CARDIOVASCULAR CARDIOVASCULAR SYSTEMSYSTEM

COURSE OUTLINECOURSE OUTLINE

A. Review of Anatomy and PhysiologyA. Review of Anatomy and Physiology

1. Heart1. Heart

2. Blood vessels2. Blood vessels

3. Blood circulation3. Blood circulation

B. History and Assessment FindingsB. History and Assessment Findings

1. Risk Factors for Cardiac 1. Risk Factors for Cardiac DiseasesDiseases

2. Physical Assessment2. Physical Assessment20092009

ANATOMY ANATOMY AND AND

PHYSIOLOGYPHYSIOLOGY20092009

THE HEARTTHE HEART

20092009

I. Anatomy & Physiology:I. Anatomy & Physiology:

300 gms / cone shaped & tilted 300 gms / cone shaped & tilted forward forward & to the left& to the left

size of a fist / rests only size of a fist / rests only location: mediastinumlocation: mediastinum

During the course of the day, your heart During the course of the day, your heart will beat approx will beat approx 100,000 times 100,000 times driving driving 2,000 gallons 2,000 gallons of oxygen-rich blood through of oxygen-rich blood through 60,000 miles 60,000 miles of blood vessels.of blood vessels.

20092009

The HeartThe Heart

Figure 11.120092009

Heart wall has three layersHeart wall has three layers

Myocardium Myocardium

EpicardiumEpicardium

EndocardiumEndocardium

Layers:Layers:

1.1. PericardiumPericardium ParietalParietal VisceralVisceral Pericardial spacePericardial space

2.2. EpicardiumEpicardium

3.3. MyocardiumMyocardium

4.4. EndocardiumEndocardium

20092009

Chambers of the heart:Chambers of the heart:

1.1. Right AtriumRight Atrium2.2. Right VentricleRight Ventricle3.3. Left AtriumLeft Atrium4.4. Left VentricleLeft Ventricle

20092009

Superior Vena Cava

Brachiocephalic Artery

Common Carotid Artery

Subclavian Artery

Aorta

PulmonaryArtery

ParietalPericardium

Right Atrium

Right Ventricle

Right CoronaryVein

Right CoronaryArtery

Left Atrium

Apex

LeftVentricle

Left Coronary Vein

Left Coronary Artery

LigamentumArteriosum

HEART VALVESHEART VALVES

20092009

Valves:Valves:1.1. AV ValvesAV Valves

a.a. TricuspidTricuspidb.b. MitralMitral

2.2. Semilunar ValvesSemilunar Valvesa.a. Pulmonic valvePulmonic valveb.b. Aortic valveAortic valve

20092009

BLOOD SUPPLY BLOOD SUPPLY OF THE HEARTOF THE HEART

20092009

Coronary Arteries:Coronary Arteries:

1.1. Right Coronary Right Coronary ArteryArtery

Right atrium & Right atrium & ventricleventricle

Inferior portion Inferior portion of left ventricleof left ventricle

Posterior Posterior septal wallseptal wall

SA & AV nodesSA & AV nodes

20092009

2.2. Left Coronary ArteryLeft Coronary Artery

a.a. Left Anterior Descending Coronary Left Anterior Descending Coronary ArteryArtery

anterior wall of left ventricleanterior wall of left ventricle

anterior ventricular apex of left anterior ventricular apex of left ventricleventricle

b.b. Circumflex ArteryCircumflex Artery

left atrium left atrium

lateral & posterior surfaces of left lateral & posterior surfaces of left ventricleventricle

20092009

20092009

CoronarySinus

The Vascular System:The Vascular System:

ArteriesArteries

ArteriolesArterioles

CapillariesCapillaries

VenulesVenules

VeinsVeins

ValvesValves

LymphaticsLymphatics

20092009

The Vascular SystemThe Vascular System

Figure 11.8b20092009

Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Blood Circulation

Figure 11.3

Properties of Cardiac Muscle:Properties of Cardiac Muscle:

1.1. AutomaticityAutomaticity

2.2. ExcitabilityExcitability

3.3. ConductivityConductivity

4.4. ContractilityContractility

20092009

Cardiac Conduction System:Cardiac Conduction System:

1.1. Sino-Atrial (SA) Sino-Atrial (SA) Node – Node – PacemakerPacemaker

2.2. Atrioventricular Atrioventricular Node (AV) Node (AV)

3.3. Bundle of HisBundle of His

4.4. Purkinje fibersPurkinje fibers

20092009

Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Heart Contractions

Figure 11.5

Heart Sounds:Heart Sounds:

1.1. S1 – AV valves S1 – AV valves closeclose

2.2. S2 – Semilunar S2 – Semilunar valves closevalves close

3.3. S3 – Ventricular S3 – Ventricular gallopgallop

4.4. S4 – Atrial gallopS4 – Atrial gallop

20092009

Cardiac Output:Cardiac Output:blood ejected from left ventricle / min.blood ejected from left ventricle / min.

ave.: 5L/min.ave.: 5L/min.

CO = stroke vol. X HRCO = stroke vol. X HRStroke Volume – blood ejected / Stroke Volume – blood ejected / heartbeatheartbeat

Preload – myocardial fiber length at end Preload – myocardial fiber length at end diastolediastole

Afterload – resistance to left ventricular Afterload – resistance to left ventricular ejectionejection

20092009

Blood PressureBlood Pressure• The pressure exerted by the blood against the blood

vessel wall• Factors affecting Blood Pressure

1. Neural Factors : the Autonomic Nervous System, particularly the Sympathetic Nervous System which often causes vasoconstriction or narrowing of the vessels and thus increasing blood pressure

2. Renal Factors : the Kidneys3. Temperature :

• Cold – causes vasoconstriction• Heat – causes vasodilatation

4. Chemicals and Hormones• Catecholamines, Antidiuretic Hormone,

Aldosterone, Atrial Natriuretic Peptide, Nicotine, Histamine & Alcohol

5. Diet

Blood Pressure Control:Blood Pressure Control:

1.1. Baroreceptors (pressoreceptors) – Baroreceptors (pressoreceptors) – aortic arch & carotid sinusaortic arch & carotid sinus

2.2. Stretch receptors – vena cava & Stretch receptors – vena cava & right atriumright atrium

3.3. Anti-diuretic HormoneAnti-diuretic Hormone

4.4. AldosteroneAldosterone

5.5. Renin-Angiotensin SystemRenin-Angiotensin System

20092009

HISTORY AND HISTORY AND ASSESSMENT ASSESSMENT

FINDINGSFINDINGS

20092009

ASSESSMENT WITH CV ASSESSMENT WITH CV DISORDERSDISORDERS

NURSING HISTORYNURSING HISTORY- - RISK FACTORS RISK FACTORS

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION COMMON SIGNS/ SYPMTOMSCOMMON SIGNS/ SYPMTOMS DIAGNOSTIC PROCEDURES DIAGNOSTIC PROCEDURES

20092009

RISK FACTORSRISK FACTORS

NON- MODIFIABLENON- MODIFIABLE

AGEAGE

SEX/GENDERSEX/GENDER

HEREDITYHEREDITY

RACERACE

MODIFIABLEMODIFIABLE

DIETDIET

EXERCISEEXERCISE

STRESSSTRESS

SMOKINGSMOKING

ALCOHOLALCOHOL

DISEASES(HTN,DM)DISEASES(HTN,DM)

OBESITYOBESITY

PERSONALITYPERSONALITY

CONTRECEPTIVESCONTRECEPTIVES

20092009

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

INSPECTIONINSPECTION

SKIN COLORSKIN COLOR

NECK VEIN NECK VEIN ENGORGEMENTENGORGEMENT

RESPIRATIONRESPIRATION

PMIPMI

PERIPHERAL PERIPHERAL EDEMAEDEMA

PALPATIONPALPATION

PULSESPULSES

APICAL PULSEAPICAL PULSE

20092009

Jugular vein assessmentJugular vein assessment

20092009

20092009

Peripheral-Vascular Flow Peripheral-Vascular Flow AssessementAssessement

20092009

AUSCULTATIONAUSCULTATION

Heart soundsHeart sounds

S1-AV closureS1-AV closure

S2- semilunar S2- semilunar valve closurevalve closure

S3-ventricular S3-ventricular gallopgallop

S4-atrial gallopS4-atrial gallop

MurmursMurmurs

Pericardial friction Pericardial friction rubrub

20092009

20092009

Common Signs and Common Signs and Symptoms:Symptoms:

1.1. SubjectiveSubjective

a.a. DyspneaDyspnea

b.b. Chest painChest pain

c.c. Weight gainWeight gain

d.d. SyncopeSyncope

e.e. PalpitationsPalpitations

f.f. FatigueFatigue

2.2. ObjectiveObjective

a.a. Neck vein Neck vein distentiondistention

b.b. RespirationRespiration

c.c. Peripheral Peripheral edemaedema

d.d. MurmursMurmurs

20092009

20092009

20092009

A. Cardiac EnzymesA. Cardiac Enzymes

EnzymeEnzyme OnsetOnset PeakPeak Normal Normal ValuesValues: :

a.a. AST/AST/SGOTSGOT

b.b. CPK-MBCPK-MB

c.c. LDHLDH

d.d. TroponinTroponin

e.e. MyoglobiMyoglobinn

f.f. HRDHRD

4-6 hrs4-6 hrs

3-6 hrs.3-6 hrs.

within 12 hrs.within 12 hrs.

within 3 hrs.within 3 hrs.

1hr. 1hr.

10-12 hrs10-12 hrs

24-36 hrs24-36 hrs

12-18 hrs.12-18 hrs.

48-72 hrs.48-72 hrs.

Up to 7 daysUp to 7 days

4-6 hrs.4-6 hrs.

48-72 hrs48-72 hrs

7-40 mu/ml7-40 mu/ml

50-325 50-325 mu./mlmu./ml

100-225 IU/L100-225 IU/L

< 0.6 ng/ml< 0.6 ng/ml

0-85 ng/ml0-85 ng/ml

140 – 350 140 – 350 mu/mlmu/ml

DIAGNOSTIC TESTDIAGNOSTIC TEST

20092009

B. ElectrolytesB. Electrolytes

ELECTROLYTELECTROLYTEE

IncreasedIncreased DecreasedDecreased

Potassium Potassium

Sodium Sodium

CalciumCalcium

Magnesium Magnesium

Ventricular Ventricular dysrhythmia Digitalis dysrhythmia Digitalis toxicity toxicity

water toxicity water toxicity

AV block / tachycardia AV block / tachycardia shortened QT interval shortened QT interval muscle weakness/ muscle weakness/ hypotension prolonged hypotension prolonged PR interval wide QRS PR interval wide QRS complexcomplex

Ventricular Ventricular dysrhythmia asystoledysrhythmia asystole

diuretics use / HF diuretics use / HF ventricular ventricular dysrhythmia dysrhythmia prolonged QT interval prolonged QT interval ventricular ventricular tachycardia tachycardia fibrillationfibrillation

20092009

20092009

Lead PlacementLead Placement

20092009

20092009

20092009

20092009

Electrocardiogram (ECG)Electrocardiogram (ECG)

20092009

20092009

Methods for Calculating Heart RateMethods for Calculating Heart Rate

20092009

ECG InterpretaionECG Interpretaion

20092009

20092009

20092009

COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY

Allows visualization of the Allows visualization of the arterial wall arterial wall and its structuresand its structures

May detect Abdominal Aortic May detect Abdominal Aortic AneurymsAneuryms

Nursing InterventionsNursing Interventions::– Explain the procedureExplain the procedure– NPO, if with contrast mediumNPO, if with contrast medium– Ascertain history to allergy to iodine and seafoodsAscertain history to allergy to iodine and seafoods– Assess for claustrophobiaAssess for claustrophobia– Advise to remain still during the entire procedureAdvise to remain still during the entire procedure– Sedation if unable to remain still Sedation if unable to remain still

20092009

CARDIAC CARDIAC DISORDERSDISORDERS

20092009

VALVULAR VALVULAR HEART HEART

DISEASEDISEASE

20092009

VALVULAR HEART DISEASEVALVULAR HEART DISEASE

Mitral Valve DiseaseMitral Valve Disease– Mitral Valve prolapseMitral Valve prolapse– Mitral Valve stenosisMitral Valve stenosis– Mitral Valve regurgitationMitral Valve regurgitation

Aortic Valve DiseaseAortic Valve Disease– Aortic StenosisAortic Stenosis– Aortic RegurgitationAortic Regurgitation

Tricuspid Valve DiseaseTricuspid Valve Disease Pulmonic Valve DiseasePulmonic Valve Disease

20092009

2009

MITRAL VALVE PROLAPSEMITRAL VALVE PROLAPSE Occurs when the cusps of the mitral Occurs when the cusps of the mitral

valve billow upward into the atrium valve billow upward into the atrium during systolic contractionduring systolic contraction

Chorda tendinae lengthens and cusps Chorda tendinae lengthens and cusps may enlarge and thickensmay enlarge and thickens

Diagnostics: echocardiography, stress Diagnostics: echocardiography, stress test, chest x-ray, cardiac catheterizationtest, chest x-ray, cardiac catheterization

Manifestations: asymptomatic; maybe Manifestations: asymptomatic; maybe vaguevague

Management: symptomatic treatment Management: symptomatic treatment (aspirin to prevent TIA, antibiotics, beta-(aspirin to prevent TIA, antibiotics, beta-blockers)blockers)

20092009

Mitral valve prolapseMitral valve prolapse

20092009

MITRAL VALVE STENOSISMITRAL VALVE STENOSIS Mitral valve becomes calcified and Mitral valve becomes calcified and

immobile and the valvular orifice immobile and the valvular orifice narrowsnarrows

Can result to heart failure and Can result to heart failure and decreased cardiac outputdecreased cardiac output

Manifestations: atrial fibrillation, Manifestations: atrial fibrillation, decreased exercise tolerance, decreased exercise tolerance, dyspnea, orthopnea, murmursdyspnea, orthopnea, murmurs

Management: oral diuretics and Na – Management: oral diuretics and Na – restricted diet in heart failure, restricted diet in heart failure, anticoagulants, digitalis, beta-anticoagulants, digitalis, beta-blockersblockers

20092009

Mitral stenosis Mitral stenosis

20092009

MITRAL VALVE MITRAL VALVE REGURGITATIONREGURGITATION

Occurs when much pressure is generated Occurs when much pressure is generated within the left ventricle to be generated to within the left ventricle to be generated to the aorta resulting to backflow of blood to the aorta resulting to backflow of blood to the left atriumthe left atrium

Pressure is reflected back to the Pressure is reflected back to the pulmonary veins and arteriespulmonary veins and arteries

Manifestations: asymptomatic until cardiac Manifestations: asymptomatic until cardiac output falls, murmurs, atrial fibrillation, output falls, murmurs, atrial fibrillation, pulmonary manifestationspulmonary manifestations

Management: restrict physical activities, Management: restrict physical activities, restrict sodium, diuretics, digitalisrestrict sodium, diuretics, digitalis

20092009

AORTIC STENOSISAORTIC STENOSIS Caused by calcification of the Caused by calcification of the

valve and stiffening of the valve valve and stiffening of the valve from rheumatic heart feverfrom rheumatic heart fever

Results in decreased cardiac Results in decreased cardiac outputoutput

Manifestations: initially Manifestations: initially asymptomatic, angina pectoris, asymptomatic, angina pectoris, syncope, dyspneasyncope, dyspnea

Management: avoid vigorous Management: avoid vigorous physical activity, antibiotics, physical activity, antibiotics, digitalis, beta-blockersdigitalis, beta-blockers

20092009

AORTIC REGURGITATIONAORTIC REGURGITATION

Blood propelled into the aorta Blood propelled into the aorta propels back to the left propels back to the left ventricle through an ventricle through an incompetent valveincompetent valve

Manifestations: initially Manifestations: initially asymptomatic, palpitations, asymptomatic, palpitations, murmurs, low BPmurmurs, low BP

Management: same for aortic Management: same for aortic stenosisstenosis

20092009

TRICUSPID VALVE DISEASETRICUSPID VALVE DISEASE

Tricuspid stenosis or Tricuspid stenosis or regurgitation usually occurs regurgitation usually occurs after rheumatic heart diseaseafter rheumatic heart disease

Causes decreased cardiac Causes decreased cardiac output and increased right atrial output and increased right atrial pressurepressure

Manifestations: neck distention, Manifestations: neck distention, peripheral edema, murmursperipheral edema, murmurs

Management: diuretics, digitalisManagement: diuretics, digitalis20092009

PULMONIC VALVE DISEASEPULMONIC VALVE DISEASE

Usually congenital defectsUsually congenital defects Causes: mitral stenosis, Causes: mitral stenosis,

pulmonary emboli, chronic lung pulmonary emboli, chronic lung diseasesdiseases

Can lead to decreased cardiac Can lead to decreased cardiac outputoutput

Manifestations: murmurs, Manifestations: murmurs, fatigue, dyspneafatigue, dyspnea

Management: treat the Management: treat the underlying causeunderlying cause

20092009

2009

INFECTIOUS INFECTIOUS DISORDERS OF DISORDERS OF

THE HEARTTHE HEART

20092009

INFECTIOUS DISORDERS OF INFECTIOUS DISORDERS OF THE HEARTTHE HEART

1. Pericarditis1. Pericarditis acute or chronic inflammation of the acute or chronic inflammation of the

pericardiumpericardiumAssessment:Assessment:

precordial pain precordial pain pain (inspiration, coughing & swallowing)pain (inspiration, coughing & swallowing)pain worse when supinepain worse when supinepericardial friction rubpericardial friction rubfever & chillsfever & chillselevated WBC ct.elevated WBC ct.cardiomegalycardiomegaly

20092009

2009

2. Myocarditis:2. Myocarditis:

acute / chronic inflammation of the acute / chronic inflammation of the myocardiummyocardium

Etiology:Etiology:Bacterial : staphylococcus / Bacterial : staphylococcus / pneumococcalpneumococcalViral : coxsackievirus / mumps / influenzaViral : coxsackievirus / mumps / influenzaParasitic : ToxoplasmosisParasitic : ToxoplasmosisRadiation / LeadRadiation / LeadMeds: Lithium / CocaineMeds: Lithium / Cocaine

20092009

3. Endocarditis:3. Endocarditis:

Inflammation of the endocardium; platelets and fibrin deposit on the mitral and/or aortic valves causing deformity, insufficiency or stenosis

Assessment:Assessment:

fever, anorexia, wt loss, fatiguefever, anorexia, wt loss, fatigue

cardiac murmurscardiac murmurs

Janeway’s lesionsJaneway’s lesions

Ossler’s nodesOssler’s nodes

Petechiae, splinter hemorrhages in nailbedsPetechiae, splinter hemorrhages in nailbeds

SplenomegalySplenomegaly

20092009

2009

RHEUMATIC FEVER/RHDRHEUMATIC FEVER/RHD

A A pancarditispancarditis that follows exposure of that follows exposure of child to throat and skin infection child to throat and skin infection caused by Group A B-hemolytic caused by Group A B-hemolytic organismsorganisms

Repeated bouts with permanent Repeated bouts with permanent scarring of the valvesscarring of the valves RHD RHD heart failureheart failure

20092009

Erythema marginatum

Subcutaneous Nodules

20092009

CARDIAC TAMPONADECARDIAC TAMPONADE

pericardial effusion occurs when the pericardial effusion occurs when the space bet. the parietal & visceral space bet. the parietal & visceral layers of the pericardium fill with layers of the pericardium fill with fluid. fluid.

Etiology:Etiology:

stab woundstab wound

tumortumor

surgerysurgery

20092009

Cardiac tamponadeCardiac tamponade

2009

2009

2009

CORONARY CORONARY ARTERY ARTERY

DISORDERSDISORDERS

20092009

CORONARY ARTERY CORONARY ARTERY DISEASEDISEASE

Narrowing or obstruction Narrowing or obstruction of one or more coronary of one or more coronary arteries as a result of:arteries as a result of:– Atherosclerosis Atherosclerosis – ArteriosclerosisArteriosclerosis

20092009

20092009

20092009

20092009

20092009

20092009

20092009

20092009

20092009

20092009

CORONARY ARTERY BYPASS GRAFTING CORONARY ARTERY BYPASS GRAFTING (CABG)(CABG)

20092009

2009

20092009

ANGINA PECTORISANGINA PECTORIS

20092009

ANGINA PECTORISANGINA PECTORIS

chest pain resulting from myocardial ischemia; a symptom of an existing disease; no necrosis

20092009

20092009

MYOCARDIAL MYOCARDIAL INFARCTIONINFARCTION

20092009

20092009

MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION

sudden decrease of oxygenation due to reduced coronary blood flow that results to destruction of myocardial tissue in regions of the heart

after 15 mins. = necrosis

20092009

20092009

20092009

2009

20092009

VASCULAR VASCULAR DISORDERSDISORDERS

20092009

HYPERTENSIONHYPERTENSION

20092009

HYPERTENSIONHYPERTENSION

abnormal elevation of BP above abnormal elevation of BP above 140/90 mmHg based on at rest140/90 mmHg based on at rest

least 2 readings on same conditions.least 2 readings on same conditions.

20092009

HypertensionHypertension

2009

ARTERIAL ULCERSARTERIAL ULCERS

20092009

ARTERIAL ULCERSARTERIAL ULCERS

Skin breakdown due to local pressure or Skin breakdown due to local pressure or minor trauma in an ischemic extremityminor trauma in an ischemic extremity

Painful and heals poorly; forced to Painful and heals poorly; forced to undergo limb amputation if untreatedundergo limb amputation if untreated

Management: revascularization (arterial Management: revascularization (arterial bypass surgery), skin grafting to cover bypass surgery), skin grafting to cover the ulcer, keep area free from pressure the ulcer, keep area free from pressure and irritation, bed rest, debridement and irritation, bed rest, debridement

20092009

ANEURYMSANEURYMS

20092009

ANEURYSMSANEURYSMS

Permanent localized dilation of an Permanent localized dilation of an artery that enlarges graduallyartery that enlarges gradually

Causes: atherosclerosis, congenital Causes: atherosclerosis, congenital malformations, infection, connective malformations, infection, connective tissue disorders, hypertensiontissue disorders, hypertension

Complications: rupture, pressure on Complications: rupture, pressure on surrounding structures, thrombosis surrounding structures, thrombosis and embolizationand embolization

20092009

20092009

RAYNAUD’S RAYNAUD’S SYNDROMESYNDROME

20092009

RAYNAUD’S SYNDROMERAYNAUD’S SYNDROME

- vasospasm of the arterioles & - vasospasm of the arterioles & arteries of extremities.arteries of extremities.

Etiology:Etiology: coldcold stressstress SmokingSmoking caffeinecaffeine

20092009

BueRGER’S BueRGER’S DISEASEDISEASE

20092009

BUERGER’S DISEASEBUERGER’S DISEASE

Also called “Thromboangitis obliterans”Also called “Thromboangitis obliterans”

occlusive disease of the median & small occlusive disease of the median & small arteries & veins accompanied by clot arteries & veins accompanied by clot formation.formation.

Etiology:Etiology: unknown unknown smokingsmoking malesmales

20092009

VARICOSE VEINSVARICOSE VEINS

20092009

VARICOSE VEINSVARICOSE VEINS

Permanently distended veins that develop Permanently distended veins that develop due to loss of valvular competence maybe due to loss of valvular competence maybe due to prolonged standingdue to prolonged standing

Common sites: greater and lower Common sites: greater and lower saphenous veins and perforator veinssaphenous veins and perforator veins

Incidence: higher in femalesIncidence: higher in females Types:Types:

– Primary – congenital/familial originPrimary – congenital/familial origin– Secondary – from trauma, obstruction, DVT or Secondary – from trauma, obstruction, DVT or

inflammationinflammation

20092009

CHRONIC VENOUS CHRONIC VENOUS INSUFFICIENCYINSUFFICIENCY

20092009

CHRONIC VENOUS CHRONIC VENOUS INSUFFICIENCYINSUFFICIENCY

Group of disorders resulting from Group of disorders resulting from faulty venous valvesfaulty venous valves

Manifestations: swollen limbs, thick Manifestations: swollen limbs, thick and brownish skin, venous stasis and brownish skin, venous stasis ulcerations, itchy scaly skinulcerations, itchy scaly skin

20092009

LYMPHEDEMALYMPHEDEMA

20092009

LYMPHEDEMALYMPHEDEMA

Swelling caused by impaired Swelling caused by impaired transcapillary fluid transport and transcapillary fluid transport and transportation of lymphtransportation of lymph

ClassificationClassification– Primary – according to age of onsetPrimary – according to age of onset

Congenital (Milroy’s disease)Congenital (Milroy’s disease) Praecox (before age 35)Praecox (before age 35) Tarda (after age 35)Tarda (after age 35)

– Secondary – due to damage of the lymphatic Secondary – due to damage of the lymphatic system by another disease process (filariasis, system by another disease process (filariasis, inflammation, neoplasms, surgical excision)inflammation, neoplasms, surgical excision)

20092009

THE ENDTHE END