the cardiovascular system
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The Cardiovascular System
Chapters 15-18
The Heart
• Location:– Thoracic cavity– Behind sternum– Between the lungs
The Heart:
• Protective sac– PERICARDIUM
• Layers of heart tissue– Epicardium– Myocardium– Endocardium
The Heart
• Function– Double pump– Right
• Receives blood from the body (pumps blood to)
• Lungs– Left
• Receives blood from the lungs
• body
The Heart: Blood flow
• Inferior & Superior Vena cava
• Right Atrium – Tricuspid valve
• Right Ventricle – Pulmonary valve
• Pulmonary Arteries – Pulmonary arterioles – Pulmonary capillaries – Pulmonary venules
• Pulmonary veins
The Heart: Blood flow
• Pulmonary veins • Left Atrium
– Bicuspid (mitral) valve • Left ventricle • Aorta
– Aortic Valve• (body)• Arteries• Capillaries • Vein
The Heart: Blood flow
• Veins • Inferior & Superior Vena cava
• Right Atrium
– Tricuspid valve• Right Ventricle • Pulmonary Arteries
– Pulmonary arterioles – Pulmonary capillaries – Pulmonary venules
• Pulmonary veins
Heart Beat
• Lub-dub; lub-dub• First sound– S1 (lub)– “AV valves” close– (valves between the
atriums & ventricles)– Tricuspid– Bicuspid
• Second sound– S2 (dub)– “semilunar valves” close– Aortic valve– Pulmonary valve
Conduction System
• Cardiac muscle does not need the nervous system to generate an electrical impulse
Cardiac Cycle
• Contraction & relaxation of the heart =– One heart beat
• Diastole– Ventricles relax
• Systole– Ventricles contact
Normal Heart Rate
• 70-90 / minute• > tachycardia• < bradycardia
Cardiac output
• Stroke Volume (SV)– Amount of blood pushed
from the heart with each heart beat (ventricle contraction)
– @ 70 mL
• Cardiac Output (CO)– Amount of blood
pumped by the ventricles in 1 minute
• CO = HR (pulse) x SV– @4-8 L/min
Peripheral Vascular System• Network of blood vessels
that carry blood to peripheral tissues and then return it to the heart
• Arteries – carry blood away from the
heart• Capillaries• Veins
– carry blood towards the heart
Arteries & Veins
• Aorta – Arteries
• Arterioles– Capillaries
• Venules– Veins
• Superior & Inferior Vena Cava
Capillaries
• Where Oxygen & nutrients are exchanges
• Very permeable
Blood vessel structure
• Inner layer – Slick surface
• Middle layer– Smooth muscle
• Out layer – Protection
Blood Vessel Structure
• Smooth muscle function– Constriction
• Narrowing– Dilation
• Widening
Blood Vessel Structure
• Veins have something Arteries don’t have!– Valves
Blood Pressure (BP)
• Force exerted by blood against the walls of the arteries
• SYSTOLIC– Pressure exerted when
the heart contracts• DYASTOLIC– Pressure when the heart
is filling
Blood Pressure (BP)
• Optimal Blood Pressure– <120 / 80
Blood
• Oxygenated– Blood that is carrying
oxygen• Deoxygenated– Blood that is not carrying
oxygen– Carrying CO2
Oxygenated & Deoxygenated
• Inferior & Superior Vena cava
• Right Atrium – Tricuspid valve
• Right Ventricle – Pulmonary valve
• Pulmonary Arteries – Pulmonary arterioles – Pulmonary capillaries – Pulmonary venules
• Pulmonary veins
Oxygenated & Deoxygenated
• Pulmonary veins • Left Atrium
– Bicuspid (mitral) valve • Left ventricle • Aorta
– Aortic Valve• (body)• Arteries• Capillaries • Vein
The Heart: Blood flow
• Veins • Inferior & Superior Vena cava
• Right Atrium
– Tricuspid valve• Right Ventricle • Pulmonary Arteries
– Pulmonary arterioles – Pulmonary capillaries – Pulmonary venules
• Pulmonary veins
Small Group Questions
• Fill in the chart.• Describe blood flow
through the heart & body.
• Where is oxygenated blood and deoxygenated blood found?
Cardiac Assessment
• Health History– Chest pain– Breathing problems
• Short of breath– Changes in energy levels– Medication– Life style
• Alcohol intake• Exercise• Smoking• Illicit drugs
Cardiac Assessment
• Skin Color– Pallor
• Pale– Cyanosis
• Blue
Cardiac Assessment
• Vital Signs• Peripheral pulses• Capillary refill• Edema?• Auscultate the heart
Diagnostic Tests
• Lipid profile– Cholesterol– Triglycerides– High-density lipoproteins
(HDL’s)– Low-density lipoproteins
(LDL’s)
• Assess risk for atherosclerosis & coronary heart disease
Diagnostic Tests
• Serum Cardiac Markers(Cardiac enzymes)– Creatine phosphokinase– CK-MB– cTnT
– cTn1
• Heart muscle cells that are dead or damaged release these proteins.
• Increased levels = heart damage
Diagnostic Test
• Electrocardiogram (ECG)– Record of the electricity
of the heart
Imaging Techniques
• CT scan– 3-D X-ray machine
Imaging Techniques
• MRI scan– Magnetic resonance
imaging
MRI: Rules
• No METAL in the room with the machine
• Assess for – Metal implants– Claustraphobia
• http://www.youtube.com/watch?v=7g5UVrOt2CI
• http://www.youtube.com/watch?v=6BBx8BwLhqg&NR=1
Imaging Techniques
• Angiography– INVASIVE
• Insertion into an artery– X-rays + fluoroscopy
Imaging Techniques
• Angiography– INVASIVE– Risks – • Bleeding• Clot
– Assess:• Insertion site• Pedal pulses
WARNING: Angiography
–Closely monitory the client, the insertion site, the extremity after the procedure. Immediately report evidence of bleeding, pain or a pale pulseless extremity to the charge nurse & physician
Coronary Heart Disease
• AKA– Coronary Artery Disease
• Definition– Narrowing of the
arteries that supply blood to the heart muscles
Arteriosclerosis & Atherosclerosis
Arteriosclerosis• Arteries that are
– Thick– Non-elactic
Atherosclerosis• Plaque buildup in the
arteries• #1 cause of CHD
CHD: Risk Factors
Changeable• Smoking• Obesity• Physical inactivity• High fat diet• High blood pressure
– Hypertension / HTN• High blood lipids
– Hyperlipidemia• Diabetes Mellitus
Non-changeable• Age• Gender• Race• Heredity
Atherosclerosis: Pathophysiology
• Narrow arteries • i blood flow • ISCHEMIA– Not enough blood or
oxygen for their metabolic needs
• Infarction– Tissue death
S&S of atherosclerosis
• No symptoms until 75% of the lumen is occluded
• Symptoms are due to ISCHEMIA
Atherosclerosis: IDT Interventions
• Quit smoking• Diet– Low fat
• Exercise• Control BP• Control DM
Atherosclerosis: IDT Interventions
• Medications– Cholesterol-Lowering
Drugs• Statins
– Lipitor– Lescol– Mevacor– Pravachol– Crestor– Zocor
• Nursing Implications– Monitor serum lipid
levels– Assess liver
Angina Pectoris
• “Chest pain when there is a temporary imbalance between myocardial blood supply and demand”.
• Chest pain due to i blood/ oxygen to the heart muscle
Angina Pectoris: S&S
• Pain– Chest– Radiating to
• Neck• Shoulder• Arm • Jaw
– Tight, squeezing, heavy• Shortness of Breath
(SOB)
IDT: Angina Pectoris
• WARNING!!!!
IDT: Angina Pectoris
• Medications– Nitrates– Beta Blockers– Calcium Channel
blockers
Nitrates
• Action:– Dilate blood vessels – h blood flow to the
heart• E.G.– Nitroglycerin
• Route– Sub-lingual– Patches– Ointment
Beta-Blockers
• Decrease workload of the heart
• Nrs Implications– Take BP & pulse before– Hold if <50/min
Calcium Channel Blockers
• Purpose– Treat angina and HTN
• Nrs. Implications– BP & pulse before– Hold if < 50/min
Myocardial Infarction (MI)
• AKA: Heart attack• i blood / oxygen to the
heart muscle • Ischemia • Infarction / necrosis • i cardiac output• Death
Myocardial infarction: S&S
• Chest pain• Tachycardia• Short of breath– Dyspnea
• Skin: cool, clammy• Diaphoresis• Anxiety• N&V
IDT: Myocardial Infarction
• IV (for meds)• Oxygen (via nasal
cannula)• Bed Rest
Meds: Myocardial Infarction
• Aspirin– Thins the blood
• Fibrinolytic agents– Drugs that dissolve clots
• Pain reliever– Nitroglycerin– Morphine sulfate– Relax blood vessels
vasodilation h blood flow
Heart Failure
• “Inability of the heart to function as a pump to meet the needs of the body”
Left-side heart failure
• i cardiac output• h pulmonary
pressure (backs up)
S&S: Left Sided Heart Failure
• Activity intolerance• Short of breath• Orthopnea• Cough• Crackles
Right-side heart failure
• h venous pressure • Edema
S&S: Right-Side Heart Failure
• Activity intolerance• Edema• Jugular vein distention
Medications: Heart Failure
• Diuretics– Furosemide / Lasix– Action
• h urine output
• Positive Inotropic Agents– Digoxin / Lanoxin
• h contractility (heart contraction strength)
Hypertension
• AKA: – high blood pressure
• BP – > 140 systolic– > 90 diastolic
• Pg 430 - 438
Hypertension: Risk Factors
Changeable• Diet
– High Na+– Low K+
• Obesity• Smoking• Alcohol (excess)• Stress• Diabetes
Non-changeable• Family history• Age• Race
Hypertension: S&S
• “The Silent Killer”– H/A– Blurred vision
IDT Tx: Hypertension
• Monitor BP • No Caffeine• No smoking• Lifestyle changes– Diet– Alcohol / Smoking– Physical Activity– Stress reduction
Hypertension: Rx
• Broad classification– Anti-hypertensives
Hypertension: Rx
• ACE inhibitors – (angiotensin-converting
enzyme)– Blocks formation of
angiotensin II • vasodilation
– Blocks aldosterone• i fluid volume
Hypertension: Rx
• Beta-blockers– i the heart rate– i contractility –
• i cardiac output
Hypertension: Rx
• Calcium Channel blockers– Block Ca+ channels in
arterial smooth muscle – Vasodilation
Hypertension: Rx
• Diuretics– h urine output – i fluid volume
Venous Thrombosis
• Thrombo = clot• -osis = abnormal condition• Blood clot (forms on the
wall) of the vein – blockage of blood flow
back to the heart
• Pg 448 - 454
Thrombophlebitis
• Thrombo = – Clot
• Phlebo – Vien
• -itis– Inflammation
• Inflammation caused by clot in the vien
Venous thrombosis
• 3 Factors– Venous stasis
• Slow blood flow– h blood coagulation– Vessel wall injury
Venous thrombosis
• Blood returns to the heart through collateral vessels
Venous thrombosis
• Thrombus (thrombi) may break loose – Embolus (emboli)
• Thrombi =– Stationary
• Emboli– Mobile
Deep Vein Thrombi: S&S
• Most common place– Calf
Deep Vein Thrombi: S&S
• Calf pain• Muscle tenderness• Enlarged calf• h temperature
Deep Vein Thrombi: Complications
• Pulmonary embolism– Clot that travel to the
lung – Blocks the pulmonary
artery
Deep Vein Thrombi: Dx
• Doppler ultrasonography– Used to visualize the
vein and blood flow
Deep Vein Thrombi: Rx
• NSAID’s• Anticoagulants• Fibroinolytic drugs
Deep Vein Thrombi: Rx
• NSAID’s– i inflammation
Deep Vein Thrombi: Rx
• Anticoagulants– Prevent blood clotting– E.G.
• Heparin• Warfarin (Coumadin)
– S/E• Bleeding
Deep Vein Thrombi: Rx
• Fibrinolytic drugs– Breaks up clots– S/E
• Bleeding / hemorrhage
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