Cardiovascular Anatomy and Physiology

Daymar CollegeLisa H. Young, RN, BSN, MAE.

Dextrocardia

Skeleton of the heart

Anterior View of the Heart

Walls of the Heart

Heart Valves

Structures of the AV Valves

Heart Valveshttp://www.youtube.com/watch?v=39n4XWv7flQ

Left Ventricle Wall Surfaces

Heart Chambers

Heart Chambers

Left and Right Atrium Receives un-oxygenated blood from the

body and the lungs. Expands to accommodate

large volumes of blood from the body. Left and Right Ventricles Thick muscular walls to forcefully expel

blood to the body. Does not expand well.

Pressure Differences of the Heart

Blood flows from higher-pressure to lower pressure

Pressure order: highest to lowest◦Left ventricle◦Left atrium◦Right ventricle◦Right atrium

Animation of Blood Flow

http://www.youtube.com/watch?v=FCimR_P9ID0

Blood Flow

Fetal Blood Flow

Heart Rate

Autonomic Nervous System (ANS)

Sympathetic Nervous SystemAdrenergic response

Norepinephrine released Increased heart rate and blood pressure Decreases digestion

Heart Rate

Parasympathetic Nervous System Cholinergic response Acetycholine released Decreases heart rate, blood pressure

Increases digestion

Cardiac Cells

Electrical Cells Automaticity Excitability Conductivity

Mechanical Cells Contractility Extensibility

Chemical Basis for Impulse Formation

Cardiac Action Potential Phases

http://www.youtube.com/watch?v=7EyhsOewnH4

Cardiac Electrolytes

Hypokalemia (low potassium levels)http://www.youtube.com/watch?v=oXaff1v

bFnAHyperkalemia (high potassium levels)http://www.youtube.com/watch?v=xluHUc

QbWXoHypocalcemia (low calcium levels)http://www.youtube.com/watch?v=6_Khrzr

0x_AHypercalcemia (high calcium levels)http://www.youtube.com/watch?v=LIdAVj

WwIFo

Cardiac Electrolytes

Hypomagnesemia (low magnesium)http://www.youtube.com/watch?v=e0APN

C968MYHypermagnesemia (high magnesium)http://www.youtube.com/watch?v=4Gv3JR

4s_Gc

Electrical Conduction Pathway

Cardiac Cycle

Phases of Systole

Ventricular Systole/Diastole

Heart Action during SystoleA B

Atrial Kick

Physiologic Control Mechanisms of Blood Pressure

Compliance

Preload: L Ventricular Wall Stress at End Diastolic Volume

Afterload: L Ventricular Wall Stress During Systole (Ejection out L Ventricle)

Contractility

Pressure differences in the left and right heart

Pressure Volume Loophttp://www.youtube.com/watch?v=AnwPH5yU8rY

Normal Values

Right & Left heart pressures:◦Right atria 2-6 mmHg◦Right ventricle 25/0 mmHg◦Pulmonary arteries 25/8 mmHg◦Pulmonary veins 8 mmHg◦Left atria 6 mmHg◦Left ventricle 120/0 mmHg◦Aorta 120/80 mmHg

Pulmonary Vascular Resistance◦Less 2.5 mmHg/L/min or 200 Dynes

Systemic Vascular Resistance◦less than 20 mmHg/L/ min or 1600 Dynes

Cardiac Cycle (Pressure/Volume)

http://www.youtube.com/watch?v=7w6awkDREQM

http://www.youtube.com/watch?v=PUArUV4VdaY

Cardiac Output

Heart rate X Stroke Volume = CO5 liters / min. (at rest)4- 8 liters / min when pumpingFrank –Starling LawDecreased cardiac output signs and

symptomsEpinephrine, thyroxine, sympathetic

nervous system, fever, fear, exercise, low BP increase CO

Normal Values

Right heart oxygen saturation – 75%Left heart oxygen saturation – 95%Mean arterial pressure – 93 mmHgSystemic blood pressure – 120/80 mmHgAortic pulse pressure – 40 mmHgCardiac output – 5L/minStroke volume – 60 – 130 mL/beat

Carotid Arteries and Aortic Arch

Baroreceptors

◦Specialized nerve tissue (sensors)

◦Detect changes in blood pressure

◦Increase / decrease sympathetic tone

◦Dilation of blood vessels

Carotid Artery and Aortic Arch

Chemoreceptorsspecialized nerve tissue (sensors)

detect changes in concentration of pH, 02, C02

sympathetic or parasympathetic response

Coronary Arteries & Veins

Systemic Vasculature Layers

Vascular Layers & Arterioles

Vascular Circulation

Congenital Heart Disease

Coarctation of the Aorta (CoA)

Patent ductus arteriosus (PDA)

Septal defects

Tetralogy of Fallot

Transposition of the great arteries (TGA)http://www.youtube.com/watch?v=yePivAlbR4A

http://www.youtube.com/watch?v=cgR_XmRJcIg

http://www.youtube.com/watch?v=O83cYwKOKtI

http://www.youtube.com/watch?v=e46jtin-H50

Cardiovascular Assessment

Health HistoryA. Chief complainB. Family HistoryC. Coping and emotional historyD. MedicationsE. SurgeriesF. Activities of daily living

http://www.youtube.com/watch?v=JLLUkiZZfBo

Assessing the Heart

General appearanceInspectionPalpationPercussionAusculatation

http://www.youtube.com/watch?v=MIfmjFG6BTQ

Blood Pressure

Cardiac output X peripheral vascular resistance

Systolic measurement

Diastolic measurement

Korotkoff soundhttp://www.youtube.com/watch?v=ALqdHnD7c18

Pulses

Location

Pressure points

Heave and Thrill

Pulse Pressure

Aortic Pulse Pressure

Mean Arterial Pressure

http://www.youtube.com/watch?v=74v4mEWhOao

Measuring Blood PressureProcess7 important aspects Distal arteriesWhat affects measurementChanges related to cuff sizeClassifications BP

classification

Normal

Pre-hypertensive

Stage 1 Stage 2

SBP (mmHg)

< 120 120 to 139 140 to 159

160

DBP (mmHg)

< 80 80 to 99 90 to 99 > 100

http://www.youtube.com/watch?v=diG519dFVNs

Hypertension

“Silent Killer”Essential HypertensionMalignant HypertensionSecondary HypertensionPseudohypertensionRisk Factors

Hypertension

CauseSigns and symptomsDiagnostic TestsTreatment

Myocardial Infarction

Atherosclerosishttp://www.youtube.com/watch?v=qRK7-DCDKEA

Assessing Chest Pain

P Provokes (Relieves)

QQuality

RRegion / Radiation

S Severity

T Time

•Other associated complaints / Pertinent

Chest Pain

TightnessSqueezingAchingPressureShoulder painJaw painDyspneaSyncopePalpitations

http://www.youtube.com/watch?v=4h80Isb72Xghttp://www.youtube.com/watch?v=H_VsHmoRQKk

Angina Caused by exertion. Result of progressive CAD. Symptoms: typical chest pain.ST segment depression OR T wave

inversionST segment resolves, no elevated

enzymeshttp://www.youtube.com/watch?v=SR8sBJgD7UE

STEMI vs NonSTEMI

Cardiac Enzyme Duration

Test Initial elevation

Peak Return to Normal

CK :Creatinekinase

2 – 6 hours 18-36 hours 3 – 6 days

CKMB :Creatine kinase MB

2-3 hours 24 hours 2 – 3 days

LDH :Lactic dehydrogenase

12-24 hours 24-48 hours 5 -6 days

Myoglobin 1-2 hours 4-6 hours 24 hours

Troponin 4-8 hours 14-18 hours < 10 days

Cardiac Diagnostic Procedures

Cardiac Revascularization

• Percutaneous coronary intervention• Intracoronary Stenting• Directional Atherectomy • Rotational Atherectomy• Extraction techniques• Laser• Cutting balloons

Heart Failure

http://www.youtube.com/watch?v=GnpLm9fzYxU&NR=1&feature=endscreen

http://www.youtube.com/watch?v=JHz_JivtNLc

Congestive Heart Failure

Pulmonary edemaShortness of breath, fatigue, and exercise

intoleranceHTN, CAD, MI, ischemic heart disease,

valvular heart disease and cardiomyopathy

ComplicationsAdaptation

Non-heart Related Causes of CHF

Pregnancy and childbirthIncreased environmental temperature or

humiditySevere physical or mental stressThyrotoxicosisAcute blood lossPulmonary embolismSevere infectionChronic obstructive pulmonary disease (COPD)HypervolemiaSepsis

Classifications of CHF

Acute Decompensated Heart Failure: sudden development of symptoms

Sudden Death

Chronic: symptoms over long period of time with development of compensatory mechanisms

Classification of CHF

Left-side Heart Failure: ineffective left ventricular contraction

Left ventricular dysfunction

Neurohormonal responses: SNS RAAS

Left-ventricular Remodeling

Classifications of CHF

Right-side Heart Failure: ineffective right ventricular contraction

Systolic Dysfunction or Heart Failure: during systole, left ventricle can’t pump blood out

Heart Structure Changes with CHF

Classifications of CHF

Diastolic Dysfunction or Heart Failure: during diastole, left ventricle can’t relax to fill with blood

Systolic dysfunction

2/3 of pts with heart failure

Decreased left ventricular contractility and ejection fraction.

Most common cause is CHD resulting in MI or Chronic ischemia.

Diastolicdysfunction

1/3 of pts with heart failure

Impaired left ventricular relaxation and abnormal filling

Usually related to chronic hypertension or ischemic heart disease.

Clinical Signs & Symptoms

Left-side Heart Failure Right-side Heart FailureDyspnea, initially on

exertionParoxysmal nocturnal

dyspneaCheyne-Stokes

respirationsCoughOrthopena“Cardiac Asthma”TachycardiaFatigue

Edema, initially dependent

Jugular vein distentionHepatomegalyAscites

Tests for Diagnosis of CHF

Blood testsECG changesChest X-rayCardiac catheterizationEchocardiographyTransesophageal echocardiography (TEE)Cardiopulmonary exercise test

Treatment for CHF

MedicationsMedication Class Expected Action

ACE inhibitors / ARBs Interrupt response of RAASReduce mortality and morbidity

Beta-blockers Interrupt response of SNSReduce hospitalizationsNot used in acute decompensated state

DiureticsLoop diuretics with the addition of a thiazide diuretic if needed

Decrease ECF loadMaintain ECF volume status and sodium balanceNo impact on mortality

DigoxinDosage is usually 0.25 mg

Improves symptomsSymptomatic and on more than 3 meds.

Aldosterone antagonists Reserved for moderate to severe heart failure

Treatment for CHF

Lifestyle Changes

Cardiac Resynchronization Therapy

Surgical / devices interventions

Lipoprotein Disorders of CAD

Dyslipidemia

LDL (low-density lipoprotein)

HDL (high-density lipoprotein)

Triglycerides

Management of Lipoprotein Disorders

Dietary changes

Medications

Exercise

Monitor cholesterol levels

Diabetes and CAD/CVD

What is Diabetes?

Diabetes and CAD/CVD

CAD: Coronary Artery Disease

CVD: Cerebral Vascular Disease

Greater risk for heart disease

What causes heart disease in diabetics?

Diabetes and CAD/CVD

Metabolic syndrome Risk Factorsexcessive fat tissue in and around abdomenBlood fat disorders Insulin resistanceHigh fibrinogen inhibitorRaised blood pressureElevated high-sensitivity C-reactive protein

Diabetes and CAD/CVD

Other types of heart disease that occur in people with diabetes:

TIAsHeart FailureCardiomyopathyPeripheral Arterial Disease (PAD)

Cardiac Revascularization

Clinical Procedures - Treatments

Heart Transplant (LVAD)http://www.youtube.com/watch?v=KsAf-tM

mpyg&list=PL6F28DDE8FDC248C3Percutaneous Coronary Intervention (PCI)

Clinical Procedures: Treatment

Cardioversion (defibrillation)Thrombolytic Therapy

Diagnostic Procedure

Cardiac Catheterization