Heart Anatomy

§Approximately the size of  fist

§Location

§Superior surface of diaphragm

§Left of the midline

§Anterior to the vertebral column, posterior to the sternum

Coverings of the Heart: Anatomy

§Pericardium – a double-walled sac around the heart composed of:

        A superficial fibrous pericardium

        A deep two-layer serous pericardium

        The parietal layer lines the internal surface of the fibrous pericardium

        The visceral layer or epicardium lines the surface of the heart

       They are separated by the fluid-filled pericardial cavity

§Epicardium – visceral layer of the serous pericardium

§Myocardium – cardiac muscle layer forming the bulk of the heart

§Endocardium – endothelial layer of the inner myocardial surface

External Heart: Major Vessels of the Heart (Anterior View)

  §Vessels returning blood to the heart include:

        Superior and inferior venae cavae

        Right and left pulmonary veins

  §Vessels conveying blood away from the heart include:

        Pulmonary trunk,     which splits into right and left pulmonary arteries

        Ascending aorta (three branches) –

        Brachiocephalic

        Left common carotid

        Subclavian arteries

External Heart: Vessels that Supply/Drain the Heart (Anterior View)

§Arteries – right and left coronary (in atrioventricular groove), marginal, circumflex, and anterior interventricular arteries

§Veins – small cardiac, anterior cardiac, and great cardiac veins

External Heart: Major Vessels of the Heart (Posterior View)

§Vessels returning blood to the heart include:

Right and left pulmonary veins

Superior and inferior venae cavae

§Vessels conveying blood away from the heart include:

Aorta

Right and left pulmonary arteries

External Heart: Vessels that Supply/Drain the Heart (Posterior View)

§Arteries – right coronary artery (in atrioventricular groove) and the posterior  interventricular artery (in interventricular groove)

§Veins – great cardiac vein, posterior vein to left ventricle, coronary sinus, and middle cardiac vein

Gross Anatomy of Heart: Frontal Section

 Atria of the Heart

§Atria are the receiving chambers of the heart

§Each atrium has a protruding auricle

§Pectinate muscles mark atrial walls

§Blood enters right atria from superior and inferior venae cavae and coronary sinus

§Blood enters left atria from pulmonary veins

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Ventricles of the Heart

§Ventricles are the discharging chambers of the heart

§Papillary muscles and trabeculae carneae muscles mark ventricular walls

§Right ventricle pumps blood into the pulmonary trunk

§Left ventricle pumps blood into the aorta

Pathway of Blood Through the Heart and Lungs

§Right atrium à tricuspid valve à right ventricle

§Right ventricle à pulmonary semilunar valve à pulmonary arteries à lungs

§Lungs à pulmonary veins à left atrium

§Left atrium à bicuspid valve à left ventricle

§Left ventricle à aortic semilunar valve à aorta

§Aorta à systemic circulation

Pathway of Blood Through the Heart and Lungs

Coronary Circulation

§Coronary circulation is the functional blood supply to the heart muscle itself

§Collateral routes ensure blood delivery to heart even if major vessels are occluded

Coronary Circulation: Arterial Supply

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Heart Valves

§Heart valves ensure unidirectional blood flow through the heart

§Atrioventricular (AV) valves lie between the atria and the ventricles

§AV valves prevent backflow into the atria when ventricles contract

§Chordae tendineae anchor AV valves to papillary muscles

Heart Valves

§Semilunar valves prevent backflow of blood into the ventricles

§Aortic semilunar valve lies between the left ventricle and the aorta

§Pulmonary semilunar valve lies between the right ventricle and pulmonary trunk

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Note: Images are subjected for representative purposes only.

MANIA

MANIA

An abnormally elevated mood state characterized by such symptoms as

•      Inappropriate elation

•      Increased irritability

•      Severe insomnia

•      Grandiose notions

•      Increased speed or volume of speech

•      Disconnected & racing thoughts

•      Increased sexual activity level

•      Poor judgment and appropriate social behavior

HYPOMANIA

•      Lesser degree of mania

•      Mild elevation of mood

•      Increased sense of   psychological wellbeing  and happiness , not keeping with ongoing events.

PREDISPOSING FACTORS

•      Biological theories

•      Psychosocial theories

•      The transactional model

BIOLOGICAL THEORIES

•      Genetics

•      Biochemical influences

ü  Biogenic amines

ü  electrolytes

•      Physiological influences

ü  Brain lesions

ü  Medication side effects

  PSYCHOSOCIAL THEORIES

•      Importance declined

•      Mania is viewed as  disease of brain with biological etiologies

CLINICAL FEATURES

The underlined characteristics are:-

•      Elevated mood

•      An increase in quantity & speed of physical & mental activity

AFFECTIVE SYMPTOMS

•      Elevated mood: it has 4 stages depending on severity of manic episodes

•      EUPHORIA (stage-I) : increased sense of psychological well being & happiness not in keeping with ongoing events

•      ELATION (stage-II) : moderate elevation of mood with increased psychomotor activity

•      EXALTATION (stage-III) : intense elation of mood with Delusions of Grandeur.

•      ECSTASY (stage-IV) : severe elevation of mood , intense sense of rapture or blissfullness seen in delirious or stuporous mania

•      Elevated mood

•      Expensiveness

•      Humorousness

•      Inflated self esteem

•      Intolerance of criticism

•      Lack of shame or guilt

•      Sometimes irritable mood is predominant

•      May shift from Euphoria to Depression or Anger

BEHAVIORAL SYMPTOMS

•      Aggressiveness

•      Grandiose acts

•      Hyperactivity

•      Increased motor activity

•      Irresponsibility

•      Irritability

•      Argumentativeness

•      Poor personal grooming

•      Provocativeness

•      Increased social activity

•      Dressed up in gaudy or  flamboyant clothes

•      Sexual hyperactivity

COGNITIVE SYMPTOMS

•      Ambitiousness

•      Denial of realistic danger

•      Easily distracted

•      Flight of ideas

•      Uses playful language  

•      Speaks loudly

•      Delusions of grandeur

•      Delusion of persecution

•      Lack of judgment

•      Distractibility

PHYSIOLOGICAL SYMPTOMS

•      Dehydration

•      Inadequate nutrition (due to over-activity)

•      Little need of sleep

•      Weight loss

CLASSIFICATION

•      By ICD-10

•      F-30 = manic episode

DIAGNOSIS

•      ICD-10

•      Psychological tests as Young mania Rating Scale

•      MSE

MENTAL STATUS EXAMINATION

•      GENERAL APPEARANCE & BEHAVIOR:-

•      Psychomotor agitation  ; sitting still is difficult

•      may wear clothes that reflect elevated mood---brightly colored clothes, flamboyant, attention-getting, Pressured speech

•      Interrupts and cannot listen to others

Mood & affect

•      Euphoric, grandiosity, and false sense of well-being.

•      Mood is quite labile.

Thought process and content

•      flight of ideas

•      Cannot connect concepts and jump from one subject to another

•      Circumstantiality and Tangentiality

•      Do not consider risks or personal experience, abilities or resources.

•      Some experience psychotic features– grandiose delusions

Sensorium and intellectual processes

•      Oriented to person and place but rarely to time

•      Intellectual function is difficult to assess during the manic phase

•      Claims to have many abilities that they do not possess

•      Impaired ability to concentrate or pay attention

•      If psychotic—may experience hallucination

Judgment and insight

•      Easily angered and irritated

•      Impulsive and rarely think before acting or speaking

•      Insight is limited---believes they are “fine” and have no problems

•      Blames any difficulties on others

Self-concept

•      Exaggerated self-esteem—believes they can accomplish anything

•      A false sense of well being

Roles and Relationships

•      Rarely can fulfill role & responsibilities.

•      Have trouble at work or school---too distracted and hyperactive to pay attention to children or ADLs.

•      Begins many tasks or projects but completes few.

Physiologic and self-care considerations

•      Can go days w/o sleep or food and not even realize they are hungry or tired

•      Unwilling to stop or unable to rest or sleep

•      Ignores personal hygiene

•      destroy valued items

•      May physically injure themselves

•      Tend to ignore or be unaware of health needs

TREATMENT

•      Pharmacotherapy

•      Electro-convulsive therapy

•      Psychological treatment

PSYCHOPHARMACOLOGY

•      MOOD STABILIZERS

•      Antimanic - Lithium

•      Anticonvulsant - clonazepam, valproic acid

•      Calcium channel blocker - verapamil

•      ANTIPSYCHOTICS

•      Olanzapine, Risperidone, Quetiapine
Chlorpromazine, Haloperidol

•      SEDTIVES/HYPNOTICS

•      benzodiazepines

NURSING MANAGEMENT

•      ASSESSMENT :- 

•      Severity of disorder.

•      Knowing the causes.

•      Resources available.

•      Judging the effect of  patient’s behavior on other people.

•      MSE

Nursing Diagnosis

•      Risk for injury related to extreme hyperactivity

•      Risk for violence r/t manic excitement

•      Imbalanced nutrition less than body requirement related to refusal

•      Impaired social interaction r/t egocentric behaviour

                                         

                                                    THANKS