Introduction
Modern day health care systems focus on offering holistic care that is patient-centric, safe, effective, efficient and timely. To this end, medical practitioners must have a diverse set of skills and knowledge from pharmacology to human anatomy and physiology. Of this, a sound understanding of anatomy and physiology are critical in provision of care for long term care. Physiology is the study of function in living systems while anatomy is the study of structure in living things. These two disciplines have been central in the delivery of health services since Ancient Greece where philosophers such as Aristotle explained the relationship between structure and functioning. Cardiovascular disease is an umbrella term that refers to many health conditions affecting the heart and the circulation system. In the management of cardiovascular disease, knowledge of human anatomy and physiology is vital because cardiovascular diseases usually result from altered anatomy. Understanding the normal anatomy and comparing it to the altered physiology and anatomy enables health care providers to design interventions that are effective in reversing the course of the disease and alleviating the symptoms. In addition, a sound knowledge of anatomy and physiology helps health care workers to interpret vital signs correctly and thereby enhance safety in health care delivery as the practitioners can identify which interventions promote normalization of vital signs.
In this essay, knowledge of human anatomy and physiology is applied in the care and management of patients suffering from cardiovascular disease. This is done through a critical evaluation of the cardiovascular and circulatory system, a discussion of normal anatomy, alterations in anatomy and physiology which lead to the cardiovascular disease and relevant management practices in the care of cardiovascular disease patients.
Cardiovascular Disease
Cardiovascular disease is an umbrella term of various conditions affecting the heart and the circulation system. The most common diseases classified under cardiovascular disease include the coronary heart disease, hypertensive disease, heart failure, cardiac dysrythmias, valvular heart disease, inflammatory heart disease, congenital heart disease, and cardiomyopathy (British Nutrition Foundation, 2008). Coronary heart disease is commonly called a heart attack and results from partial interruption of blood supply to the heart muscle due to blockage of the coronary artery. The condition can be fatal and even when a patient survives; the functioning of the heart is affected permanently. Loss of blood flow deprives oxygen to the heart muscles leading to death of cell (Rodgers, 2010). Hypertensive disease is characterized by a higher than normal blood pressure and results from hardening and loss of elasticity of blood vessels. Cardiac dysrythmias is abnormalities in heart rate while heart failure is the loss of pumping action of the heart. Valvular heart disease results from malfunctioning of the valves leading to leakage of blood and loss of pressure. Congenital heart disease results from anatomical and structural malfunctioning that are present at birth.
The cardio vascular disease is largely caused by structural and anatomical alterations leading to inefficiencies in the functioning of the heart, and the circulation system. It is therefore important to understand human anatomy and physiology and apply the knowledge in the management of cardiovascular disease. The cardiovascular disease is a significant health burden due to its wide prevalence rates. In the US alone, cardiovascular disease and related complications accounted for 1 in 3 deaths in 2008 (Rodger et al., 2012). In the following parts of the essay, the cardiovascular system and circulation system are discussed with special emphasis of alterations in anatomy and physiology which lead to the heart disease.
The Cardiovascular system
The cardiovascular system is made up of the heart, blood vessels and blood. The heart’s function is pumping blood while the blood vessels carry the blood. The function of blood is transportation and defense. The blood transports oxygen, nutrients, hormones and metabolic waste while it carries white blood cells which are responsible for defending the body against foreign bodies such as viruses and bacteria. In addition to transportation and defense, the cardiovascular system is also responsible for homeostatic control. This includes regulation of temperature, body pH, and cells osmotic pressure. Blood vessels are muscular and flexible tubes which carry blood and are divided into veins, arteries and capillaries. Arteries and arterioles carry blood rich in oxygen and nutrients away from the heart. The only exception is the pulmonary artery which carries deoxygenated blood from the heart to the lungs. Arteries carry blood under high pressure. Veins carry deoxygenated blood poor in nutrients towards the heart. The only exceptions are the pulmonary vein which carries oxygenated blood form the lungs to the heart, the hepatic portal which carry nutrients rich blood from the digestive system to the liver and the hepatic vein which carries nutrient rich blood to the heart. Veins carry blood under low pressure.
The heart is the central part of the cardiovascular system. It is made up of muscles and connective tissues. The heart is made up of four chambers. The superior atria chambers receive blood from the major veins while the inferior ventricles discharge blood form the heart through the major arteries (Laizzo, 2009). Blood flow in the heart is described through the pulmonary and the systemic circulations. The pulmonary circulation receives deoxygenated blood from the body through the right atrium, the blood then flows through a valve to the right ventricle from where it is pumped to the lungs through the pulmonary artery. From the lungs, oxygenated blood is carries by the pulmonary vein and received in the heart through the left atrium. From the left atrium, oxygenated blood follows the systemic circulation to the left ventricle from where it is pumped under high pressure to the body through the aorta. Deoxygenated blood from the body is returned to the heart through the venacava completing the cycle.
Physiological and Anatomical alterations in the cardiovascular system which lead to the cardiovascular disease
Alteration in the anatomy and physiology of the cardiovascular system often leads to the cardiovascular disease (Tofler & Muller, 2006). The diversity of the alterations is the cause of diversity in health conditions classified under cardiovascular diseases. Under normal conditions blood vessels especially arteries are strong but very flexible. This allows them to contract and expand in response to blood pressure and blood needs for various organs. When fat deposits such as cholesterol and triglycerides are deposited on the walls of arteries, the arteries become hard and lose their elasticity. This alteration in the structure of arteries leads to a narrower lumen to carry blood and an increase in arterial blood pressure and is described as atheroscelerosis (Laizzo, 2009). When a person takes a diet rich in lipids and cholesterols, low density lipoproteins accumulate in the blood and when oxidized by free radicals produce toxins which poison the endothelium cells which line the inner surface of the blood vessels. The immune system responds by producing white blood cells to absorb the oxidized low density lipoproteins. When the toxins are available in large quantities due to a high concentration of lipids in the diet, the white blood cells may fail to absorb all toxins or rapture releasing the absorbed oxidized low density lipoprotein triggering more death of endothelial cells. A mixture of the white blood cells and accumulated cholesterol on the walls of arteries is what causes blockage of arteries. Various factors such as age, diabetes, smoking, obesity, dietary iodine and vitamin B6 deficiency have been identified as risk factors in atheroscelerosis (Chambless et al., 2002). Increased blood pressure due to atheroscelerosis is a major cause of hypertensive disease. Atheroscelerosis can occur in any artery but is serious when it occurs in the major arteries. Atheroscelerosis in the carotid artery leads to stroke due to depravation of oxygen and nutrients in the brain. The heart muscle is supplied with oxygen and nutrients by the right and left coronary arteries and drained by the coronary veins. When the atheroscelerosis affect the coronary artery, Acute Myocardial Infraction or a heart attack results due to partial interruption on blood supply to the heart muscle.
Mallinson identifies the major symptoms of a heart attack as; short breath, nausea, vomiting, palpitations, anxiety and sudden retrostenal chest pain radiating to the left arm or left side of the neck (2010). A heart attack is a serious, often fatal cardiovascular event due to resulting complications. If a large part of the heart muscle is deprived oxygen and dies, the heart is no longer able to function and a heart failure may result. For small scale heart damage, a patient may survive but has cardiac dysrythmias and an increased risk of a subsequent heart attack.
Valve problems in the cardiac system may be congenital or acquired and represent anatomical alterations that inhibit normal functioning of the valves. This is the cause of the valvular heart disease. Loss of valve functioning affects the performance of the heart and often requires the defective valve to be replaced. Acquired valvular disease results from infections such as, rheumatic fever and marantic endocarditis; which alter the shape of the heart valves leading to leakage when the valves are closed under pressure (Bathina et al., 2010).
The congenital heart disease results form defects in the anatomical structure of the heart and the great vessels which are present at birth. These defects are a major cause of birth related deaths and they affect up to 9 babies in 1000 live births (Rodgers, 2010). In its most common form, congenital heart disease results when the foramen ovale fails to close leading to the mixing of oxygenated and deoxygenated blood. The foramen ovale is a whole which by passes the pulmonary circulation system before birth because the lungs are not used to oxygenate blood in the fetus since fetuses obtain oxygen and nutrients from the mother through the umbilical cord and the placenta.
Management Practices for Cardiovascular Disease
Cardiovascular disease is best managed by prevention through reduced exposure to risk factors such as obesity and smoking. When it is not possible to prevent the condition, management focuses on the alleviating of symptoms and other treatment procedures. As part of diagnosis, the vital signs of patients suspected to be suffering form a cardiovascular disease is the basic care provided as it allows the doctors to infer the underlying condition. Vital signs are physiological measures that can be used to assess physiological functions. For cardiovascular events such as a heart attack, temperature, pulse rate and blood pressure are the basic vital signs taken. Body temperature is an indication of the rate of metabolisim. Pulse rate is a physical manifestation of tactile arterial palpation of the heartbeat and is usually determined by pressing an artery against a bone. Some pulse patterns such as pulsus alternans which characterized by strong pulses followed by weak pulses can indicate progressive systolic heart failure and the heart struggles to sustain systole pressure (Randall et al., 2008). Blood pressure results from the hearts pumping action. The blood pressure taken is the arterial blood pressure in systemic circulation. The maximum pressure is systolic while the minimum is diastolic pressure.
A heart attack which is the most serious cardiovascular even is irreversible and management procedure focus on reducing loss of heart muscle. This is because if a large part of the heart muscle dies, subsequent effects such as heart failure can occur. Since the heart muscle cells die from deprivation of oxygen and nutrients, providing oxygen to patients of ischemic heart failure is the routine course of action. Management of ischemic heart attack victims also focuses on reducing future recurrence by addressing the risk factors.
Majority of cardiovascular diseases result from anatomical and physiological changes affecting the cardiovascular systems. Consequently, the major management practices are related to altering the anatomy of the cardiovascular system to restore normal function of various parts. These procedures include heart surgeries to close the foramen ovale or to install artificial heart valves to correct congenital heart disease and valvular heart disease respectively. When the foramen ovale is closed, oxygenated blood can no longer mix with deoxygenated blood. This anatomical improvement restores the physiology of the heart and promotes good health. Heart valves control blood flow between the different chambers of the heart. They are especially important in preventing backflow of blood into the atriums when the ventricles are contracting to pump blood under pressure into the major arteries. When the valves are defective, back flow of blood does occur leading to loss of blood pressure. Addressing the cause of the condition in the heart by replacing the defective valves is the best cause of action rather than addressing the resulting low blood pressure which is a secondary consequent and a symptom of the defects in the heart. Addressing the course of the diseases rather than the symptoms of the disease is the major focus of modern day health care system.
Atheroscelerosis is a major risk factor in causing serious cardiovascular events such as heart attack. The most basic and efficient management strategy to control atheroscelerosis is dieting and physical exercises. Dieting is an efficient way in minimizing the available lipids and low density lipoproteins in the blood. This preempts the accumulation of fat deposits in the arteries which trigger atheroscelerosis. Physical exercises promote the body to use available lipids reducing the amounts available for deposits along the blood vessels.
Blood Pressure Management
Changes in blood pressure indicate the state of the heart and blood vessels. It is important to maintain blood pressure within the normal range because higher blood pressure may trigger a heart attack (Tofler & Muller, 2006). In the body, blood pressure is maintained through various systems such as baroreceptor reflex, adolsterone, and the rennin-angiotensin system. Adolsterone is a steroid hormone produced in the adrenal cortex which in large concentration boosts fluid retention in the kidneys increasing blood pressure due to increased blood volume. The rennin-angiotensin system alters the size of blood vessels by altering the amount of vasodilators and vasoconstrictors in the blood (Kanwar et al., 2008). Baroreceptors are pressure receptors which link with the autonomic nervous system to control blood pressure by altering the force and speed of heartbeat. Medication to reduce blood pressure in patients suffering from cardiovascular disease usually focus on altering the rennin-angiotensin system by introducing angeotensin inhibitors hence promoting blood vessel dilation. Dilation of blood vessels is an important anatomical alteration that can lower blood pressure and promote proper functioning of the heart. Medical interventions are used in conjunctions with lifestyle changes such as diet and physical exercises to manage blood pressure in patients suffering from cardiovascular disease.
Conclusions
Medical care services offered to patients ought to be safe and be of high quality. To meet these demands, medical care providers should have developed skills in a varied range of topics to enable them to offer comprehensive care. One of these important knowledge areas is anatomy and physiology. Anatomy is the study of structure while physiology is the study of body function. This knowledge is important when providing care for acute diseases such as the cardiovascular disease. The cardiovascular disease results largely from anatomical changes in the cardiovascular systems. These changes may be congenital or acquired. Congenital heart defects such as the failure of the foramen ovale to close well leads to mixing of oxygenated and deoxygenated blood in different chambers of the heart. Acquired cardiovascular defects such as atheroscelerosis develop later in life due to exposure to risk factors such as obesity and smoking. In addition, infections such as rheumatic disease and injuries can lead to heart defects especially when they affect the valves.
Since some cardiovascular conditions are not treatable, management efforts focus on prevention and management of the condition by alleviating the symptoms. For a heart attack which one of the most serious cardiovascular event, management requires application of knowledge and physiology. The proper determination and interpretation of vital signs such as blood pressure and pulse rate relies on a good understanding of their physiological indications. The pulse rate is a measure of heart beats while blood pressure is a measure of arterial blood pressure in the systemic circulation. Medical interventions used in the management of heart attack commonly focus on the reduction of blood pressure by altering the size of the arteries.
References
Bathina, J. D., Daher, I. N., Plana, J. C., Durand, J. B., & Yusuf, S. W. (2010). Acute myocardial infarction associated with nonbacterial thrombotic endocarditis. Texas
Heart Institute Journal, 37(2), 208.
British Nutrition Foundation (2008). Cardiovascular Disease: Diet, Nutrition and Emerging Risk
Factors, London, UK: John Wiley & Sons.
Chambless, L. E., Folsom, A. R., Davis, V., Sharrett, R., Heiss, G., Sorlie, P., & Evans, G. W.
(2002). Risk factors for progression of common carotid atherosclerosis: the Atherosclerosis Risk in Communities Study, 1987–1998. American journal of epidemiology, 155(1), 38-47.
Kanwar, Y. S., Wada, J., Sun, L., Xie, P., Wallner, E. I., Chen, S., & Danesh, F. R. (2008).
Diabetic nephropathy: mechanisms of renal disease progression. Experimental Biology and Medicine, 233(1), 4-11.
Laizzo, P. A. (2009). Handbook of Cardiac Anatomy, Physiology and Devices. New York, NY;
Springer.
Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.
Randall, W. C., Euler, D. E., Jacobs, H. K., Wehrmacher, W., Kaye, M. P., & Hageman, G.
(2008). Autonomic neural control of cardiac rhythm: the role of autonomic imbalance in the genesis of cardiac dysrhythmia. Cardiology, 61(1), 20-36.
Rodgers, K. (2010). The Cardiovascular System. New York, NY: The Rosen Publishing Group.
Roger, V. L. , Gom, A. S., Lloyd-Jones, D. M., et al. (January 2012). "Executive summary: heart
disease and stroke statistics--2012 update: a report from the American Heart Association". Circulation 125 (1): 188–97.
Tofler, G. H., & Muller, J. E. (2006). Triggering of acute cardiovascular disease and potential
preventive strategies. Circulation, 114(17), 1863-1872.
