Cardiovascular System

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Cardiovascular System
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Cardiovascular System

• Functions
• pump saturated oxygenated blood into arterial
  system ? cells
• pump desaturated deoxygenated blood to lungs via
  veins for reoxygenation
• Heart size depends on persons size
• ? size of fist

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Four Chambers

• Right atrium (deoxygenated bld)
• ?
• Right ventricle (to lungs)
• ?
• Left atrium (receives oxygenated blood)
• ?
• Left ventricle (to systemic circulation)

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2 Types of Valves

• AV valves - mitral between LA LV
• - tricuspid between RA RV
• Prevents backflow during contraction - systole
• Semilunar valves - prevent backflow during
  relaxation of ventricles - diastole

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Cardiovascular System

• Right left side of heart is divided by cardiac
  septum.

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Cardiac Cycle

• Systole Diastole 1 heartbeat
• Systole - period when ventricles contract eject
  blood
• - mitral tricuspid close
• - S1 produced

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Cardiac Cycle

• Diastole - ventricles in relaxed state
• - atria contract ? blood to ventricles
• - aortic pulmonary valve close
• - S2 produced

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Neck Vessels
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Cardiovascular System

• under (N) circumstances impulse originates in
  S.A. node ? pacemaker
• (N) rate 60 - 100 bpm
• Dysrhythmias ? other cells also fire
• PAC ? abnormal firing in atrium
• PVC ? abnormal firing in ventricle

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EKG

• Electrical activity recorded as specific waves.
• Records 2 Electrical Events
• 1. Depolarization - spread of impulse through
  heart
• 2. Repolarization - return of heart muscle to
  resting state.
• Sequence of R D ACTION POTENTIAL

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EKG other terms

• Conductivity - cells ability to conduct
  transmit electrical impulse
• Contractility - ability of fibers to contract
• - ? contractility ? C.O.
• EKG
• P waves
• QRS complex
• ST segment

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Factors Affecting Heart

• Exercise - ?
• Pain - ?
• Anxiety - ?
• Athletic fitness - ?
• Thyroxin - ?
• Epinephrine - ?
• ? temp - ?
• ? temp - ?

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Blood Pressure

• Measure of pressure exerted by blood against
  walls of arteries.
• Systolic - pressure when heart contracts
• Diastolic - pressure with relaxation

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Factors Affecting Blood Pressure

• Cardiac output - ? C.O. ? B/P
• - ? C.O. ? B/P
• Elasticity - ? with hardening ? B/P
• Blood viscosity - Polycythemia ? B/P
• - Anemia ?B/P

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Factors Affecting Blood Pressure cont

• Age
• Weight
• Emotion
• Exercise

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Assessment

• 1. History - major symptom, chest pain.
• P - exercise, straining, ?activity, emotional
• - rest, NTG, O2
• Q - crushing, heavy, dull, burning, pressure
• (own words)
• R - (L) Anterior chest
• - (R) arm, jaw, neck, shoulders

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Assessment

• S - anorexia, N V
• - SOB, anxious, sweaty, dizzy
• T - constant, intermittent, sudden,
  insidious
• 2. SOB/Dyspnea - orthopnea
• 3. Palpitations - flutterings

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Assessment

• 4. Sensation of skipped beats
• 5. Syncope - ? C.O. ? brain perfusion
• 6. Fatigue/weakness
• 7. Peripheral skin changes - edema - CHF
• tightness
• 8. Smoking - vasoconstriction
• 9. Weight gain

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Assessment

• 10. Cough
• 11. Anxiety
• 12. Family history
• 13. Medications
• 14. Lifestyle
• 15. Post history

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Physical Exam

• Cyanosis
• clubbing
• edema
• ? capillary refill
• pulse - rate, rhythm, strength
• pulse pressure - 120/80 pp - 40
• General appearance - distress, color, ? LOC
• Urinary output - ? kidney perfusion

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Palpate Carotid artery
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Abnormal Pulsations on Precordium
Base
Left Sternal Border
Apex
Apex
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Congenital Heart Defects
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Murmurs due to Vascular Defects
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Murmurs due to valvular defects
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Jugular Vein Pressure
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Hepatojugular Reflex
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Palpate Apical Impulse
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Palpate Across Precordium
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Auscultation

• S1, S2, S3, S4
• Look _at_ abnormal sounds
• Pericardial Friction Rub - coarse, scratchy
• Murmurs - rumbling, swishing
• - heard at valve area
• S3 ventricular wall compliance ?

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Auscultatory Areas
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Auscultate Heart Sounds
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First and Second Heart sound
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Auscultate Extra heart Sounds
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Congestive Heart Failure
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EKG readings

• Dysrhythmias indicate irregular pulse, chest
  pain, syncope, dyspnea
• Ventricular fibrillation (rapid bizarre
  pattern)
• palpate radial pulse - irregular ? possible
  atrial fibrillation
• Assess jugular vein pressure in semifowlers 45?

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Diagnostic Tests

• Invasive
• Noninvasive
• 1. CXR - heart size
• - calcification of arteries, valves
• - position of heart

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Diagnostic Tests

• 2. EKG - electrical activity
• - telemetry
• - dysrhythmias
• - drug therapy response Purpose of
• - response to activity telemetry
• detects pacemaker - pacemaker beats
• demand pacemaker - stimulates heart when
  rate drops below set level

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Diagnostic Tests

• 3. Echocardiogram
• - high frequency sound waves through chest wall
• - Image on screen
• - returning signals recorded
• - look _at_ size, shape, motion
• - detect hypertrophy, pericardial effusion
  function of prosthetic valves.

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Diagnostic Tests

• 4. Nuclear Medicine Testing
• - inject IV radioactive isotopes
• - uptake counted
• i.e. 1. Thallium scan - evaluates blood flow in
  different parts of heart
• - see old infarcts cold spots ?perfusion

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Diagnostic Tests

• 4. Nuclear Medicine testing cont
• i.e. 2. Technetium Scan - taken up in area of MI
• - hot spots extent of damage
• - best 1 - 6 days

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Diagnostic Tests

• Invasive
• 1. Cardiac catheterization
• 2. Biopsy
• 3. Pericardiocentesis - removal of fluid from
  pericardial sac.
• - see inflammation, tumor.

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Diagnostic Tests

• Invasive cont
• 4. Stress test
• - detect etiology of chest pain
• - screen for CAD
• - functional capacity of heart after MI
• - drug therapy
• - identify dysrhymias by exercise

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Diagnostic Tests

• Bloodwork
• - CBC - O2 capacity ? RBC, Hgb
• - WBC - ? MI (necrotic tissue)
• - ESR - Inflammation
• - Lytes - K
• - PT / PTT

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Diagnostic Tests

• Bloodwork cont
• - Enzymes - CK - ? 6 hrs
• - peak 18 - 36 hrs
• - RTN 3 - 6 days
• - LD - ? 12 hrs
• - peak 48 - 72 hrs
• - RTN 10 - 14 days

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Diagnostic Tests

• Bloodwork cont
• - Cholesterol / lipids
• - LDL - low density
• - HDL - high density ? carry lipids away
  from arteries.