Heart disease in tHe fire service - West Valley City Firefighters, IAFF ...

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Heart Disease in the Fire Service cHaPter 3 • anatOmy and functiOn Of tHe cardiOvascular system The cardiovascular or circulatory system consists of the heart and blood vessels responsible for the vital function of transporting blood, oxygen and essential materials throughout the body necessary for survival. The following summary of the anatomy and function of the circulatory system may be helpful in appreciating how diseases of the heart and blood vessels can lead to adverse health outcomes. THE CIRCULATORY SYSTEM AND NORMAL HEART The heart’s main function is to serve as a pump for blood that transports oxygen and essential materials throughout the body. As Figure 3.1 illustrates, the heart has four chambers: two upper chambers called atria and two lower chambers called ventricles. The right atrium receives blood from the rest of the body and after it fills with blood, it contracts to send blood into the right ventricle. The right ventricle then pumps blood to the lungs where it can pick up oxygen. Blood returning from the lungs enters the left atrium where it is forced into the left ventricle. The left ventricle then pumps out blood to the rest of the body where oxygen can be delivered. The walls of each heart chamber contain myocardium, a type of muscle that is unique to the heart. When myocardium contracts, blood is forced out of a chamber through one-way valves, that when functioning normally, prevent back-flow so the chamber can fill with blood for the next heart beat. Figure 3.1 i HEART VALVES Heart valves help ensure that the flow of blood is one-way through each chamber, preventing back-flow that would decrease heart output. The sounds from each heart beat are generated from the closing of these valves. There are four heart valves; the tricuspid, pulmonary, mitral and aortic. The tricuspid valve separates the right atrium and right ventricle; the pulmonary valve separates the right ventricle from the pulmonary artery; mitral valve separates the left atrium and left ventricle; and the aortic valve Figure 3.2 ii separates the left ventricle from the aorta. The locations of the heart valves in relation to the rest of the heart can be seen in Figure 3.2. 7
CONDUCTION SYSTEM BLOOD VESSELS The body has several types of hollow, tubular vessels that are used to carry blood. Arteries carry blood away from the heart to the tissues and contain muscles that help control the relatively high pressure created when the left ventricle contracts to send blood through the body. Arteries lead to capillaries, which have a very small diameter. Individual red blood cells flow through capillaries in single file, allowing for oxygen exchange between red blood cells and tissue. Capillaries lead to veins that bring blood back towards the right side of the heart. Unlike arteries, veins have thin walls and are under low pressure with blood flow dependent on gravity and pumping action from muscles in the arm and legs that press on the walls of veins. Veins often contain one-way valves to prevent backflow of blood as it is carried back to the heart. MYOCARDIUM The heart contains a special type of muscle, called myocardium. Myocardial cells contract and relax to generate the pressure necessary to pump blood. Individual myocardial cells are connected via intercalated discs to form long fibers that form a lattice. The intercalated discs allow individual cells to communicate Figure 3.3 iii with each other. Ions passing through cells create an electric current that releases calcium inside the myocardial cells causing a synchronized contraction of myocardium. Myocardial cells require oxygen to function and receive it through special arteries, called coronary arteries. CORONARY ARTERIES The coronary arteries carry oxygen rich blood from the left ventricle to supply the myocardium. There are two major coronary arteries, which supply different areas of the heart. The right coronary artery supplies the myocardium in the right ventricle and part of the left ventricle, and branches of left coronary artery supply myocardium elsewhere in the heart. Figure 3.3 illustrates the major coronary arteries. Commonly, a blockage in a coronary artery interferes with delivery of oxygen to myocardium. If myocardium does not receive enough oxygen, it becomes ischemic (oxygen deprived), and if oxygen is deprived for a long enough period of time, the myocardium will die or “infarct”. Thus, doctors refer to heart attacks as myocardial infarctions or the end manifestation of myocardial ischemia caused by lack of oxygen in an area of heart muscle. As previously mentioned, the flow of ions between myocardial cells creates an electrical current that triggers contraction of the heart muscle. To generate an effective contraction of a chamber in the heart, myocardial cells must function in a coordinated manner. Specialized cells in the sinoatrial node (SA node) of the right atrium act as a pacemaker to establish the rate at which the heart beats. These cells generate the flow of ions that start the contraction of the heart. From the SA node, an electrical current spreads through both atria, triggering a contraction and sends blood into both ventricles. The current is also carried to cells in the atrioventricular node (AV node), which then transmit the current into the ventricles via dedicated cells called the AV bundle and Purkinje fibers. After a short delay, through these cells, the flow of ions is carried from the atria into both ventricles to create a synchronized contraction. Figure 3.4 illustrates the locations of the components of the conduction system. Figure 3.4 iv 8
Page 2 and 3: Acknowledgements Heart disease in t
Page 4 and 5: Heart Disease in the Fire Service c
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Page 12 and 13: BLOOD PRESSURE (hg) Blood pressure
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Page 24 and 25: ACUTE CARDIOVASCULAR STRAIN OF FIRE
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Page 36 and 37: STATES WITH PRESUMPTIVE HEART LAWS
Page 38: • Public Law 109-162 January 5, 2

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