ARRHTYMIA (Cardiac Arrhythmia) 2.

Re-entry Tachycardias
– a condition in which the heart beats with an irregular or abnormal rhythm.  Atrial Fibrillation
 loss of the normal organised propagation of electrical activity
ABNORMAL RHYTHM  atria fibrillate, they no longer contract in a mechanically useful way
CAN BE OF TWO EXTREME FORMS  a degree of stasis to blood flow and predisposing to clot (thrombus)
Bradycardia - Cardiac beats below 60 beats per minute formation within the chambers
Tachycardia – Cardiac beat above 100 beats per minute  Ventricular Fibrillation
ETIOLOGY  Uncoordinated contraction of the Cardiac Muscle
 Coronary artery disease.  Quiver rather than contract properly
 Electrolyte imbalances in your blood (such as sodium or potassium).  Commonly identified arrhythmia in Cardiac Arrest patients
 Changes in your heart muscle.  As a consequence, Sudden Cardiac Death
 Injury from a heart attack.  Wolf Parkinson White Syndrome (WPW)
 Healing process after heart surgery.  WPW is caused by the presence of an abnormal accessory electrical
 Irregular heart rhythms can also occur in "normal, healthy" hearts. conduction pathway between the atria and the ventricles.
 Ischemic Heart Disease  Electrical Signals through abnormal pathway stimulate the
 Drugs related ventricles to contract prematurely
 Others
 A unique type of supraventricular tachycardia referred to as an
”atrioventricular reciprocating tachycardia”
Arrhythmia Presentation
3. Delayed Repolarization
(SYMPTOMS)
 Causes
 Palpitation  Dyspnea  Sudden cardiac death
 Ischemia
 Dizziness  Fainting  Shortness of Breath  Drugs related (Potassium Blockers)
 Chest Pain  Swelling  Exercise Intolerance  Electrolyte Imbalance
 Effects
Mechanism of Arrhythmias
 Bradycardia  Long QT interval
1. SA node : Slowed / Absent  R on T Phenomenon
 Causes  Premature Ventricular Beat
 Decreased Sympathetic Signals  SA node Damage  Ventricular Fibrillation
 Increased Parasympathetic Signals
2. Blockage of Conduction from SA node THE LYMPHATIC AND IMMUNE SYSTEMS
 AV node Blockage
 Causes Lymphatic system
 Ischemia  Viral Infection – Main function is to return excess tissue fluid to blood vascular system
 Fibrosis – Lymphatic vessels collect tissue fluid
 RESULTS in HEART ATTACK
Immune system
 LEFT BUNDLE BRUNCH BLOCK (LBBB)
– Protects our bodies from foreign organisms
 No Impulse conduction through Bundle Brunch
– Confers immunity to disease
 Action Potential transferred RV to LV
– Main components
 RESULTS in Wide QRS complex
 Lymphocytes, lymphoid tissue, and lymphoid organs
 Tachycardia
Lymphatic vessels collect tissue fluid from loose connective tissue
1. Increased Pacemaker Activity (SA Node)- Sinus Tachycardia
– Carry fluid to great veins in the neck
 Causes
– Fluid flows only toward the heart
 Increased Sympathetic Signals
– Once tissue fluid is within lymphatic vessels it is termed lymph
 Decreased Parasympathetic Signals
 SA node Dysfunction Functions of lymphatic vessels – collect excess tissue fluid and blood proteins
 Example : Sick Sinus Syndrome Return tissue fluid and blood proteins to bloodstream

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Orders of Lymphatic Vessels
 Lymph capillaries – smallest lymph vessels
– First to receive lymph
 Lymphatic collecting vessels – collect from lymph capillaries
– Lymph nodes are scattered along collection vessels
 Lymph nodes – Scattered along collecting vessels
 Lymph trunks – Collect lymph from collecting vessels
 Lymph ducts – Empty into veins of the neck
Lymph Trunks
 Lymphatic collecting vessels converge
 Five major lymph trunks
– Lumbar trunks – receives lymph from lower limbs
– Intestinal trunk – receives chyle from digestive organs
– Bronchomediastinal trunks – collects lymph from thoracic viscera
– Subclavian trunks – receive lymph from upper limbs and thoracic wall
– Jugular trunks – drain lymph from the head and neck

Lymphatic Capillaries Lymph Ducts

 Located near blood capillaries  Cisterna chyli
 Receive tissue fluid from CT – Located at the union of lumbar and intestinal trunks
– Increased volume of tissue fluid  Thoracic duct
• Minivalve flaps open and allow fluid to enter – Ascends along vertebral bodies
 High permeability allows entrance of – Empties into venous circulation
– Tissue fluid and protein molecules • Junction of left internal jugular and left subclavian veins
– Bacteria, viruses, and cancer cells • Drains three quarters of the body
 Lacteals—specialized lymphatic capillaries Right Lymphatic Duct
– Located in the villi of the small intestines  Empties into right internal jugular and subclavian veins
• Receive digested fats
• Fatty lymph—chyle The Immune System
 Recognizes specific foreign molecules
Lymphatic Collecting Vessels  Destroys pathogens effectively
 Accompany blood vessels  Key cells—lymphocytes
 Composed of the same three tunics as blood vessels  Also includes lymphoid tissue and lymphoid organs
 Contain more valves than veins do  Lymphoid organs
– Helps direct the flow of blood – Lymph nodes, spleen, thymus, tonsils, aggregated lymphoid nodules, and
 Lymph propelled by appendix
– Skeletal muscles bulging
– Nearby arteries pulsing Lymphocytes
– Tunica media of the lymph vessels  Infectious organisms attacked by inflammatory response
 Lymph flow is unaided by heartbeat – Macrophages, then lymphocytes
 Are effective fighters of infectious organisms
Lymph Nodes – Each lymphocyte recognizes a specific foreign molecule
 Cleanse the lymph of pathogens • Antigens are any molecules inducing a response from a
 Human body contains around 500 lymphocyte
 Superficial lymph nodes located in  B lymphocytes and T lymphocytes are the two main classes of lymphocytes
– Cervical, axillary, and inguinal regions  Cytotoxic T lymphocytes
 Deep nodes are – Attack foreign cells directly
– Tracheobronchial, aortic, and iliac lymph nodes • Binds to antigen-bearing cells
• Perforates cell membrane
Microscopic Anatomy of a Lymph Node • Signals cell to undergo apoptosis
 Fibrous capsule—surrounds lymph nodes • Destroy virus infected cells and some cancer cells
 B lymphocytes
 Trabeculae—connective tissue strands
– Become plasma cells
 Lymph vessels
– Secrete antibodies
– Afferent lymphatic vessels
• Mark cells for destruction by macrophages
– Efferent lymphatic vessels
– Respond primarily to bacteria and bacterial toxins

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Lymphocyte Function Thymus
(a) Action of cytotoxic T lymphocyte  Immature lymphocytes develop into T lymphocytes
1. T lymphocyte binds to target cell, secretes proteins that lyse the cell’s  Secretes thymic hormones
membrane, and signals the cell to die.  Most active in childhood
2. T lymphocyte detaches from target cell  Functional tissue atrophies with age
3. Target cell dies by apoptosis  Composed of cortex and medulla
(b) Differentiation and activity of B lymphocyte – Medulla contains Hassall’s corpuscles (thymic corpuscles)
1. B lymphocyte gives rise to plasma cell, which secretes antibodies  Differs from other lymphoid organs
2. Antibodies bind to antigens on bacteria, marking the bacteria for destruction – Functions strictly in lymphocyte maturation
3. Antibody-coated bacteria are avidly phagocytized – Arises from epithelial tissue

Lymphocyte Activation Lymph Nodes

 Lymphocytes originate in bone marrow  Function
 Some travel to the thymus gland – Lymph percolates through lymph sinuses
– T lymphocytes – Most antigenic challenges occur in lymph nodes
 Some stay in bone marrow – Antigens destroyed and activate B and T lymphocytes
– B lymphocytes
 Able to recognize a unique antigen Spleen
– Gain immunocompetence  Largest lymphoid organ
• Travels through blood stream  Two main blood-cleansing functions
– Meets and binds to a specific antigen – Removal of blood-borne antigens
 During activation – Removal and destruction of old or defective blood cells
– Lymphocyte is presented its antigen by  Site of hematopoiesis in the fetus
• A macrophage or a dendritic cell  Destruction of antigens
 Both T and B lymphocytes produce clones of  Site of B cell maturation into plasma cells
– Effector lymphocytes  Phagocytosis of bacteria and worn-out RBCs, WBCs and platelets
• Respond immediately, then die  Storage of platelets
– Memory cells  White pulp
• Wait until the body encounters the antigen again – Thick sleeves of lymphoid tissue
• Basis of acquired immunity – Blood-borne antigens are destroyed as they activate the immune
• Prevent subsequent infections of the same illness response
Lymphoid Tissue – Provides the immune function of the spleen
• Most important tissue of the immune system  Red pulp
• Two general locations – Surrounds white pulp
– Mucous membranes of – Composed of
• Digestive, urinary, respiratory, and reproductive tracts • Venous sinuses
– Mucosa-associated lymphoid tissue (MALT) • Splenic cords
• Lymphoid organs (except thymus) • Responsible for disposing of worn out RBCs
Lymphoid Organs
 Primary lymphoid organs Tonsils
– Bone marrow  Simplest lymphoid organs
– Thymus
 Four groups of tonsils
 Secondary lymphoid organs – Palatine, lingual, pharyngeal, and tubal tonsils
– Lymph nodes, spleen, tonsils  Arranged in a ring to gather and remove pathogens
– Aggregated lymphoid nodules
 Underlying lamina propria consists of MALT
– Appendix
 Designed to gather and destroy infectious microorganisms and to store
lymphocytes

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Aggregated Lymphoid Nodules & Appendix
 MALT—abundant in walls of intestines
 Fight invading bacteria
 Generate a wide variety of memory lymphocytes
– Aggregated lymphoid nodules (Peyer’s patches)
• Located in the distal part of the small intestine
– Appendix—tubular offshoot of the cecum

Disorders of the Lymphatic and Immune Systems

 Chylothorax
– Leakage of fatty lymph into the thorax
 Lymphangitis
– Inflammation of a lymph vessel
 Mononucleosis
– Viral disease caused by Epstein-Barr virus
– Attacks B lymphocytes
 Hodgkin’s disease
– Malignancy of lymph nodes
 Non-Hodgkin’s lymphoma
– Uncontrolled multiplication and metastasis of undifferentiated
lymphocytes

The Lymphatic and Immune Systems Throughout Life

 Lymphatic vessels and lymph nodes
– Develop from lymphatic sacs
 Thymus originates as an outgrowth of the endoderm
 Spleen, lymph nodes, and MALT
– Arise from mesodermal mesenchyme

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