arteries and capillaries throughout the body which makes a complete blockage even more susceptible. If a blockage occurs, it prevents the blood flow to the muscle or organ in which it is supplying leading to system failure.

Heartburn

Heartburn, as called pyrosis or acid indigestion, is a burning sensation in the chest directly behind the breastbone. The pain can radiate to the neck, throat or jaw. Although heartburn is generally associated with gastric acid, it can also be a key symptom of ischaemic heart disease. Heartburn may also be a symptom of an acute myocardial infarction. Episodic or occasional heartburn is common in a lot of people. It can usually be managed by avoiding certain foods and activities or by taking over the counter medication. There are two different types of treatment for episodic heartburn. Antacids neutralize existing stomach acids and provide short term relief. H2 blockers block the production of stomach acid which provides a longer lasting relief. Patients that have frequent heartburn do not benefit from dietary changes. They often suffer from the pain two or more times a week. Patients who have more frequent episodes need to have further testing done to find the underlying cause. Patients who have ischaemic heart disease are also known to have frequent heartburn. This is due to the relation in cause of both diseases. Poor diet is the most common cause of heartburn and in return is also the most common cause of ischaemic heart disease. Poor diet leads to an increase in cholesterol which deteriorates organ health.

PEG tubes

If a clot forms and travels through the cardiac arteries, a stroke or heart attack can occur. Patients who suffer from a stroke due to a blockage in the heart are often left temporarily or permanently paralyzed. They can be left unable to eat or obtain medications through their mouths. When this is the case, the patients are inserted with a PEG tube to give them nutrients and medications directly into their stomachs. A PEG tube is a percutaneous endoscopic gastronomy tube. An endoscope is used to insert the PEG tube through your skin and into your stomach. The end of the tube that sits inside your stomach is held in place by stitches to ensure it does not slide outside of the stomach. The other end of the tube is secured outside of the body on the skin of the abdomen. A PEG tube has several purposes. It can be used to feed the patient or insert medications directly into the stomach. It can also be used to decompress the stomach by letting air or fluids out of the gastric cavity by connected the external end of the tube to a suctioning machine or bag. The most common reason a PEG tube is inserted to decompress the stomach to prevent vomiting. Patients that have trouble eating or swallowing benefit tremendously by PEG tube insertion. Patients with severe dementia, Parkinson disease or have had head injury or a stroke often receive PEG tube placement to help them with nourishment. When a patient has a blocked bowel, the PEG tube will be used to suction contents out of the stomach so it cannot continue into the bowels.

Nasogastric tubes for stroke patients

Patients who have had a stroke due to a blockage in the heart are usually left partially or completely paralyzed and unable consume their own food. Nasogastric, or NG, tubes are often placed in patients who cannot consume their own food or may have trouble digesting what nutrients are able to make it to the stomach. NG tubes are usually not uncomfortable for the patient if positioned and placed correctly. The purpose of a nasogastric tube is to aspirate the contents of the stomach such as food, air or blood. It is important to be sure that the drainage container is emptied frequently so the tubes can flow appropriately. NG tubes can also be used to place fluids into the stomach for feedings or lavages. There are many steps to inserting a nasogastric tube. The most important is making sure that the patient is propped in an upright position. Using the NG tube as a measuring device determine the length of the NG tube to be passed by measuring the length from the earlobe to the nose and then from the earlobe to the xiphoid process. These measurements should then be added together to get the total length needed for the tube. The patient should blow his or her nose before the tube is placed if able. Lubricate the first 6 inches of the NG tube with a water soluble lubricant. The largest nostril should be chosen and then the NG tube can be passed through the nostril to the nasopharynx. Once in the pharynx the patient should be instructed to swallow either mimicking the action or by sipping on small amounts of water. If awake and alert have the patient place chin to chest to allow the tube to pass easily. Allow the full length of the tube to be passed until the marked section that was previously measured. You can be sure that placement is correct by doing a chest x-ray. Once placed correctly, you will see gastric contents begin to come through the tube and empty into the container. The patient should be able to cough and speak normally. Once it is determined that the NG tube is placed correctly, it needs to be secured. Place one end of tape from the bridge to the tip of the nose and the other end wrapped around the tube itself. If possible the nose should be clean and prepped prior to securing with tincture of benzoin. The Tube should also be secured to the chest of the patient to prevent being pulled out.

Heart Attack

Heart attacks, also called myocardial infarctions, are one of the leading causes of death in the United States. Heart attacks are caused when an area of the heart muscle is completely deprived of blood supply. Plaque inside the hearts arteries builds up after time. Theses plaque builds up can break off from the arterial wall and form a clot which blocks the blood flow to the heart. If no blood supply can get to the heart then the muscle is at severe risk of dying which can cause severe permanent damage or more then likely, death. Plaque is made up of cholesterol, white blood cells, calcium and other components. Symptoms of a heart attack include chest pain or discomfort, sweating, shortness of breath, nausea or vomiting, dizziness, irregular heart beat and loss of consciousness. It is extremely importnat to be able to recognize these symptoms and get help immediatly if they occur. Men are more likely to have a heart attack then women however, women are more likely to die from a heart attack. Medication can be prescribed to help prevent heart attacks in patients who have high cholesterol levels or other heart conditions. Blood thinners are often taken by patients who have high cholesterol levels to help decrease their chances of a blockage.

Blood Clots

Blood clots are a great concern for post operation patients. Patients who are coming out of surgery and are in recovery spend most of their stay in bed. Prolonged lying or sitting can cause blood clots in the lower extremities due to lack of circulation. To prevent clots, the hospital requires patients to wear compression stockings and boots. Patients are measured from heal to knee and the circumference of the leg to obtain the right fit stocking. The boots are fit over the stockings and hooked to a pump that compresses and decompresses air into the boot surrounding the leg. The pressure circulates the blood in the legs and prevents clots from forming. Most patients say that the pressure from the boots pressing and releasing against their legs is very relaxing. When circulation of blood slows due to lack of movement, it begins to thicken and clot. These clots travel through the capillaries and arteries of the body. Patients who have coronary artery disease are at high risk for a heart attack if clots occur due to the altered passageway that already exists in the heart. It is crucial that patients maintain movement immediatly after surgery to prevent serious complications.

Cholesterol

Cholesterol is produced naturally by your body and also ingested through foods that we eat. Not all cholesterol is bad and it is important that you recognize which is beneficial or harmful towards your body. Cholesterol is broken down into good cholesterol and bad cholesterol. It is important to recognize the benefits and risks of each type at different levels. Your liver produces about seventy five percent of the cholesterol in your blood. The other twenty five percent is consumed through animal products. HDL is the good cholesterol. It is produced by your body to control the amount of bad cholesterol that circulates in your blood. The bad cholesterol, or LDL, is also produced by your body but is also obtained by consuming trans fats, saturated fats and having an unbalanced diet. LDL production can also be inherited. Genetics play a major role in cholesterol production. Too much LDL circulating in your blood can cause a block in your arteries. The cholesterol contributes to the build up of plaque along the artery walls which restricts the flow of blood to the heart. High cholesterol is a major contributor to coronary artery disease, heart attacks and stroke. Keeping a good level of HDL is necessary because it is responsible for carrying the bad cholesterol away from the arterial walls and keeping the blood flow at a healthy pace. Keeping your HDL at an appropriate level can be obtained by keep a nutritious diet and exercising regularly. If diet and exercise are not enough to bring your HDL levels to an appropriate level, your healthcare provider can prescribe medication to raise your levels.

Coronary Artery Disease

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Coronary artery disease is a life threatening condition that affects millions of people. It was one of the leading causes of death in America. Also known as artherosclerotic heart disease, this is the condition of an accumulation of plaque along the arterial walls that supply the myocardium, or muscles of the heart. The most common symptom of CAD is chest pain which is caused by the heart not getting enough blood. Fatigue and shortness of breath are also common symptoms. There are several ways to treat CAD. Consuming a small dosage of aspirin daily thins the blood and prevents clots in the arteries. This is important because the arterial walls have become narrow from the plaque build up making the passage of blood very difficult. Plaque is made up of fat, cholesterol, calcium and other substances that are found in the blood. Over time, the lack of oxygen supplied to the heart muscles can cause heart failure. Smokers have a much greater chance of plaque build up then non smokers. CAD is diagnosed in several ways. Electrocardiograms are done to check the flow of electricity through the heart, blood work is done to check cholesterol levels and a stress test is done to check the hearts ability to maintain homeostasis under extreme physical stress. Other then taking aspirin to thin the blood, other medications are offered and prescribed to prevent the continual thickening of the arteries.

The Coronary Arteries

In addition to the heart having pathways to supply the entire body with nutrients and oxygen, it also supplies itself with the oxygenated blood. The heart is composed of muscles and therefore needs to same amount of oxygen and proteins as the rest of the muscles in the body. The coronary arteries supply the heart with what it needs to stay functional. There are two main coronary arteries which branch from the Aorta. The right coronary artery supplies the right atrium and the right ventricle along with the bottom half of both ventricles and the back of the septum. The entire right side of the heart is supplied by the right coronary artery. The left coronary artery supplies blood to the circumflex artery which sends it to the left atrium and side and back of the left ventricle. It also moves from through the left anterior descending artery which supplies the front and bottom of the left ventricle and the front of the septum.

Divisions of the Heart

The human heart is divided into four main chambers. The right and left atrium and the right and left ventricle work together to pump blood throughout the body and supply nutrients and oxygen to all organs. Blood flows into the heart through the superior vena cava into the right atrium. The right atrium is larger then the left atrium and has much thinner muscle walls due to its stronger need to pump the blood further in the body then any other compartment of the heart. The blood that flows into the heart from the vena cava is blood that has already traveled through the body and dispersed nutrients and oxygen to the organs. The blood then travels through the coronary sinus and tricuspid valve into the right ventricle. The right ventricle pumps the blood out of the heart and into the lungs in order to be re oxygenated. Once the blood has traveled through the lungs and has been resupplied of oxygen it then travels through the pulmonary veins back to the heart into the left atrium. The left atrium is much smaller then the right atrium because it does not need as much strength to pump the blood through the body. Once the left atrium fills with blood, the bicuspid valve opens in a one way direction and allows the blood to flow into the left ventricle. The left ventricle then contracts and sends the blood out of the heart and into the rest of the body. The blood travels the full extent of the body through the arteries and capillaries and passes into the veins which return the blood back into the heart to start the cycle over again. The heart pumps the blood in this continuous cycle to keep the body alive.

Anatomy of the human heart

The human heart is an extraordinary organ that is the vital component to life. It is primarily a pump that moves blood throughout the entire body. Composed of four sections contained in the size of a fist, the heart pumps approximately seventy two beats per minute. Blood carries vital nutrients and proteins throughout the body and carries away wastes that have been removed from cells and organs back into the blood stream to be removed from the body. Without the continuous pump of blood, body organs will begin to shut down and soon after the discontinuation of blood supply, will die. The heart contracts and expands to control the movement of blood. The heart pumps at an "all or nothing" rate. Each beat is with full force of the organ. Once the blood has left the heart and traveled the full extent of the body it is returned back into the heart to be re oxygenated again. Once the blood has been oxygenated, it makes the travel through the body again in a continuous cycle. During this cycle, the heart rests only for about four tenths of a second.

Smallest pathway to and from the heart

The human body depends on capillaries as a route for blood to transport oxygen and carbon dioxide along with other nutrients and wastes to and from the lungs and heart. The capillaries are the smallest blood vessel in the body at only 5-10 microns in diameter. The lumen, or the center opening which allows the flow of blood, is only the width of a single red blood cell. The human body contains billions of capillaries in three different forms.

The most common capillary is the continuous capillary which supplies the skin and muscles. Its endothelium cells are in a continuous wall around the lumen of the capillary and are met by tight junctions between cells. Where a tight junction is not present between endothelium cells there is an intercellular cleft. Water and small ions are able to pass through the intercellular clefts into the skin and muscles. Pinocytotic vesicles run the length of the endothelium cells and supply the capillary with nutrients. Pericytes on the exterior of the basement membrane are large and cover an outstanding amount of the capillary.

The endocrine system, kidneys and pancreas contain fenestrated capillaries. These capillaries contain the same basement membrane and endothelium cells as the continuous capillary, however they contain small pores, fenestrations, within the endothelium which allow passage of small molecules and a trace amount of protein in and out of the capillary.

The last of the capillary types is called a sinusoid or discontinuous capillary. Although there are similarities between a sinusoid and the other types of capillaries, it is very distinctive. There are very large intercellular clefts within the capillary walls that split the basement membrane and endothelium cells far apart. The liver, spleen and bone marrow contain discontinuous capillaries. These large openings allow larger molecules and even blood cells to pass through the capillary walls. In the liver, macrophages are present on the exterior of the capillary which allow the destruction of foreign materials. The spleen has phagocytes present outside the capillary walls with extensions that reach through the intercellular clefts into the capillary to destroy foreign materials and prevent them from flowing through the blood stream and throughout the entire body. Each type of capillary is adapted for the type of tissue in which is accommodating.