Based of the slides text I rpvodied you fill out my study guide.

Airway (A):
Objective: Ensure that the patient's airway is clear and open.
Significance: A blocked or compromised airway can result in hypoxia (lack of oxygen), which may lead to brain damage or death.
Indicators:
Signs of Compromise: Stridor (high-pitched wheezing), choking, gurgling, inability to speak, or unconsciousness.
Possible Causes: Foreign object obstruction, trauma to the neck, severe allergic reactions (anaphylaxis), or swelling.
Actions: Perform airway maneuvers such as head tilt, chin lift, or jaw thrust. In cases of obstruction, consider suction or the Heimlich maneuver.
Breathing (B):
Objective: Ensure the patient is breathing effectively.
Significance: Inadequate breathing can lead to hypoxia, affecting brain and organ function.
Indicators:
Signs of Compromise: Cyanosis (bluish skin), labored breathing, accessory muscle use, abnormal breathing sounds (wheezing, crackles), or rapid/shallow breathing.
Possible Causes: Asthma, COPD exacerbation, pneumothorax, or respiratory infection.
Actions: Provide oxygen, assist ventilation, or treat underlying conditions such as bronchospasm.
Circulation (C):
Objective: Assess the patient's circulatory status.
Significance: Poor circulation can lead to shock, organ failure, and death.
Indicators:
Signs of Compromise: Pale, cool, or clammy skin; weak or absent pulse; hypotension; chest pain; or altered mental status.
Possible Causes: Heart attack, severe bleeding (internal or external), dehydration, or hypovolemic shock.
Actions: Control any major bleeding, start intravenous fluids, and monitor heart rate and rhythm.
Disability (D) - Neurological Assessment:
Objective: Quickly assess the patient's level of consciousness and neurological function.
Significance: Changes in consciousness or neurological function can indicate serious issues such as stroke, head trauma, or brain injury.
Indicators:
Signs of Compromise: Disorientation, confusion, altered mental status, seizures, or unequal pupil response.
Possible Causes: Stroke, head injury, overdose, hypoglycemia, or severe infection (sepsis).
Actions: Perform a quick neurological check (AVPU scale: Alert, Verbal response, Painful stimuli response, Unresponsive), check glucose levels, and manage any visible signs of injury.
Exposure (E):
Objective: Expose the patient to assess for any injuries, burns, or rashes while preventing heat loss.
Significance: Some injuries or conditions may be missed without a thorough visual examination. However, prolonged exposure can also lead to hypothermia.
Indicators:
Signs of Compromise: Visible trauma, bleeding, signs of infection, or rashes.
Possible Causes: Burns, fractures, bites, or environmental exposure.
Actions: Expose the patient adequately to examine, then cover them to prevent hypothermia, if necessary. 2) Vital SIGN INFORMATIOn ie BP, RR, BP. When to be concerned and why. 3) Chest trauma and physiology. Know lung anatomy discussed in class and edpuzzles. Chest/Lung Trauma. ie. All the pneumo's, flail chest, including mechanisms , signs and symptoms and treatment modalities that where briefly discussed in class 4) Heart anatomy and physiology( for 2 extra quiz points bring in detailed/labeled foam hears to class. Know blood flow through the heart, pulmonary and systemic, physiological difference between caps, venules, veins, arterioles and arteries. Pressure differences in each. Explain cardiac tamponade and pericarditis which includes mechanisms discussed in class. Know MAP, its calculation/significance. 5) SA and AV node . There signifcance in heart function 6) How to take BP. What are koracoff sounds? 7) BASIC EKG ANALYSIS. ie what is signified in a PQRST wave. How to figure out HR using a EKG 8) what should a normal Sinus Rythym look like vs an irregular/ or tachycardic one. 9)Congestive Heart Failure
AT THE CLINIC
Let’s get down to business with some
anatomy,physiology and diagnosis.
But before we begin.

and only

150 for 5 hours!!!!!

Anyway. Let’s discuss A and B of the
primary survey

Fractures and Associated Injuries
Sternum, Scapular, and Rib Fractures
Ribs 1-3

• Severe force, high mortality risk
with associated injuries

Ribs 4-9

• Pulmonary contusion and
pneumothorax

Ribs 10-12
• Suspect intra-abdominal injury

Pain Control
is Key!

What is
this?
What
are
your concerns?
Flail
Chest
and
Pulmonary
Contusion
• Oxygen
• Analgesia
• paradoxical movement

Intrapulmonary Foreign Bodies
What are you worried about?
• When left in lung:
– 20% developed into
chronic bronchitis

• Case Presentation
Jerry, a healthy 60 year old teacher,great shape, extremely
good looking, wise, an environmental steward, was biking
home from work one evening when he experienced
sudden stabbing pain in his right pectoral and right lateral
axillary regions. He began to feel out of breath and both
his respiratory rate and heart rate increased dramatically.
As luck would have it, Jerry passed a hospital each day on
his way home and was able to get himself to the hospital’s
emergency room.
The emergency room physician listened to Jerry’s breathing
with a stethoscope and requested blood gas analysis and
a chest x-ray. Jerry answered a few of the doctor’s
questions. The doctor noted that Jerry had no history of
respiratory problems but spent years exposed to
respiratory irritants as a bio major and teacher.

Possible Diagnosis?
• Anyone
• Heart Attack
• Anxiety
• GERD
• Pneumothorax
• cardiac tampon
• flail chest

ONE MORE
• Case Presentation
• There is 2-car MVC with head on collision. The
posted speed limit is marked at 40 MPH. Upon
EMS arrival to the scene an unrestrained adult
driver is found inside the vehicle with noted +
steering wheel deformity(air bag did not
deploy!). The patient is appears restless and
agitated.

What are your physiological
concerns?
• What do we need to know?

Vital sign Information
• Airway: Patent
• Breathing: RR: fast; labored with asymmetric
chest expansion and use of accessory muscles
but no paradoxical movement; left side appears
hyperinflated and does not move.
• Breath sounds absent on left, diminished on
right; no adventitious sounds. crackles, and wheezes
• No open wounds; trachea midline. SpO2 86%,
7.

• Circulation: JVD present; radial pulses absent;
carotid pulses fast, weak and thready; equal
bilaterally. Severe chest pain & difficulty
breathing
• Disability/LOC: Eyes open spontaneously, pt is
awake, alert & oriented to voice & is able to
move all extremities to command; PERL,
• pupils equal reactive to light There is an abrasion to L
anterior chest; the pt is alert, but still restless &
agitated.
• Pain: 9/10
• VS: BP 84/60, P 116, R 24

Diagnosis Considers
• What two immediate life-threats should be
suspected based on this presentation?
• Which one is most likely based on the
mechanism of injury? What is the
pathophysiology and the classic clinical
findings of this injury?
• What is the mechanism of death in this injury?
•

Pulse measurement

Please take several minutes to take each
others radial and
If you like an apical one as well, a peripheral
pulse should be the same as an apical pulse
(heart rate). Apical tomorrow

apical pulse
• This is where the stethoscope comes in handy.
• Place the diaphragm of your stethoscope over
the PMI and auscultate for normal S1 and S2
heart sounds. You will usually hear them as
"lub-dub." If the apical pulse is regular, count
for 30 seconds, then multiply that number by
2.

Stethoscope Basics. Tomorrow lesson
• Medical term for listening for sounds within
the body, typically using a stethoscope?
– Auscultation

• What are we listening for?
Heart rate and rhythm
Heart sounds
Breath sounds
-

Bowel sounds
Bruits

Normal Heart Sounds
• S1: Mitral and tricuspid valve closure (Lub)
• S2: Aortic and pulmonary valve closure(Dub)
S2 DUB ON
TOP

(Mitral)

S1 LUB ON
BOTTOM

The Cardiac Cycle
• Systole: Between the first heart sound (S1)
and the second (S2)
• Diastole: Between the (S2) and (S1)
– Lasts longer than systole

Mechanism of Injury

OK let’s see how skilled you are?
• Scenario: A 50 y/o restrained driver of a single
vehicle crash who drove off the road and
laterally hit into a tree at 40 mph on the
drivers side. Upon arrival, assessment reveals
the car to be a vintage model with only the lap
belt available. Therefore the patient is
slumped sideways in to the center of the
vehicle, moaning.

On primary assessment you note the
following
• Airway: patent Breathing: labored; rapid rate.
Breath sounds normal and equal bilaterally.
• Circulation: Radial pulses rapid and weak; skin
pale and cool to touch.
• LOC: Eyes closed; responds to verbal stimuli by
moaning; not moving extremities to
command.
• Pupils PERL, sluggish to respond.

More valuable information
•

VS: BP: 88/54; P: 110; RR: 24.

•

Multiple abrasions to the lateral aspects of the pt’s head with lac to L
forehead and bleeding. Pupils as noted above; bleeding coming from
mouth with loose teeth.

•

Neck: Trachea midline; jugular veins flat.

•

Chest: No injury noted to chest with equal chest expansion; no
paradoxical movements.

•

Extremities: multiple abrasions but no entrapment or extrication
needed.

Clinical Questions.
• 1.What abdominal injuries should be
suspected based on this presentation and
mechanism of injury?
• 2. Which abdominal injury is the patient at
greatest risk?
• 3. Why? Does this injury to the abdomen
create an immediate life-threat?

BP

Blood Pressure Reading
• Systolic: the top number, which is also the
higher of the two numbers, measures the pressure
in the arteries when the heart beats (when the
heart muscle contracts).

• Diastolic: the bottom number, which is also the
lower of the two numbers, measures the pressure
in the arteries between heartbeats (when the left
ventricle muscle is resting between beats and
refilling with blood).

Blood Pressure Reading
Blood Pressure
Systolic
Category
mm Hg (upper #)
Normal
less than 120
Prehypertension
120 – 139
High Blood
140 – 159
Pressure
(Hypertension)
Stage 1
High Blood
160 or higher
Pressure
(Hypertension)
Stage 2
Hypertensive
Higher than 180
Crisis
(Emergency care
needed)

and
or
or

Diastolic
mm Hg (lower #)
less than 80
80 – 89
90 – 99

or

100 or higher

or

Higher than 110

Blood Pressure Variables – An Overview
CAUSE

SYSTOLIC BP

CORRECTIVE ACTION

Sit without back support

+ 6 to 10

Support back (sit in chair)

Full bladder

+ 15

Empty bladder before BP taken

Tobacco/caffeine use

+ 6 to 11

Don’t use before clinic appointment

BP taken when arm is:
∙Parallel to body
∙Unsupported
∙Elbow too high
∙Elbow too low
“White coat” reaction

+ 11 to 28

Have someone else take the BP

Talking or hand gestures

+7

No talking or use of hands during BP

Cuff too narrow/small

+ 8 to 10

Cuff too wide/large

False low

Cuff not centered

+4

Cuff over clothing

+ 5 to 50

∙+ 9 to 13
∙ + 1 to 7
∙+5
∙ False low

While seated in chair, patient’s arm
must be straight out and supported,
with elbow at heart level

Right-sized cuff properly placed over
bare upper arm
(Pickering et al., 2005; Perry & Potter, 2006)

MIND OVER BLOOD PRESSURE. Regulation of Blood
Pressure & the white collar effect
• Main coordinating center is in
the medulla oblongata of the
brain; medullary
cardiovascular control center
• Reflex control of blood
pressure
• Baroreceptor reflex

My doctor is
my former
student!

Measurement Site
Blood Pressure

• Brachial artery is the most common
measurement site:
▪ Close to heart
▪ Convenient for measuring

• Other sites are radial artery and wrist.

Auscultatory Method
Blood Pressure

• Pulse waves when first propagate through the brachial
artery, generate Korotkoff sounds. First sound you hear.
• Laminar – Non Turbulance pulses are transmitted
smoothly

Cont. Korotkoff sounds
Blood Pressure
The first Korotkoff sound will
be heard.

As the pressure in the artery rises above the pressure in the cuff and
then drops back down (because of beating), resulting in turbulence
that produces an audible sound.

Auscultatory Method Procedure
Blood Pressure

• EKG

The Normal Conduction System

ECG Graph Paper
Voltage
(millivolts;
mV)y

0.04
seconds

(1 × 1)
mm2

x
’

0.1 mV

x Time

(seconds; s)
Question: What would the
bigger square, i.e. the (5 × 5)
mm2, represent?

y
’

Answer: 0.2 seconds.

Electrocardiography (ECG or EKG*)
• In a conventional 12 lead ECG, ten electrodes are
placed on the patient's limbs and on the surface of
the chest recorded over a period of time (usually 10
seconds). Our Portable only one lead) Lead 2
• A typical ECG tracing is a repeating cycle of three electrical
entities:
a. a P wave (atrial depolarization)
b. a QRS complex (ventricular depolarization)
c. a T wave (ventricular repolarization).

• What’s a normal adult heart rate?
• Normal = 60 – 100 bpm
• Tachycardia > 100 bpm
• Bradycardia < 60 bpm

• If the rhythm is irregular:
• The first method of calculating the heart rate
doesn’t work when the R-R interval differs
significantly throughout the ECG and therefore
another method is required
– Count the number of complexes on the rhythm
strip (each rhythm strip is 10 seconds long)
– Multiply the number of complexes by 6 (giving you
the average number of complexes in 1 minute)
Basic
ElectroCardiogram
)ECG

Electrocardiography (ECG or EKG*)

• the process of recording the
electrical activity of the heart
over a period of time using
electrodes placed on a patient's
body.

Electrocardiography (ECG or EKG*)
• These electrodes detect the
tiny electrical changes on the
skin that arise from the heart
muscle depolarizing during
each heartbeat.

Cardiac Conduction System
Anatomical orientation:

Figure 1:

(Marquette Electronics, 1996)

(From: Yanowitz, FG. The Alan E Lindsay ECG Learning Centre in Cyberspace [homepage on the
Internet]. c2012. Available from: http://library.med.utah.edu/kw/ecg/index.html.)

intrinsic Electrical Conduction System
• Depolarization that starts with pacemaker cells in the
sinoatrial node,
spreads out through the atrium,
node

atrioventricular

Bundle of His
Right and Left Bundle Branches
Purkinje fibers spreading down and to the
left throughout the ventricles.

ECG Graph Paper
Voltage
(millivolts; mV)

0.04 seconds

y

(1 × 1) mm2

x’

0.1 mV

x

Time (seconds; s)

Question: What would the bigger
square, i.e. the (5 × 5) mm2, represent?

y’

Answer: 0.2 seconds.

Electrocardiography (ECG or EKG*)
• In a conventional 12 lead ECG, ten electrodes are placed on the patient's
limbs and on the surface of the chest recorded over a period of time
(usually 10 seconds).
• A typical ECG tracing is a repeating cycle of three electrical entities:
a. a P wave (atrial depolarization)
b. a QRS complex (ventricular depolarization)
c. a T wave (ventricular repolarization).

ECG measures the following:
• rate and rhythm of heartbeats
• the size and position of the heart chambers
• the presence of any damage to the heart's muscle
cells or conduction system
• the effects of cardiac drugs
• the function of implanted pacemakers.

Step 1

Determine HR

What isWhat is the heart rate? the heart
rate?

Analyze the Rhythm
Problem:
For a patient with a pulmonary arterial
pressure of 15 mmHg, a pulmonary venous
pressure of 0 mmHg and a pulmonary
vascular resistance of 3 mmHg∙L/min, what
is the pulmonary flow?

Answer: 5 L/min

Question:
A hypertensive patient is prescribed a vasodilator, and it was noted
that the diameter of one of his blood vessels doubled.
What is the change in the resistance? What is the change in flow?
Resistance decreases by a factor of 16
Flow increases by a factor of 16
If vessel radius = 1, flow is 1ml/min
If vessel radius = 2, flow is 16ml/min
If vessel radius = 4, flow is 256ml/min

Mean Arterial Pressure =
Cardiac Output X Resistance
•

•
•

Resistance is total peripheral
resistance (TPR), the sum of resistances to flow by
all systemic blood vessels
To maintain blood flow MAP must be greater than
resistance
Changes in MAP is the result of changes in these
two variables

Summing up Flow, Pressure , and
Resistance
• Flow = Pressure in arteries – pressure in veins
resistance
– To increase flow, decrease resistance, or
increase pressure difference
– An example:
• during rigorous exercise CO and SV
increase, increasing pressure in the aorta
• Blood vessels in skeletal muscles dilate
• What happens to blood flow?

Objective 4
Pressure

Mean Arterial

A. Mean Arterial Pressure
∙

is the average pressure exerted by the blood on the walls
of arteries

∙

is the driving force for the circulation of blood
MAP

=

PD +

PP/3

Mean Arterial Pressure (MAP)
= diastolic pressure + pulse pressure/3

• Given the following values calculate
MAP
– Systolic pressure = 135 mmHg
– Diastolic pressure = 80 mmHg

• If person has a blood pressure of
128/92, what is their MAP?

Systolic Arterial Pressure (Ps):
∙

is the pressure in an artery at the peak of ventricular systole

∙

during ventricular systole, the artery receives the stroke volume

∙

systolic pressure averages 120 mmHg

C. Diastolic Arterial Pressure (PD):
∙
is the pressure in an artery at the end of ventricular
diastole
∙
during ventricular diastole, blood is moving from the
elastic arteries into smaller vessels
∙
wall

this is facilitated by the elastic recoil of the arterial

∙

diastolic pressure averages 80 mmHg

Factors that influence pulse pressure:
∙ Arterial distensibility (compliance*):

how well the artery can expand to
receive a stroke volume

∙ Amount of stroke volume

Ps

Pd
*Compliance = the ease with which a structure can be
stretched

Question:
What happens to pulse pressure when arteries
become rigid?
increases

What happens to pulse pressure when blood
volume decreases?
decreases

Venous Pressure: normally 0-20 mmHg
∙ venous return is enhanced by respiratory pump and the skeletal
muscle pump

Cardiac Output, Resistance and MAP
Mean Arterial Pressure =

Cardiac Output X Resistance

Mean Arterial Pressure =

(SV X HR) X Resistance

Factors Which Increase MAP

Factors Which Decrease MAP

Increased cardiac output

Decreased cardiac output

Increased blood volume

Decreased blood volume

Increased peripheral resistance

Decreased peripheral resistance

Regulation of MAP consists of:
•Short term controls (baroreceptor reflexes,
chemoreceptor reflexes, chemical factors)
•Long term controls (kidney regulation via blood volume)

Control of MAP via altering resistance
vasoconstriction vs vasodilation

Increased
resistance

Decreased
resistance
OMG what is going on
here

Let’s talk Brittany

What is Brittany’s heart rate? 8.5 × 0.04 = 0.34
60/0.34 = 176.5 bpm
Or if you say 8 boxes: 8 × 0.04 = 0.32 60/0.34 = 187.5
bpm

Both work for now

Determination of the Blood Pressure
A Bit of a review before we get
started

Brittany’s heart rate is over twice the typical rate (75 × 2 =

150). Her heart rate is 134% higher than would be expected
(or 149% higher if students used 187 bpm). 176 − 75 = 101
bpm above 101/75 = 1.34 × 100 = 134% higher than
baseline (or her heart rate is 234% of baseline) Holy Molly

What is the typical percent increase
from baseline heart rate for someone
who is 35 weeks pregnant? HW??
Roughly 18–20%. Assuming resting is 75
bpm then values around 88–90 bpm would
be expected at 35 weeks pregnant

Compare Brittany’s ECG to the normal
sinus rhythm. What aspects of
Brittany’s ECG look different?

a

trioventricular nodal reentrant tachycardia (AVNRT) typically shows the following

characteristics:
● Heart rate: A regular tachycardia between 140 and 280 beats per minute (bpm)
● QRS complexes: Narrow QRS complexes that are usually less than 120 milliseconds
(ms)
● P waves: P waves that may be hidden, visible after the QRS complex, or very rarely
visible before the QRS complex

Explain what the ECG of someone with AVNRT would
look like.
P wave may not be visible and may be lumped into
the QRS due to the fact that the signal gets to the atria
and ventricles at almost the same time.

WPW pattern or preexcitation consists of a
short PR interval and prolonged QRS with an
initial slurring upstroke (“delta” wave) in the
presence of sinus rhythm.

A delta wave is slurring of the upstroke of the
QRS complex. This occurs because the action
potential from the sinoatrial node is able to
conduct to the ventricles very quickly through
the accessory pathway, and thus the QRS
occurs immediately after the P wave, making
the delta wave.

We will continue tomorrow

Blood Pressure Determinations
DEFINITION

Blood pressure (BP) is the lateral pressure exerted by the column of blood
on the wall of the artery.

APPARATUS

Sphygmomanometer and stethoscope.

PRINCIPLE

The pressure of blood in the artery (brachial artery) is balanced against the pressure
of air in a rubber cuff surrounding the artery. The pressure of air in the cuff is then
measured by means of a mercury manometer.

Blood Pressure Determinations
Systolic pressure is the maximum pressure in the arteries during systole.
It indicates:
a. The extent of work done by the heart
b. The force with which the heart is working
c. The degree of pressure which the arterial walls have to withstand.
Diastolic pressure is the minimum pressure at the end of ventricular
diastole. It is the measure of constant stretch to which walls of the arteries
are subjected. It is more important than systolic pressure because:
a. It is less fluctuating
b. It is the constant load against which the heart has to work
c. It is the pressure of peripheral resistance and depends mainly on the
tone of the arteries.

Pulse pressure is the difference between the systolic and diastolic
pressures. It is the rise in pressure caused by the ejection of blood
into the aorta by ventricular contraction. It is a measure of stroke
volume and compliance of arteries.
Mean arterial pressure is the average pressure present throughout
the cardiac cycle. It is responsible for pushing the blood through the
systemic circulatory system. It is equal to diastolic pressure + 1/3
pulse pressure

Mean arterial pressure (MAP) is a
critical hemodynamic factor. The
absence of proper regulation of MAP can
have important pathophysiological
consequences. Low MAP can cause
inadequate blood flow to organs,
syncope, and shock.

On the other hand, elevated MAP contributes to
increased oxygen demand by the heart,
ventricular remodeling, vascular injury,
end organ damage, and stroke.

NORMAL VALUES
The average systolic pressure in healthy adults is 100–140 mm Hg. The
average diastolic pressure is 60–90 mm Hg. In children it is closer to the
lower end of the scale and in the elderly, it reaches or even exceeds the
higher figure. The difference between the systolic and diastolic pressure is
the pulse pressure 30–60 mm Hg.

BP

Blood Pressure Reading
• Systolic: the top number, which is also the higher of the two
numbers, measures the pressure in the arteries when the heart beats
(when the heart muscle contracts).

• Diastolic: the bottom number, which is also the lower of the two
numbers, measures the pressure in the arteries between heartbeats
26

(when the left ventricle muscle is resting between beats and
refilling with blood).

Blood Pressure Reading
Blood Pressure
Category

Systolic
mm Hg (upper #)

Diastolic
mm Hg (lower #)

Normal

less than 120

and

less than 80

Prehypertension

120 – 139

or

80 – 89

High Blood Pressure
(Hypertension) Stage 1

140 – 159

or

90 – 99

High Blood Pressure
(Hypertension) Stage 2
27

160 or higher

or

100 or higher

Hypertensive Crisis
(Emergency care
needed)

Higher than 180

or

Higher than 110

Measurement Site
Blood Pressure

• Brachial artery is the most common measurement site:
▪ Close to heart
▪ Convenient for measuring

• Other sites are radial artery and wrist.
28

Auscultatory Method
Blood Pressure

• Pulse waves when first propagate through the brachial artery, generate
Korotkoff sounds. First sound you hear.
• Laminar – Non Turbulance pulses are transmitted smoothly

29

Cont. Korotkoff sounds
The first Korotkoff sound will be heard. Blood Pressure
As the pressure in the artery rises above the pressure in the cuff and then drops back down
(because of beating), resulting in turbulence that produces an audible sound.

30

Auscultatory Method Procedure
Blood Pressure
The actors in the story.
►Ms Chan a 43 year old former
athlete. Mixed Martian Arts Fighter
►Dr. Maggio – Cardiologists who
graduated from Sophie Davis.
►Narrator- Student at Stuyvesant
who wants and needs to be
recognized by Mr. Jerry Citron( for
grade purposes).

The Narrator. Use deep commanding,
but non threatening voice.
► Ms. Chan was a 43-year-old former college athlete who enjoyed
staying at home with her three young children. Even though she
had always tried to maintain an active healthy lifestyle, over
the past several months Ms Chan had felt increasingly tired to
the point that she sometimes was unable to do normal
household activities like cooking dinner or folding laundry.
Initially Ms Chan chalked up her exhaustion to “just being 40something,” but following an episode where she awoke in the
middle of the night feeling very short of breath, she decided to
see her primary care physician. Upon listening to her heart with
a stethoscope, her doctor referred her to a cardiologist.

Narrator continues
► Tree weeks later, Ms Chan was sitting nervously in the

cardiologist’s exam room waiting for him to enter. Tis was
her second appointment with Dr. Maggio, and the plan was
to discuss the results from her physical examination, labs,
and echocardiogram. She heard footsteps coming down
the hall, a rustling of papers at the door, and then a quick
knock before Dr. Maggio poked his head in. Ms Chan and
her doctor exchanged pleasantries before Dr. Maggio
became more serious and took a seat in his exam chair
across from her.

The dialogue
Chan,” she began, “based on the results of the tests we ran last
week and your physical exam, I am diagnosing you with congestive
heart failure.”
“

Ms Chan’s head was spinning. ( talking to herself) “That sounded
serious—potentially life-threateningly serious!” Her mind raced. “I’m
too young for this... I’ve always lived a healthy lifestyle and expected
a different result... This isn’t fair! What will my kids do if I die?”
Dr. Maggio continued. “I recognize this is a shock. I want you to know
that as your doctor, I’m here to help you develop the best possible
plan to ensure the greatest quality of life despite this diagnosis. What
questions do you have right now that I can help with?” Where’s Dr
Citron. I want to yell at him. Not sure why, but I find it enjoyable!!!

Dialogue continues
“Uh…what is congestive heart failure?” Chan

stammered.

“Am I going to die?”
“Let me explain to you a little about the anatomy of the heart

and its function to help you better understand this disease,”
was Dr. Maggio gentle reply. “But first give me that candy bar if
you want to be treated by me.”

Working with those next to you please
respond to the following
1.Label the following on (next page): right atrium, left atrium, right ventricle, left ventricle, bicuspid
valve, tricuspid valve, aortic semilunar valve, pulmonary semilunar valve.
2. Label the blood vessels on the diagram: inferior vena cava, superior vena cava, pulmonary trunk,
pulmonary arteries, pulmonary veins, and aorta.
3. List the order that blood passes through each of the structures you’ve labelled, beginning with the
inferior and superior vena cava
Use markers, crayons, or colored pencils to color the chambers of the heart and blood vessels either red
or blue, depending on how highly oxygenated the blood contained within them is. Highly oxygenated
blood is bright red, so color areas containing highly oxygenated blood red and those containing blood
with lower oxygen levels blue.
5. Explain why there is a diference in oxygen content of the blood on the two sides of the heart.

Can use a box diagram too. Take two
minutes

► Dr. Maggio continued with his teaching “The right side of the
heart pumps deoxygenated blood to the lungs, while the left
side of the heart pumps highly oxygenated blood that has
just returned from the lungs to all the tissues of the body.
With congestive heart failure, your heart has weakened, and
it doesn’t pump as effectively.
► Less blood and therefore less oxygen gets to your tissues and
organs. Ms Chan, this is why you’ve felt so tired and also
short of breath.”

gain with you comrades respond to the questions
below
A

1.In your own words, define pulmonary circuit and systemic circuit.
2. Based on where they must pump blood to, which side of the heart
do you think must pump harder, right or left? Explain your answer,
and use anatomical evidence from the heart to support your
argument.
3. Based on what you’ve learned so far, which side of the heart do
you think more commonly weakens faster and fails first? Explain your
answer.

Blood Flow in Heart Failure

“I took a class at Stuyvesant High School, taught by

some dude and remember learning about the systemic
and pulmonary circuits,” Chan responded. “I always
found them kind of confusing because the textbooks
would show them as a figure eight with the heart at
the center, and with all the valves inside and
thevessels coming of of the heart. I got confused
about where the blood was moving.”

So simple and sweet
“I’ve got a picture that I think may simplify that for you quite a bit and help you
to understand what is going on with blood fow in your body. Take a look at this,”
Dr. Maggio said as she handed Ms Chan a paper with a diagram on it.

Doctor continued
“Let me explain this to you,” she continued. “I think it will simplify the
circuits and help you to understand how blood is moving through the
body, and why there is a problem if one or both sides of the heart fail.
This leaves out all of the additional anatomy so that you can just focus
on the left side of the heart being a pump that moves blood from the
pulmonary circuit to the systemic circuit, and the right side of the
heart a pump that moves blood from the systemic circuit to the
pulmonary. The arrows in this diagram can help you remember in which
direction the blood is moving.”

The medical questions.
1.

If the left side of the heart fails, where in the circulation would blood back up? What about the
right side?

3.Describe what would happen to pressure in the blood vessels where
blood is backing up and pooling due to failure of the heart.
4. Capillaries are by far the most common type of blood vessel in the
body, and most capillaries are very porous— they leak fluid. Blood is
mostly fluid ,primarily composed of plasma (the liquid component),
which makes up around 55% of blood volume
The swelling caused by fluids leaking from the blood into tissues is
known as edema. Predict where in the body you would see edema
related to left-sided heart failure, and where you would see edema
related to right-sided heart failure. Be sure to explain your answers

Q’s
5.

Describe why heart failure is so often referred to as “congestive”
heart failure.
6. If the left side of the heart were failing, how would this change the pressure
that the right side of the heart needed to generate to continue moving blood into
the pulmonary circuit?
7.Left-sided heart failure is the primary cause of right-sided heart failure.
Explain why this might be.

Ate. Feeling short of breath was one of
the symptoms that led C Chan to see her
doctor originally. What do you think
happens to oxygen levels in the blood
when the left side of the heart fails?
Explain your answer and discuss why C
Chan has been feeling short of breath

Blood Flow and Valve Issues
“This all makes sense,” Ms Chan said, “but what I don’t understand and what I’m
really frustrated about is I’ve always been active! Until I became too exhausted
to do anything I worked out regularly. I eat a healthy diet. I don’t smoke! I don’t
have any of the risk factors that would predispose me to this disease, so why do I
have it? Why me?”
“Ms Chan, you have a narrowed bicuspid valve that has caused the problem. It’s
possible this was a congenital heart defect that was never noticed and didn’t
cause a lot of problems until your heart was permanently damaged. It’s also
possible that damage was caused to the valve by an infection like rheumatic
fever. Unfortunately, congestive heart failure isn’t something that can always be
prevented.”

1.How would a stenotic bicuspid (mitral) valve
afect the movement of blood from the left
atrium to the left ventricle?
2. Which of the four chambers of the heart
would have its workload increased the most by a
stenotic bicuspid (mitral) valve? Explain your
answer.
3. Suppose it were the pulmonary semilunar
valve that were stenotic. Which of the four

In conclusion
Describe how a stenotic valve increases the risk of
heart failure.
5. In Ms Chan’s case congestive heart failure was
caused by a stenotic bicuspid (mitral) valve. However,
other valve abnormalities can also cause heart failure.
Define valve regurgitation and explain how it could
also lead to a failing heart.

A. Regulation of MAP by altering resistance (short term controls)
The vasomotor center, baroreceptors and chemoreptors (short term)
vasomotor center: sympathetic neurons in the medulla
oblongata that
control the resistance by
stimulating vasoconstriction
vasomotor tone:
a state of partial arteriolar constriction that
to maintain normal MAP

helps

baroreceptors:
blood pressure receptors in the carotid sinuses and in
the aortic arch; activated by
increased MAP
chemoreceptors:
receptors (aortic and carotid bodies) in the
aortic
arch and carotid sinuses that monitor
blood pH and plasma O2 and
CO2
higher brain centers: the cerebral cortex and the hypothalamus
can
modify mean arterial pressure by acting through the medulla oblongata

based of the key notes I state dat the top and teh notes I provided make a study guide that answeers all the quesitosn iN eed to knwo for thequiz, im sothing is missing form the lsdies just say it from ur knoweldge