Contemporary Diagnosis and Management

Question: Discuss about the Contemporary Diagnosis and Management. Answer: Introduction: The human heart is a hollow organ of the cardiovascular system. Its composed of four chambers: two atria that receive venous blood and two ventricles which pump blood into arteries emptying the heart (Van et al. 2013). The right ventricle empties the heart of deoxygenated blood through the right atria and the pulmonary artery into the lungs. The left ventricle pumps and drains the heart of oxygenated blood to body tissues and cells through the aorta. The heart also consists of three layers, epicardium which is a fibrous sac that encloses the heart, endocardium which is made up endothelial tissues, and the myocardium that is made up of muscle fibers responsible for heart pumping action (Marieb Hoehn, 2015). Valves too make up part of the heart, they are four in total, and they include an atrioventricular group of valves such as tricuspid valves and the mitral valves. The second group is semilunar valves that include pulmonic valve and aortic valve. The heart also consists of coronary arteries, right and left pulmonary artery and superficial to these arteries are the pulmonary veins (Van et al. 2013). Functions of the heart The major function is pumping of blood, and this involves cardiac conduction system. The specialized cells of this system generate and conduct electrical impulses to the myocardial cells (Van et al. 2013). As a result, atrioventricular contractions occurs providing effective blood flow hence optimizing cardiac output. The electrical impulse is initiated at the Sino atrial node (SA), the primary pacemaker. The impulses cause subsequent stimulation and contraction of the right atrium. The impulses are then transmitted to the atrioventricular (AV) node where they are delayed for some time to allow atria to contract and complete ventricular filling (Marieb Hoehn, 2015). The AV relays the impulse to the ventricles through the bundle of His that passes through the septum demarcating right and left ventricles. The bundle of His segregates into the right and left bundle branches (Van et al. 2013). The right bundle branch transmits impulses to the right ventricle while the left bundle branch transmits impulses to the left ventricle. From the bundle branches, the impulses are transmitted to the terminal end of the conduction system, Purkinje fibers. The myocardial cells of the heart are consequently stimulated causing ventricular contraction, and therefore ejection of blood occurs (Marieb Hoehn, 2015). Adaptations of the heart to deviations from homeostasis Homeostasis is the stability or balance in the system whereby the body tries to maintain a constant internal environment through adjustments as conditions change. When any alterations affecting the cardiovascular system occur, the heart responds by either negative or positive feedback. As noted by Marieb and Hoehn (2015), negative feedback is a reaction in which the heart responds in a way to reverse any alterations. For instance, when the blood pressure increases above normal, baroreceptors in the aortic arch and carotid sinuses become increasingly stretched resulting in increased frequency of action potentials transmitted to the cardiac and vasomotor centers in the oblongata, hence lowering the blood pressure. Secondly, it does so through positive feedback, and this does not result in homeostasis. For example, in blood vessels, a threshold electric potential, triggers production of much larger action potentials resulting in further destabilization (Buja et al. 2014). Congestive heart failure (CHF) This is a cardiovascular disease in which the hearts blood pumping function is both ineffectively and insufficiently to meet the demands of body tissues for oxygen and nutrients (Peteiro et al. 2011). It can be categorized into classes 1 to 4 as the condition progresses from one class, which is asymptomatic to last class that is severe (Ramani et al. 2010). The last class is characterized by limitation in physical activity and danger signs like fatigue, palpitations, dyspnea and chest pain presents. Symptoms that commonly manifest depend on the body system where fluid overload is occurring. If cardiac congestion occurs the symptoms may include, tachycardia, cardiomegaly, delayed capillary refill, and poor peripheral perfusion (Peteiro et al. 2011). On the other hand, pulmonary congestion may occur, exhibiting symptoms such as cyanosis, dyspnea, tachypnea, and grunting, wheezing and flaring nares. In systemic venous congestion there, ascites, fatigue, anorexia, weight gain chest and e dema ensue (Williams Hopper, 2015). Pathophysiology of Congestive heart failure Several conditions lead to the development of congestive heart failure. These include hypertension, rheumatic fever, anemia, myocardial infarction and valvular disease. According to Ramani et al. (2010), these conditions partially impair the functioning of the myocardial cells thus reducing its contractility and effective pumping of blood by the ventricles. It can be either right sided or left sided heart failure. The right-sided heart failure occurs when the right ventricle is unable to adequately pump blood leading to increased pressure in the right atrium and ventricle as well as the systemic venous circulation, leading to liver and spleen enlargement and occasionally edema (Peteiro et al. 2011). As stipulated by Peteiro et al. (2011), the left-sided heart failure occurs when the left ventricle is unable to efficiently pump blood to the systemic circulation leading to increased pressure in the left atrium and ventricle as well as the pulmonary system. Lungs become congested leading to pulmonary edema. Consequently, there is the emergence of complications like kidney failure due to decreased blood flow to the renal system. There can also be liver damage due to scarring resulting from increased fluid buildup in the liver, cardiac muscles and valvular damage, distension of neck veins due to systemic overload, and pulmonary embolism as a result of clogging of blood in the lungs (Williams Hopper, 2015). References Buja, L. M., Netter, F. H., Krueger, G. R. F. (2014).Netter's Illustrated Human Pathology. Philadelphia, PA: Saunders/Elsevier. Marieb, E. N., Hoehn, K. (2015).Human anatomy physiology. Harlow, Essex: Pearson. Peteiro J, Peteiro-Vzquez J, Gaca-Campos A, Garca-Bueno L, Abugatts-de-Torres JP, Castro-Beiras A. (2011), The causes, consequences, and treatment of left or right heart failure. VHRM. doi:10.2147/VHRM.S10669 Ramani GV, Uber PA, Mehra MR. (2010), Chronic Heart Failure: Contemporary Diagnosis and Management. Mayo Clinic Proceedings. 85(2):180-195. doi:10.4065/mcp.2009.0494 Van, D. G. K. M., Rhees, R. W., Palmer, S. (2013).Human anatomy and physiology. New York: McGraw-Hill Education. Williams, L. S., Hopper, P. D. (2015).Understanding medical, surgical nursing. Philadelphia: F.A. Davis Company.