Anatomy & Physiology
Review

Cardiovascular system
Heart
 Pumps 1000 gallons of






blood daily
Beats 100,000 times a
day
Located in the
mediastinum between
the lungs...
Tissue Layers
 Epicardium—outer layer
 Myocardium—middle layer (bulk of heart,

muscle tissue)
 Endocardium—inner layer...
Chambers
 Atria=upper chambers act as reservoir
 Ventricles=lower chambers
 Right & Left side separated by septum
 Rig...
 Right side receives

deoxygenated blood,
pumps it to the lungs
via pulmonary arteries
 (gas exchange in
alveoli)
 Left...
Chambers
 Left atrium receives

oxygenated blood from
the lungs via pulmonary
veins

 Left ventricle receives

oxygenate...
Heart Valves
 4 valves in the heart keep blood moving

forward & prevent backflow
 AV VALVES


Tricuspid (3 flaps) loca...
Chordae Tendineae
 Small cordlike structures that connect the AV

valves to the walls of the heart
 Work with Papillary ...
Valves Con’t
 Semilunar valves located where blood exits

ventricles
 Composed of 3 cusps that resemble half
moon

 Pul...
Valves Con’t
 Aortic semilunar valve located between left

ventricle and aorta
 When left ventricle contracts, blood is ...
VESSELS
 Arteries=carry blood FROM the heart
 Veins=carry blood back TO the heart
 Arterioles=smallest arteries
 Venul...
Electrical Conduction System
 SA node

Located in posterior wall of Right Atrium
 Known as pacemaker of the heart
 Init...
Conduction
 Cardiac impulse spreads through atria over

intra-nodal & intratrial pathways
 When all cells in atria are e...
Conduction
 Impulse then travels to bundle of HIS & R&L bundle

branches
 Then to Purkinje fibers….. Then ventricles con...
Cardiac Cycle
 Refers to a complete heartbeat
 Atria contract while the ventricles relax
 Contraction phase=systole (de...
Cardiac Cycle
 LUBB-DUBB= heart sounds
 LUBB= heard when AV valves close
 DUBB=heard when semilunar valves close
 MURM...
Cardiac Output
 Defined as the amount of blood ejected from the left

ventricle in 1 minute(Average norm=3.5-8.0 L/min)
C...
Regulation
 Nervous system can change the heart rate
 Medulla contains C V centers
 Sympathetic nerve impulses increase...
Electrolyte Balance
 Necessary for cardiac function
 Potassium & Calcium especially
 ↑ potassium decreases heart rate
...
Hormones and Heart (cont’d)
 Aldosterone


Regulates Sodium/Potassium

 Atrial Natriuretic Peptide

Hormone secreted by...
Hormones and Heart
 Epinephrine


Increases:





Heart Rate
Force of Contraction
Cardiac Output
Systolic BP
VESSELS
 Arteries=carry blood FROM the heart
 Veins=carry blood back TO the heart
 Arterioles=smallest arteries
 Venul...
Blood Pressure
 Force of Blood Against Blood Vessel Walls
 Measured in mm/Hg
 Normal



Systolic 90 to 135 mm Hg
Dias...
Blood Presure
 Systolic—measures pressure during

ventricular contraction (systole)
 Affected by size of lumen of arteri...
Renin-angiotension mechanism
 If blood flow through kidney decreases, so does renal







filtration & urinary out...
Coronary Circulation
 Blood flows through heart muscle by way of

two small vessels--Left & Right coronary
arteries
 If ...
Pathways of Circulation
 Pulmonary Circulation—deoxygenated blood

passes through R atrium to R ventricle, to
pulmonary a...
Hepatic Portal Circulation
 Special part of the circulation –blood from

capillaries in digestive tract & spleen flows
th...
Aging and Cardiovascular system
 Older Adult
 Changes in cardiac musclereduced cardiac

output
 Decreased tissue perfu...
Nursing Assessments (Data
Collection)
 Health History (WHAT’S UP?”)

Medications
 Family history
 Health promotion


...
Diagnostic Examinations
 Fluroscopy
 Angiogram
 Aortogram
 X-ray
 CT, MRI
Cardiac Catheterization
 Long catheter inserted into vein or artery of

arm or leg
 Used to visualize chambers, valves, ...
Electrocardiography (EKG)
 Record of electrical currents generated by the heart

muscle. 12 leads placed on chest & limbs...
EKG
 QRS complex= occurs

during time necessary
for the impulse to
spread through bundle
of HIS & Purkinje fibers
and cau...
EKG (con’t)
 Helps determine the nature of MI & interpret

dysrhythmias
 Not definitive dx of MI
 NI: explain

help pa...
Ambulatory EKG
 Holter monitor
 Small portable recorder attached to patient by

1-4 leads
 Records patterns & rhythms c...
Cardiac Monitors
 Visual display of the cardiac electrical activity

of the heart

 Can set alarms to warn of abnormal r...
Stress testing
 Monitoring of the heart’s capability during

exercise
 Uses treadmill, stair climbing, etc
 Patient is ...
Stress test
 Normal finding=no ST segment depression or

arrythmia upon exercise
 Based on theory that patients with CAD...
Echocardiogram
 Ultrasound of the heart
 Shows structures of the heart
 Including valves
 Non-invasive
Thallium Scan
 Injection of Thallium 201 (ion) that is actively

transported into normal cells.
 If cell ischemic (witho...
PET Scan
 Positron Emission

Tomography=computerized xray technique
using radioactive substance to examine the
metabolic ...
Lab studies
 Blood Cultures to diagnose infective endocarditis
 Blood Chemistry







Cholesterol (desirable < 20...
Triglycerides
 10-190 (goes up with age)
 Most common reason for elevation=diabetes
 Instructions:




Fast prior fo...
Serum Enzymes & Cardiac Markers
 SGOT,AST=found in heart muscle & liver

primarily
 Increased in acute MI or liver damag...
Markers Con’t
 CPK, CK MB=found in heart muscle
 Elevated in acute MI
 Elevated in 4-6 hrs
 Peaks in 12-24hrs
 Decrea...
Troponin I, Troponin T
 Highly specific

indicators of MI
 Rises in 4-6 hrs
 Remains elevated for 2

weeks
Hemodynamic Monitoring
 To assess volume and pressure of blood

within the heart & vascular system
 Uses multi- or tripl...
Arterial Lines
 Used to draw arterial blood samples, (ABG’s) and do

continuous BP monitoring
 Used in radial, brachial ...
CVP
 Central Venous Pressure= Pressure in R

atrium. Normal =4-10cm/H2O. Uses 3 way
stop-cock, need to “zero” at levle of...
Swan-Gans Catheter
 Catheter with balloon at the tip used for

measuring pulmonary arterial pressures, right
atrial press...
Pulmonary Artery Monitoring
 Catheter (swan-gans) inserted into pulmonary

artery
 Measures pulmonary artery pressure & ...
Pulmonary Wedge Pressure
 Tiny balloon on end of swan-gans inflated with tiny

amt (0.8cc) fluid & “wedged” to obstruct f...
Electrophysiology studies
 Study of the electrical impulses which control

the pumping action of the heart.
 When the im...
Cardiac Output
 Cardiac output= amount of blood pumped out

of the ventricle each min.
 Average normal = 3.5-8.0L/min
 ...
Cardiacintro
Cardiacintro
Cardiacintro
Cardiacintro
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Cardiacintro

  1. 1. Anatomy & Physiology Review Cardiovascular system
  2. 2. Heart  Pumps 1000 gallons of     blood daily Beats 100,000 times a day Located in the mediastinum between the lungs 4 chambered pump Known as double pump
  3. 3. Tissue Layers  Epicardium—outer layer  Myocardium—middle layer (bulk of heart, muscle tissue)  Endocardium—inner layer (thin, smooth, epithelial cells)  Pericardium=tough membrane surrounding heart (double membrane) protects heart from injury d/t infection, trauma
  4. 4. Chambers  Atria=upper chambers act as reservoir  Ventricles=lower chambers  Right & Left side separated by septum  Right atrium receives deoxygenated blood from entire body  Right ventricle receives deoxygenated blood from right atrium & pumps blood to lungs via the pulmonary artery
  5. 5.  Right side receives deoxygenated blood, pumps it to the lungs via pulmonary arteries  (gas exchange in alveoli)  Left side receives oxygenated blood from the lungs via pulmonary veins & pumps it throughout the body
  6. 6. Chambers  Left atrium receives oxygenated blood from the lungs via pulmonary veins  Left ventricle receives oxygenated blood from left atrium, & pumps blood through aorta to all parts of the body
  7. 7. Heart Valves  4 valves in the heart keep blood moving forward & prevent backflow  AV VALVES  Tricuspid (3 flaps) located between right atrium & right ventricle  Mitral (bicuspid) has 2 cusps & is located between left atrium & left ventricle
  8. 8. Chordae Tendineae  Small cordlike structures that connect the AV valves to the walls of the heart  Work with Papillary muscles to make tight seal & prevent backflow with ventricular contraction
  9. 9. Valves Con’t  Semilunar valves located where blood exits ventricles  Composed of 3 cusps that resemble half moon  Pulmonary semilunar valve located between right ventricle & pulmonary artery  Blood exits right ventricle & travels to the lung via pulmonary artery
  10. 10. Valves Con’t  Aortic semilunar valve located between left ventricle and aorta  When left ventricle contracts, blood is forced into aorta, and semilunar valve closes.
  11. 11. VESSELS  Arteries=carry blood FROM the heart  Veins=carry blood back TO the heart  Arterioles=smallest arteries  Venules=smallest veins  Capillaries=smallest vessels—connect arterioles & venules
  12. 12. Electrical Conduction System  SA node Located in posterior wall of Right Atrium  Known as pacemaker of the heart  Initiates impulses that cause contraction  Produces impulses between 60-100 times/min  Average of 72 beats/min  Normal heartbeat called normal sinus rhythm 
  13. 13. Conduction  Cardiac impulse spreads through atria over intra-nodal & intratrial pathways  When all cells in atria are excited, they contract in unison  Impulse then reaches AV node (atrio- ventricular ) which stimulates ventricles (like the atria were)
  14. 14. Conduction  Impulse then travels to bundle of HIS & R&L bundle branches  Then to Purkinje fibers….. Then ventricles contract  SA nodeAV nodebundle of HISR &L bundle branchesPurkinje fibers
  15. 15. Cardiac Cycle  Refers to a complete heartbeat  Atria contract while the ventricles relax  Contraction phase=systole (depolarization)  Relaxation phase=diastole (polarization)  Complete diastole & systole takes 0.8 sec
  16. 16. Cardiac Cycle  LUBB-DUBB= heart sounds  LUBB= heard when AV valves close  DUBB=heard when semilunar valves close  MURMER=swishing sound heard with ineffective closure of the valves
  17. 17. Cardiac Output  Defined as the amount of blood ejected from the left ventricle in 1 minute(Average norm=3.5-8.0 L/min) Can be increased 2 ways—By increasing heart rate, and increasing stroke volume  Stroke volume=amt of blood pumped per contraction  Stroke Volume × Heart Rate = CO  Ejection Fraction (EF) is a measure of ventricular efficiency  Important indicator in heart failure  Normal EF=60%
  18. 18. Regulation  Nervous system can change the heart rate  Medulla contains C V centers  Sympathetic nerve impulses increase rate & force of contractions  Parasympathetic nerve impulses along vagus nerve decrease heart rate
  19. 19. Electrolyte Balance  Necessary for cardiac function  Potassium & Calcium especially  ↑ potassium decreases heart rate  ↓potassium =disturbed rhythm  ↑calcium causes increase & prolonged contractions  ↓ calcium = decreased heart function
  20. 20. Hormones and Heart (cont’d)  Aldosterone  Regulates Sodium/Potassium  Atrial Natriuretic Peptide Hormone secreted by atria  Increases excretion of Sodium 
  21. 21. Hormones and Heart  Epinephrine  Increases:     Heart Rate Force of Contraction Cardiac Output Systolic BP
  22. 22. VESSELS  Arteries=carry blood FROM the heart  Veins=carry blood back TO the heart  Arterioles=smallest arteries  Venules=smallest veins  Capillaries=smallest vessels—connect arterioles & venules
  23. 23. Blood Pressure  Force of Blood Against Blood Vessel Walls  Measured in mm/Hg  Normal   Systolic 90 to 135 mm Hg Diastolic 60 to 85 mm Hg  Pulse pressure=difference between systolic & diastolic
  24. 24. Blood Presure  Systolic—measures pressure during ventricular contraction (systole)  Affected by size of lumen of arteries, arterioles, (elasticity )  affected by athero & arterio sclerosis  Under regulation by autonomic nervous system (sympatheticvasoconstriction  Diastolic– measures pressure during ventricular relaxation (diastole)
  25. 25. Renin-angiotension mechanism  If blood flow through kidney decreases, so does renal       filtration & urinary output Decreased BP stimulates kidneys to secrete renin This sets off the angiotensin-aldosterone mechanism Renin splits the plasma protein angiotensinogen (made in liver) to angiotensin I Angiotensin I is converted to angiotension II by an enzyme found in lung tissue Angiotensin II causes vasoconstriction & stimulates the adrenal cortex to secrete aldosterone Aldosterone increases reabsorption of sodium ions by the kidneys…water follows sodium back to blood, increasing blood volume….and blood pressure
  26. 26. Coronary Circulation  Blood flows through heart muscle by way of two small vessels--Left & Right coronary arteries  If an artery becomes occluded, tiny branches provide collateral circulation.  If occlusion is severe, surgery may be needed.
  27. 27. Pathways of Circulation  Pulmonary Circulation—deoxygenated blood passes through R atrium to R ventricle, to pulmonary arteries to the lungs  Pulmonary Veins bring oxygenated blood to L atrium  Systemic Circulation---Blood is pumped from left ventricle of heart through Aorta, out to body and returns via the Vena Cava to the Right atrium
  28. 28. Hepatic Portal Circulation  Special part of the circulation –blood from capillaries in digestive tract & spleen flows through portal vein into capillaries in the liver before returning to heart  Allows liver to regulate blood levels of glucose, amino acids and iron & remove toxins (drugs, alcohol) from circulation
  29. 29. Aging and Cardiovascular system  Older Adult  Changes in cardiac musclereduced cardiac output  Decreased tissue perfusion d/t decreased cardiac output  Sclerotic changes to vesselsdecreased elasticity,  hypertension  Coronary artery changes lead to collateral coronary circulation  Polypharmacytoxicity
  30. 30. Nursing Assessments (Data Collection)  Health History (WHAT’S UP?”) Medications  Family history  Health promotion   Objective data VS  Pulses  Clubbing  Homan’s Sign 
  31. 31. Diagnostic Examinations  Fluroscopy  Angiogram  Aortogram  X-ray  CT, MRI
  32. 32. Cardiac Catheterization  Long catheter inserted into vein or artery of arm or leg  Used to visualize chambers, valves, vessels, and arteries, determine patency  Contrast dye is used  Performed under sterile asepsis  NI: determine if sensitivity to iodine exists  Pressure (sandbag) to insertion site to prevent hemorrhage  Monitor V/S, takes 1 1/2 – 3 hrs 
  33. 33. Electrocardiography (EKG)  Record of electrical currents generated by the heart muscle. 12 leads placed on chest & limbs EKG has 3 distinct waves—P,QRS,T   P wave (occurs with spread of impulse from SA node throughout atria PR interval= time it takes for impulse to reach ventricles & START contracting
  34. 34. EKG  QRS complex= occurs during time necessary for the impulse to spread through bundle of HIS & Purkinje fibers and cause ventricles to contract  S-T segment=indicates beginning of ventricular recovery  T wave=complete recovery & relaxation of the ventricle
  35. 35. EKG (con’t)  Helps determine the nature of MI & interpret dysrhythmias  Not definitive dx of MI  NI: explain  help patient undress, dress wipe off paste
  36. 36. Ambulatory EKG  Holter monitor  Small portable recorder attached to patient by 1-4 leads  Records patterns & rhythms continuously for 24 hrs  Used in conjunction with patient “log” or diary  Note any chest pain, SOB  Scanned for problems by Dr.
  37. 37. Cardiac Monitors  Visual display of the cardiac electrical activity of the heart  Can set alarms to warn of abnormal rate or rhythm  Can run a “strip” (EKG) of activity  Telemetry=transmission of data to a distant location such as the nurses station
  38. 38. Stress testing  Monitoring of the heart’s capability during exercise  Uses treadmill, stair climbing, etc  Patient is monitored carefully, and coaxed to a limit of exertion to evaluate ischemia (decreased oxygen to heart)  Can use Persantine or adenosine, injection instead of exercise
  39. 39. Stress test  Normal finding=no ST segment depression or arrythmia upon exercise  Based on theory that patients with CAD will have ST segment depression when exercising.  Abnormal Finding=>1mm ST depression  NI: no smoking, caffeine, alcohol, 2-3 hrs prior. Eat light meal  Stop if patient becomes dyspneic, fatigued, chest pain, > pulse, bp, or arrythmias
  40. 40. Echocardiogram  Ultrasound of the heart  Shows structures of the heart  Including valves  Non-invasive
  41. 41. Thallium Scan  Injection of Thallium 201 (ion) that is actively transported into normal cells.  If cell ischemic (without oxygen), thallium not picked up on image  “cold Spot” image is produced  Injected while patient exercises on a treadmill
  42. 42. PET Scan  Positron Emission Tomography=computerized xray technique using radioactive substance to examine the metabolic activity of body structures  Can distinguish between viable and non viable heart muscle to identify best candidates for bypass surgery
  43. 43. Lab studies  Blood Cultures to diagnose infective endocarditis  Blood Chemistry       Cholesterol (desirable < 200mg/dl total) Mod risk-- 200-240 High risk240 LDL—60-160 (Desired <130) HDL—29-77 (desire > 60) 1/3 of Americans have levels <200
  44. 44. Triglycerides  10-190 (goes up with age)  Most common reason for elevation=diabetes  Instructions:    Fast prior for 12 hrs Normal diet for 2 days prior No alcohol 24 hrs prior NI: avoid excess sugars & CHO
  45. 45. Serum Enzymes & Cardiac Markers  SGOT,AST=found in heart muscle & liver primarily  Increased in acute MI or liver damage  Elevated in 6-10 hrs  Peaks in 24-48 hrs  Decreased in 4-6 days  NI: no IM’s before test
  46. 46. Markers Con’t  CPK, CK MB=found in heart muscle  Elevated in acute MI  Elevated in 4-6 hrs  Peaks in 12-24hrs  Decreases in 3-4 days
  47. 47. Troponin I, Troponin T  Highly specific indicators of MI  Rises in 4-6 hrs  Remains elevated for 2 weeks
  48. 48. Hemodynamic Monitoring  To assess volume and pressure of blood within the heart & vascular system  Uses multi- or triple lumen catheters  Inserted into a central artery or vein
  49. 49. Arterial Lines  Used to draw arterial blood samples, (ABG’s) and do continuous BP monitoring  Used in radial, brachial or femoral artery  Catheter tip contains sensor that transmits fluid pressure to a transducer which converts data to a visual waveform  Eliminates need for auscultating bp
  50. 50. CVP  Central Venous Pressure= Pressure in R atrium. Normal =4-10cm/H2O. Uses 3 way stop-cock, need to “zero” at levle of patient’s R atrium—Patient in supine position.  Used to detect excess or deficits in venous blood volume
  51. 51. Swan-Gans Catheter  Catheter with balloon at the tip used for measuring pulmonary arterial pressures, right atrial pressures, left atrial pressures and left ventricular end diastolic pressures
  52. 52. Pulmonary Artery Monitoring  Catheter (swan-gans) inserted into pulmonary artery  Measures pulmonary artery pressure & right atrial pressure, & CVP  Used to aid in early treatment of fluid imbalances & left sided congestive heart failure, Pulmonary Edema (↑ PAP)
  53. 53. Pulmonary Wedge Pressure  Tiny balloon on end of swan-gans inflated with tiny amt (0.8cc) fluid & “wedged” to obstruct flow of pulmonary artery blood for few seconds. Pressure is measured (norm =4mm/hg)  Increase PWP seen in ↓ cardiac output  Balloon must then be deflated immediately to prevent pulmonary infarction
  54. 54. Electrophysiology studies  Study of the electrical impulses which control the pumping action of the heart.  When the impulses “misfire” can cause arrhythmias  Electrodes placed in the heart to deliberately provoke arrhythmias in controlled environment
  55. 55. Cardiac Output  Cardiac output= amount of blood pumped out of the ventricle each min.  Average normal = 3.5-8.0L/min  Can be increased in 2 ways Increasing the heart rate  Increasing the stroke volume (amt of blood pumped per contraction (norm=65-70 ml) 
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