Cardiovascular
Cardiovascular
Cardiovascular
CARDIOVASCULAR SYSTEM
ANATOMY AND PHYSIOLOGY Composed of the heart and Composed of the vascular system
MAJOR FUNCTION OF CARDOVASCULAR SYSTEM Transporting nutrients and oxygen to the body Removing wastes and carbon dioxide Maintaining adequate perfusion of organs and tissues
VASCULAR SYTSYEM
Is composed of the blood vessels of the body The blood vessel of the body have 3 types: Arteries (arterioles) Veins (venules) Capillaries
BLOOD VESSEL
Arteries (and arterioles) Are large, thick-walled muscular vessels that carry blood away from the heart The largest artery is the aorta. The middle layer of an artery wall consists of smooth muscle that can constrict to regulate blood flow and blood pressure. Arterioles can constrict or dilate, changing blood pressure. Veins (and venules) large blood vessels that carry blood from the tissues back to the heart Venules drain blood from capillaries, then join to form veins that take blood to the heart.
Veins have much less smooth muscle and connective tissue than arteries.
Veins often have valves that prevent the backward flow of blood when closed. Veins carry about 70% of the bodys blood and act as a reservoir during hemorrhage.
Capillaries
Are microscopic blood vessels with walls that are only one cell thick to enable nutrients and gases to diffuse easily between blood and tissues Capillaries have walls only one cell thick to allow exchange of gases and nutrients with tissue fluid. Capillary beds are present in all regions of the body but not all capillary beds are open at the same time. Contraction of a sphincter muscle closes off a bed and blood can flow through an arteriovenous shunt that bypasses the capillary bed.
Blood vessels
The walls of arteries and veins have three layers. The inner layer is composed largely of endothelium, with a basement membrane that has elastic fibers; the middle layer is smooth muscle tissue; the outer layer is is connective tissue (largely collagen fibers). Veins (on right) are larger in diameter than arteries, so that collectively veins have a larger holding capacity than arteries. Arteries (on left) have a thicker wall than veins because they have a larger middle layer than veins. Capillary walls (center) are onecell-thick endothelium.
HEART
Lying between lungs and middle mediastinum.
Inner Visecral Pericardium =lines the surface of the heart Outer Parietal Pericardium = fluid between the serous and fibrous = lubricates the layers and allows for a gliding
motion between them w/ each heartbeat
2. Left Atrium Have a thicker walls than the right Receives blood from lungs by way of for pulmonary vasculature Mitral orifice- guarded by MITRAL VALVE
3.Right Ventricle
Constitutes right inferior portion of apex of the heart. Receives blood from right atrium(RA) and brings blood to The lungs trought the PULMONARY ARTERIES.
Inner surface the muscular column = TROBECULAE CARNAE. Some muscular colums project and called = PAPILLARY MUSCLES. At ends papillae are fibrous strancolled CHORDAE TENDINAE- keeps valve leaf lets from turning out.
Pulomonary orifice- guarded by pulmonary valve Tricuspid orifice- guarded by tricuspid balve 4. Left Ventricle Constitute left inferior portion of the apex of the heart
thick walls =pumps blood received from left atrium (LA) of the blood through the aorta
RIGHT AND VENTRICLES = separated by Intervenricular Septum
Brings blood from upper portions of body 2. Inferior Vena Cava(IVC) Brings blood from lower part of the body 3. Coronary Sinus Drains blood from the heart itself
1.
ATRIOVENTRICULAR VALVES OR AV VALVES A. TRICUSPID prevents backflow of blood from right ventricle(RV) to right atrium( RA)
B.MITRAL OR BICUSPID Prevents backflow of blood from left ventricle(LV) to left atrium(LA)
2. SEMILUNAR VALVES
2. MYOCARDIUM
Middle muscular layer Heart muscular contracts rhythmically and spontaneously
3. ENDOCARDIUM Innermost layer = collagenous, elastin fibers b.v, and nerves and purkinje fibers
1.
SINO-ATRIAL NODE (SA NODE) Located post wall of right atrium (RA) Initiates heartbeat- ( CARDIAC PACEMAKER)
2. ATRIO-VENTRICULAR NODE ( AV-NODE) Located right side of inter atrial septum There is a delay in the conduction of excitation at the A NODE to allow time for a the atria to complete the emptying of their contest to the ventricles 3. BUNDLE OF HIS OR ANTRIOVENTRICULAR BUNDLES (AV BUNDLES) Goes down to the right side of inter-ventricular septum and divides into a right and left branches. Each branches divides into conducting fibers known as PURKINJE FIBERS from antrioventricular node (AV node) excitation spreads through the bundles of his 4. PURKENJE FIBERS Conducting fibers of left and right branches of the bundle of his extends over to the undersurface of endocardium
Right branch
Left branch
Purkinje fibers
Purkinje fibers
The pumping of the heart sends out blood under pressure to the arteries.
Blood pressure is greatest in the aorta; the wall of the left ventricle is thicker than that of the right ventricle and pumps blood to the entire body.
Blood pressure then decreases as the cross-sectional area of arteries and then arterioles increases.
This diagrammatic
representation of the heart allows you to trace the path of the blood through the heart.
The systemic circuit starts with the aorta carrying O2rich blood from the left ventricle. The aorta branches with an artery going to each specific organ. Generally, an artery divides into arterioles and capillaries which then lead to venules.
The vein that takes blood to the vena cava often has the same name as the artery that delivered blood to the organ. In the adult systemic circuit, arteries carry blood that is relatively high in oxygen and relatively low in carbon dioxide, and veins carry blood that is relatively low in oxygen and relatively high in carbon dioxide. This is the reverse of the pulmonary circuit.
The coronary arteries serve the heart muscle itself; they are the first branch off the aorta. Since the coronary arteries are so small, they are easily clogged, leading to heart disease.
The hepatic portal system carries blood rich in nutrients from digestion in the small intestine to the liver, the organ that monitors the composition of the blood.
Blood Flow
The beating of the heart is necessary to homeostasis because it creates pressure that propels blood in arteries and the arterioles.
Arterioles lead to the capillaries where nutrient and gas exchange with tissue fluid takes place.
The blue-colored vessels carry O2-poor blood, and the red-colored vessels carry O2-rich blood; the arrows indicate the flow of blood. Capillaries are present in all parts of the body, so no cell is located far from a capillary.
Equipment needed:
Blood Pressure
OBJECTIVES: 1. Describe the structure and function of cardiovascular system, including the pheripheral vascular system 2.Explain developmental variations a nurse considers when assessing the heart & neck vessels & pheripheral vascular system 3.State the specific areas considered essential in gathering subjective data pertaining to the cardiovascular system and the peripheral vascular system 4.Demonstrate assessment of the heart, neck vessels and pulmonary vein (PV) system
4 TECHNIQUES
Cardiovascular examination
Check pulsation, heaves, lifts, ( you may see the apical pulse) NOTE: The apical is located in the 4th or 5th intercostal space at the left midclavicle
Palpate
Feel the apical impulse. Use 1 finger pad Use palmar side of 4 fingersto feel for other pulsations on the chest (eg. Thrill)
PERCUSSION
AUSCULTATION
Aortic-2nd Rt ICS
Pulmonic-2nd left ICS
Erbs Point
Tricuspid left sternal border
These extrathoracic sounds are often referred down the airways and can often be heard over the thorax and are often mistaken as pulmonary wheezes is significant and indicates upper airway obstruction.
4. Stertor is a poorly defined and inconsistently used term to describe harsh discontinuous crackling sounds heard over the larynx or trachea.
It is also described as a sonorous snoring sound heard over extrathoracic airways.
Heart defects are among the most common birth defects and are the leading cause of birth defect-related deaths. Approximately 1 in 125 babies are born each year in the US with a Congenital Heart Defect.
may be caused by a thickening of the heart muscle because of increased workload. (This increased workload can be due to heart valve disease or high blood pressure,) This is called hypertrophy (hi-PER'tro-fe), which refers to enlargement of an organ or tissue due to an increase in cell size.
Arrhythmias Heart
is a disorder of the heart rate (pulse) or heart rhythm, such as beating too fast (tachycardia), too slow (bradycardia), or irregularly. Arrhythmias may also be caused by some substances or drugs, including: Amphetamines Caffeine Cocaine Beta blockers Psychotropics Sympathomimetics
Murmur
are extra heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noise. Most murmurs can only be heard with the assistance of a stethoscope ("on auscultation"). A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart, as opposed to structural defects in the heart itself Functional murmurs may be benign (an "innocent murmur") mildly troublesome, or serious.
Congestive Heart Failure is a condition in which the heart can't pump enough blood to the body's other organs. This can result from: narrowed arteries that supply blood to the heart muscle coronary artery disease past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work high blood pressure heart valve disease due to past rheumatic fever or other causes primary disease of the heart muscle itself, called cardiomyopathy. infection of the heart valves and/or heart muscle itself endocarditis and/or myocarditis heart defects present at birth congenital heart defects.
Septal defect
a congenital abnormality in the septum
between the left and right sides of the heart Ventricular Septal Defect (VSD)
Its the most common congenital heart defect in the newborn; its less common in older children and adults because some VSDs close on their own.
Atrial Septal Defect (ASD) is a defect in the septum between the hearts two upper chambers (atria). The septum is a wall that separates the hearts left and right sides. Septal defects are sometimes called a hole in the heart.
Angina or Myocardiac Infarction commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery
The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).
1. FAMILY HISTORY OF CARDIAC DISEASE Family members w/ any of the above described illnesses relation to the patient, specific problem, age of onset, age of death, disease/ cause of relatives death
is a type of defect or malformation in one or more structures of the heart or blood vessels that occurs before birth
Rheumatic Fever is an inflammatory disease that occurs following a Group A streptococcal infection, (such as strep throat or scarlet fever). Believed to be caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain, the illness typically develops two to three weeks after a streptococcal infection. Acute rheumatic fever commonly appears in children between the ages of 5 and 15, with only 20% of first-time attacks occurring in adults. The illness is so named because of its similarity in presentation to rheumatism.[2]
Thyroid Disease
is a medical condition impairing the function of the thyroid. is a small gland located below the skin and muscles at the front of the
Diabetes is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth.
Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood - it is the principal source of fuel for our bodies.
Obesity
is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems
Tobacco use
Smoking is a practice where a substance, most commonly tobacco, is burned and the smoke tasted or inhaled. .
Hypercholesterolemia
Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. It is closely related to the terms "hyperlipidemia" (elevated levels of lipids) and "hyperlipoproteinemia" (elevated levels of lipoproteins).
Excessive caffeine
found naturally in tea and coffee plants which acts as a mild stimulant of the central nervous system
There are several short-term effects of caffeine. Some of the most common short-term effects of drinking caffeine are: increased alertness (caffeine is a mild stimulant) makes your heart beat faster (caffeine is a mild stimulant) makes you go to the toilet more (caffeine is a diuretic) raises your body temperature makes your digestive system produce
more acid.
Alcohol or drug abuse Alcoholism is drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or job responsibilities.
3. CHEST PAIN? Often patients are unable to describe the sensation they feels as pain Can arise suddenly or gradually, and its cause may be difficult to ascertain initially.
The pain can radiate to the arms, neck, jaw, or back. It can be steady or intermittent, mild or acute
4.RHYTHM IRREGULARITIES? Are there palpatations Skipped beats Racing of the heart: when, how often; associated symptoms (shortness of breath, chespain or diaphoresis 5 .CYANOSIS? blue lips or nailbed Ashen color of skin Hacking, constant,intermittent, or rare; time of the day (e.g, early morning) Chest pain Productive or non productive: color and consistency of the sputum ( thick,thin, clear, yellow, green,maldorous, blood
tinged
5. COUGH?
Hacking, constant,intermittent, or rare; time of the day (e.g, early morning) Chest pain Productive or non productive: color and consistency of the sputum (thick,thin,clear,yellow,green,maldorous, blood tinged) 6.FATIGUE? Ability to keep up w/ friends and colleagues
7. EDEMA?
Where and when: lower legs Ankles;at night in the morning; pitting or non pitting; Unilateral or bilateral
8. Nocturia?
Date of onset Number of times each night Waking at night w/ urgent need to urinate
9. OCCUPATIONAL RISKS?
Stressful occupational Exposed to smoke Pollution Toxins Vapors Fumes Strenous excercise
Type Dosage How long Side effects Any recent changes in medication or dosages
11. PAS TWORK-UP? past cardiovascular test or surgery: Chest x-ray ECG Echocardiogram Exercise stress test Holter monitor Cardiac catherization Angiosplasty Valvuloplasty Valve replacement or bypass Results Complications
HEART EXAMINATION
Holter monitoring
Chest x-ray
Ecocardigram (ecg)
cont.heart examination
angioplasty
cont.heart examination
Valvuloplasty
cont.heart examination
Cardiac catherization
cont.heart examination
The Heartbeat
Each
heartbeat is called a cardiac cycle. When the heart beats, the two atria contract together, then the two ventricles contract; then the whole heart relaxes.
CARDIAC CYCLE
IT HAS TWO PHASE:
1. SYSTOLIC
i.
The lungs
Ventricles relax & filled with blood ( this 2/3 of the cardiac cycle)
HEART SOUNDS
S1
When closure of the Atrio-venricular (AV) Valves (tricuspid & mitral) & ventricles contract
S2
When closure of the semilunar valves (pulmonic & aortic) and the ventricles relax
S1 and S2 sound lub dup S1 and louder than S2 at the apex S2 is louder than S1 at the base S1 coincides w/ the carotid pulsation
S3 This occurs immediately after S2 Why? Resistance to filling of ventricles note: also called a ventricular gallop * it a caused by overload * use diaphraghm ( it is a high sound)
S4 This occurs at the end of diastole, just before the next S1 Why? The Atrium contract & push blood into a non-compliant ventricles. NOTE: also called an atrial gallop * caused by hypertension, Aortic stenosis, cardiompathy * used bell to listen as it is a low sound
GRADING OF MURMURS
Use VI point grading scale & record as fraction (ie. l/ lV or ll/Vl )
Grades: GRADE I : barely audible w/ stethoscope, often considered physiologic not pathologic. Requires concentration and quiet environment GRADE II: Very soft but distinctly audible GRADE III: moderately loud: there is no thrill or thrusting motion associated w/ the murmur GRADE IV: distinctly loud in addition to a palpable thrill GRADE V: very loud can actually hear w/ part of the diaphragm of the stethoscope off the chest palpable thrustand thrill present
MURMURS
Caused by turbulence
Why?
1.Velocity of blood increases (eg. Exercise)
2. Velocity of blood decreases (eg. Anemia) 3. Structural defect in valves or unsual opening accurs in chambers
PULMONARY STENOSIS Usually harsh Pitch: medium Radiation: toward the left upper neck and shoulder areas
MITRAL REGURTATION Blowing and can be harsh in sound quality Pitch: high Radiation: usually to left axilla, LSB and base
TRICUSPID REGURGITATION Blowing PITCH: high RADIATION: May radiate to LSB and MCL but not to axilla
MITRAL STENOSIS Rumbling PITCH: low and best heard with bell RADIATION: rare
Electrocardiogram
A normal ECG (top) indicates that the heart is functioning properly. The P wave occurs just prior to atrial contraction; the QRS complex occurs just prior to ventricular contraction; and the T wave occurs when the ventricles are recovering from contraction. Ventricular fibrillation (bottom) produces an irregular electrocardiogram due to irregular stimulation of the ventricles. Ventricular fibrillation is of special interest because it can be caused by an injury or drug overdose. It is the most common cause of sudden cardiac death in a seemingly healthy person over age 35. Once the ventricles are fibrillating, they have to be defibrillated by applying a strong electrical current for a short period of time. Then the SA node may be able to reestablish a coordinated beat.