Cardiovascular SystemCirculation and Blood Pressure

Cardiovascular Review

Stethoscope

• A medical instrument to listen to sounds produced in the body, especially those that emanate from the heart and lungs.

Stethoscope

Used to auscultate heart sounds (ie: normal heart sounds, heart murmurs, irregular heart rhythms, or abnormal heart sounds).

Used to auscultate the sound of air moving through the lungs in order to detect abnormalities in the air tubes and sacs found in the lung or abnormalities outside the lung.

Used to auscultate and detect abnormalities in vessel walls.

Used to auscultate BP (blood pressure).

Used to auscultate gastrointestinal sounds.

Stethoscope

Ear tips or Earpieces

Binaural or Ear Tubes

Acoustic Tubing

Chest Piece

Diaphragm (for high pitched sounds)

Bell (for low pitched sounds)

Cardiac Cycle

Is a sequence of events that occur when the heart beats.

There are two phases of the cardiac cycle.

Diastole - the ventricles are relaxed and the heart fills with blood.

Systole - the ventricles contract and pump blood to the arteries.

Diastole

During the diastole phase, the atria and ventricles are relaxed and the atrioventricular valves are opened.

Blood flows into the relaxed ventricles while the atrioventricular valves are opened.

De-oxygenated blood from the superior and inferior vena cava flows into the right atrium.

When the pressure in the ventricles gets lower than the pressure in the atria the AV valves open, allowing blood to flow into the relaxed ventricles.

The open AV valves allow blood to flow into the ventricles.

Systole

During the systolic phase, the ventricles receive impulses from the Purkinje fibers and contract.

The AV valves close due to ventricular contraction and the semilunar valves open.

The blood is pumped into the Pulmonary artery and Aorta.

Cardiac CycleOne cardiac cycle is when the heart fills with blood and the blood is then pumped from the heart. The audible sounds that can be heard from the heart are made by the closing of the heart valves. These sounds are referred to as the "lub-dub" or "lub-dupp".

The "lub" (S1) sound the are by the closing of the AV valves.

The "dub" (S2) sound is made by the semilunar valves closing.

Cardiac Cycle

Ejection Fraction (EF)

The amount of blood pumped (ejected) by your heart with each beat

Measured with an echocardiogram

Normal EF is 50% or greater, which means at least one-half of the blood in the heart is ejected with each beat

Types of CirculationCoronary - the circulation of blood within the heart (coronary arteries branch off the aorta to supply blood to the heart muscle)

Pulmonary - the flow of blood between the heart and the lungs

Systemic - the flow of blood between the heart and the cells of the body (arteries, arterioles, capillaries, venules, veins)

CADCoronary Artery

DiseaseAlso known as, ASHD- Artherosclerotic Heart Disease

A result of the accumulation of plaques on the walls of the coronary arteries (fat, cholesterol, calcium, etc)

Blocks or reduces the flow of blood to the heart muscle (myocardium)

Can cause a heart attack (myocardial infarction)

Myocardial InfarctionOccurs when blood flow is blocked to the heart muscle causing ischemia (lack of O2) and cell death or damage

Symptoms can include:

Pressure

Pain (Angina)

Diaphoresis

Nausea

PAD/PVDPeripheral Artery Disease/

Peripheral Vascular Disease

A condition of the blood vessels that leads to narrowing and hardening of the arteries that supplies the legs and feet.

The narrowing of the blood vessels leads to decrease blood flow, which can injure nerves and other tissues.

Internal Jugular VeinsLeft Subclavian ArteryLeft Subclavian VeinAortic Arch

Ascending Aorta

Descending Aorta

Pulmonary (Trunk) ArteryLeft Atrium

Left Axillary Vein

Right External Iliac Artery

Arterial & Venous Branches of the abdominal areaCommon Iliac Arteries

Femoral Veins

Femoral Arteries

LeftVentricle

Right Internal Iliac Artery

Inferior Vena Cava

Hepatic Veins

Right Ventricle

Right Atrium

Right Axillary Vein

Superior Vena Cava

Right Subclavian Vein

Right Subclavian Artery

Brachiocephalic Artery

Common Carotid Arteries

Blood PressureThe amount of pressure exerted on the arterial walls as blood pulsates through them.

Blood PressureBlood pressure is typically recorded as two numbers. Read as "117 over 76 millimeters of mercury“ (mmHg)

Systolic- the top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart muscle (ventricles) ______________

Diastolic - the bottom number, which is the lower of the two numbers, measures the pressure in the arteries when the heart muscle is ____________ between beats and refilling with blood

contractscontracts

restingresting

Healthy Blood Pressure

AHA recommendation

Systolic is < 120

Diastolic is < 80

Prehypertensive - systolic is 120-139 or diastolic is 80-89

Blood PressuresPrehypertension

Systolic Pressure - 120-139 mmHgDiastolic Pressure - 80-89 mmHg

HTN Stage 1Systolic Pressure - 140-159 mmHgDiastolic Pressure - 90-99 mmHg

HTN Stage 2Systolic Pressure > 160Diastolic Pressure > 100

Hypotension

Low blood pressureSystolic pressure is < 100 mmHg andDiastolic is < mmHg

Orthostatic HypotensionPostural Hypotension – occurs when

there is a sudden drop in both systolic and diastolic pressure

This occurs when the individual moves form a lying to a sitting or standing position

Caused by an inability of the blood vessels to compensate quickly to the change in position

SphygmomanometerA sphygmomanometer ( or blood pressure meter ) is a device used to measure blood pressure, composed of an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded.

Sphygmós means pulse, mano means pressure, and meter means measuring device.

Sphygmomanometer

A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and a mechanism for inflation which may be a manually operated bulb and valve or a pump operated electrically.

Sphygmomanometer

SphygmomanometerThe usual unit of measurement of blood pressure is millimeters of mercury (mmHg) as measured directly by a manual sphygmomanometer.

Manual sphygmomanometers require a stethoscope for auscultation. They are used by trained practitioners, and cannot be used in environments too noisy to permit hearing the characteristic sounds. It is possible to obtain a systolic reading through palpation.

Mercury Sphygmomanometer

Aneroid Sphygmomanometer

Recording Blood Pressure

Recorded as a fraction

Systolic is the top number

Diastolic is the bottom number

120/80

Procedure

Cuff appropriate size for patient

Arm free of restrictive clothing

Deflated cuff should be placed on the arm with the center of the bladder directly over the brachial artery

Lower edge of cuff should be 1-1½ inches above the bend of the elbow

Place stethoscope (bell or diaphragm directly over the brachial artery at the antecubital area (bend in the elbow)

Procedure (continued)

Hold securely with slight pressure (DO NOT use your thumb)

Chart BP correctly on graphic sheet

Do Not Use

Arm with an IV

Arm with paralysis

Surgical Arm – surgery has been done on the arm, hand, etc.