Ed tech boholano

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Ed tech boholano

  1. 1. CARDIOVASCULAR SYSTEM
  2. 2. COURSE OUTLINE <ul><li>A. Review of Anatomy and Physiology </li></ul><ul><li>1. Heart </li></ul><ul><li>2. Blood vessels </li></ul><ul><li>3. Blood circulation </li></ul><ul><li>B. History and Assessment Findings </li></ul><ul><li>1. Risk Factors for Cardiac Diseases </li></ul><ul><li>2. Physical Assessment </li></ul>2009
  3. 3. ANATOMY AND PHYSIOLOGY 2009
  4. 4. THE HEART 2009
  5. 5. I. Anatomy & Physiology: <ul><li>300 gms / cone shaped & tilted forward & to the left </li></ul><ul><li>size of a fist / rests only </li></ul><ul><li>location: mediastinum </li></ul><ul><li>During the course of the day, your heart will beat approx 100,000 times driving 2,000 gallons of oxygen-rich blood through 60,000 miles of blood vessels. </li></ul>2009
  6. 6. The Heart Figure 11.1 2009
  7. 7. <ul><ul><li>Heart wall has three layers </li></ul></ul>Myocardium <ul><li>Epicardium </li></ul>Endocardium
  8. 8. Layers: <ul><li>Pericardium </li></ul><ul><ul><li>Parietal </li></ul></ul><ul><ul><li>Visceral </li></ul></ul><ul><ul><li>Pericardial space </li></ul></ul><ul><li>Epicardium </li></ul><ul><li>Myocardium </li></ul><ul><li>Endocardium </li></ul>2009
  9. 9. Chambers of the heart: <ul><li>Right Atrium </li></ul><ul><li>Right Ventricle </li></ul><ul><li>Left Atrium </li></ul><ul><li>Left Ventricle </li></ul>2009
  10. 10. Superior Vena Cava Brachiocephalic Artery Common Carotid Artery Subclavian Artery Aorta Pulmonary Artery Parietal Pericardium Right Atrium Right Ventricle Right Coronary Vein Right Coronary Artery Left Atrium Apex Left Ventricle Left Coronary Vein Left Coronary Artery Ligamentum Arteriosum
  11. 12. HEART VALVES 2009
  12. 13. Valves: <ul><li>AV Valves </li></ul><ul><ul><li>Tricuspid </li></ul></ul><ul><ul><li>Mitral </li></ul></ul><ul><li>Semilunar Valves </li></ul><ul><ul><li>Pulmonic valve </li></ul></ul><ul><ul><li>Aortic valve </li></ul></ul>2009
  13. 14. BLOOD SUPPLY OF THE HEART 2009
  14. 15. Coronary Arteries: <ul><li>Right Coronary Artery </li></ul><ul><ul><ul><li>Right atrium & ventricle </li></ul></ul></ul><ul><ul><ul><li>Inferior portion of left ventricle </li></ul></ul></ul><ul><ul><ul><li>Posterior septal wall </li></ul></ul></ul><ul><ul><ul><li>SA & AV nodes </li></ul></ul></ul>2009
  15. 16. <ul><li>Left Coronary Artery </li></ul><ul><ul><li>Left Anterior Descending Coronary Artery </li></ul></ul><ul><ul><ul><li>anterior wall of left ventricle </li></ul></ul></ul><ul><ul><ul><li>anterior ventricular apex of left ventricle </li></ul></ul></ul><ul><ul><li>Circumflex Artery </li></ul></ul><ul><ul><ul><li>left atrium </li></ul></ul></ul><ul><ul><ul><li>lateral & posterior surfaces of left ventricle </li></ul></ul></ul>2009
  16. 17. 2009
  17. 18. Coronary Sinus
  18. 19. The Vascular System: <ul><li>Arteries </li></ul><ul><li>Arterioles </li></ul><ul><li>Capillaries </li></ul><ul><li>Venules </li></ul><ul><li>Veins </li></ul><ul><li>Valves </li></ul><ul><li>Lymphatics </li></ul>2009
  19. 20. The Vascular System Figure 11.8b 2009
  20. 21. Blood Circulation Figure 11.3
  21. 22. Properties of Cardiac Muscle: <ul><li>Automaticity </li></ul><ul><li>Excitability </li></ul><ul><li>Conductivity </li></ul><ul><li>Contractility </li></ul>2009
  22. 23. Cardiac Conduction System: <ul><li>Sino-Atrial (SA) Node – Pacemaker </li></ul><ul><li>Atrioventricular Node (AV) </li></ul><ul><li>Bundle of His </li></ul><ul><li>Purkinje fibers </li></ul>2009
  23. 24. Heart Contractions Figure 11.5
  24. 25. Heart Sounds: <ul><li>S1 – AV valves close </li></ul><ul><li>S2 – Semilunar valves close </li></ul><ul><li>S3 – Ventricular gallop </li></ul><ul><li>S4 – Atrial gallop </li></ul>2009
  25. 26. Cardiac Output: <ul><li>blood ejected from left ventricle / min. </li></ul><ul><li>ave.: 5L/min. </li></ul><ul><li>CO = stroke vol. X HR </li></ul><ul><ul><li>Stroke Volume – blood ejected / heartbeat </li></ul></ul><ul><ul><li>Preload – myocardial fiber length at end diastole </li></ul></ul><ul><ul><li>Afterload – resistance to left ventricular ejection </li></ul></ul>2009
  26. 27. <ul><li>Blood Pressure </li></ul><ul><li>The pressure exerted by the blood against the blood vessel wall </li></ul><ul><li>Factors affecting Blood Pressure </li></ul><ul><ul><li>Neural Factors : the Autonomic Nervous System, particularly the Sympathetic Nervous System which often causes vasoconstriction or narrowing of the vessels and thus increasing blood pressure </li></ul></ul><ul><ul><li>Renal Factors : the Kidneys </li></ul></ul><ul><ul><li>Temperature : </li></ul></ul><ul><ul><ul><ul><li>Cold – causes vasoconstriction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Heat – causes vasodilatation </li></ul></ul></ul></ul><ul><ul><li>Chemicals and Hormones </li></ul></ul><ul><ul><ul><ul><li>Catecholamines, Antidiuretic Hormone, Aldosterone, Atrial Natriuretic Peptide, Nicotine, Histamine & Alcohol </li></ul></ul></ul></ul><ul><ul><li>Diet </li></ul></ul>
  27. 28. Blood Pressure Control: <ul><li>Baroreceptors (pressoreceptors) – aortic arch & carotid sinus </li></ul><ul><li>Stretch receptors – vena cava & right atrium </li></ul><ul><li>Anti-diuretic Hormone </li></ul><ul><li>Aldosterone </li></ul><ul><li>Renin-Angiotensin System </li></ul>2009
  28. 29. HISTORY AND ASSESSMENT FINDINGS 2009
  29. 30. ASSESSMENT WITH CV DISORDERS <ul><li>NURSING HISTORY </li></ul><ul><li>- RISK FACTORS </li></ul><ul><li>PHYSICAL EXAMINATION </li></ul><ul><li>COMMON SIGNS/ SYPMTOMS </li></ul><ul><li>DIAGNOSTIC PROCEDURES </li></ul>2009
  30. 31. RISK FACTORS <ul><li>NON- MODIFIABLE </li></ul><ul><li>AGE </li></ul><ul><li>SEX/GENDER </li></ul><ul><li>HEREDITY </li></ul><ul><li>RACE </li></ul><ul><li>MODIFIABLE </li></ul><ul><li>DIET </li></ul><ul><li>EXERCISE </li></ul><ul><li>STRESS </li></ul><ul><li>SMOKING </li></ul><ul><li>ALCOHOL </li></ul><ul><li>DISEASES(HTN,DM) </li></ul><ul><li>OBESITY </li></ul><ul><li>PERSONALITY </li></ul><ul><li>CONTRECEPTIVES </li></ul>2009
  31. 32. PHYSICAL EXAMINATION <ul><li>INSPECTION </li></ul><ul><li>SKIN COLOR </li></ul><ul><li>NECK VEIN ENGORGEMENT </li></ul><ul><li>RESPIRATION </li></ul><ul><li>PMI </li></ul><ul><li>PERIPHERAL EDEMA </li></ul><ul><li>PALPATION </li></ul><ul><li>PULSES </li></ul><ul><li>APICAL PULSE </li></ul>2009
  32. 33. Jugular vein assessment 2009
  33. 34. 2009
  34. 35. Peripheral-Vascular Flow Assessement 2009
  35. 36. <ul><li>AUSCULTATION </li></ul><ul><li>Heart sounds </li></ul><ul><li>S1-AV closure </li></ul><ul><li>S2- semilunar valve closure </li></ul><ul><li>S3-ventricular gallop </li></ul><ul><li>S4-atrial gallop </li></ul><ul><li>Murmurs </li></ul><ul><li>Pericardial friction rub </li></ul>2009
  36. 37. 2009
  37. 38. Common Signs and Symptoms: <ul><li>Subjective </li></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Weight gain </li></ul></ul><ul><ul><li>Syncope </li></ul></ul><ul><ul><li>Palpitations </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><li>Objective </li></ul><ul><ul><li>Neck vein distention </li></ul></ul><ul><ul><li>Respiration </li></ul></ul><ul><ul><li>Peripheral edema </li></ul></ul><ul><ul><li>Murmurs </li></ul></ul>2009
  38. 39. 2009
  39. 40. 2009
  40. 41. <ul><li>A. Cardiac Enzymes </li></ul>DIAGNOSTIC TEST 2009 Enzyme Onset Peak Normal Values : <ul><li>AST/SGOT </li></ul><ul><li>CPK-MB </li></ul><ul><li>LDH </li></ul><ul><li>Troponin </li></ul><ul><li>Myoglobin </li></ul><ul><li>HRD </li></ul>4-6 hrs 3-6 hrs. within 12 hrs. within 3 hrs. 1hr. 10-12 hrs 24-36 hrs 12-18 hrs. 48-72 hrs. Up to 7 days 4-6 hrs. 48-72 hrs 7-40 mu/ml 50-325 mu./ml 100-225 IU/L < 0.6 ng/ml 0-85 ng/ml 140 – 350 mu/ml
  41. 42. <ul><li>B. Electrolytes </li></ul>2009 ELECTROLYTE Increased Decreased Potassium Sodium Calcium Magnesium Ventricular dysrhythmia Digitalis toxicity water toxicity AV block / tachycardia shortened QT interval muscle weakness/ hypotension prolonged PR interval wide QRS complex Ventricular dysrhythmia asystole diuretics use / HF ventricular dysrhythmia prolonged QT interval ventricular tachycardia fibrillation
  42. 43. 2009
  43. 44. Lead Placement 2009
  44. 45. 2009
  45. 46. 2009
  46. 47. 2009
  47. 48. Electrocardiogram (ECG) 2009
  48. 49. 2009
  49. 50. Methods for Calculating Heart Rate 2009
  50. 51. ECG Interpretaion 2009
  51. 52. 2009
  52. 53. 2009
  53. 54. COMPUTED TOMOGRAPHY <ul><li>Allows visualization of the arterial wall </li></ul><ul><li>and its structures </li></ul><ul><li>May detect Abdominal Aortic Aneuryms </li></ul><ul><li>Nursing Interventions : </li></ul><ul><ul><li>Explain the procedure </li></ul></ul><ul><ul><li>NPO, if with contrast medium </li></ul></ul><ul><ul><li>Ascertain history to allergy to iodine and seafoods </li></ul></ul><ul><ul><li>Assess for claustrophobia </li></ul></ul><ul><ul><li>Advise to remain still during the entire procedure </li></ul></ul><ul><ul><li>Sedation if unable to remain still </li></ul></ul>2009
  54. 55. CARDIAC DISORDERS 2009
  55. 56. VALVULAR HEART DISEASE 2009
  56. 57. VALVULAR HEART DISEASE <ul><li>Mitral Valve Disease </li></ul><ul><ul><li>Mitral Valve prolapse </li></ul></ul><ul><ul><li>Mitral Valve stenosis </li></ul></ul><ul><ul><li>Mitral Valve regurgitation </li></ul></ul><ul><li>Aortic Valve Disease </li></ul><ul><ul><li>Aortic Stenosis </li></ul></ul><ul><ul><li>Aortic Regurgitation </li></ul></ul><ul><li>Tricuspid Valve Disease </li></ul><ul><li>Pulmonic Valve Disease </li></ul>2009
  57. 58. 2009
  58. 59. MITRAL VALVE PROLAPSE <ul><li>Occurs when the cusps of the mitral valve billow upward into the atrium during systolic contraction </li></ul><ul><li>Chorda tendinae lengthens and cusps may enlarge and thickens </li></ul><ul><li>Diagnostics: echocardiography, stress test, chest x-ray, cardiac catheterization </li></ul><ul><li>Manifestations: asymptomatic; maybe vague </li></ul><ul><li>Management: symptomatic treatment (aspirin to prevent TIA, antibiotics, beta-blockers) </li></ul>2009
  59. 60. Mitral valve prolapse 2009
  60. 61. MITRAL VALVE STENOSIS <ul><li>Mitral valve becomes calcified and immobile and the valvular orifice narrows </li></ul><ul><li>Can result to heart failure and decreased cardiac output </li></ul><ul><li>Manifestations: atrial fibrillation, decreased exercise tolerance, dyspnea, orthopnea, murmurs </li></ul><ul><li>Management: oral diuretics and Na – restricted diet in heart failure, anticoagulants, digitalis, beta-blockers </li></ul>2009
  61. 62. Mitral stenosis 2009
  62. 63. MITRAL VALVE REGURGITATION <ul><li>Occurs when much pressure is generated within the left ventricle to be generated to the aorta resulting to backflow of blood to the left atrium </li></ul><ul><li>Pressure is reflected back to the pulmonary veins and arteries </li></ul><ul><li>Manifestations: asymptomatic until cardiac output falls, murmurs, atrial fibrillation, pulmonary manifestations </li></ul><ul><li>Management: restrict physical activities, restrict sodium, diuretics, digitalis </li></ul>2009
  63. 64. AORTIC STENOSIS <ul><li>Caused by calcification of the valve and stiffening of the valve from rheumatic heart fever </li></ul><ul><li>Results in decreased cardiac output </li></ul><ul><li>Manifestations: initially asymptomatic, angina pectoris, syncope, dyspnea </li></ul><ul><li>Management: avoid vigorous physical activity, antibiotics, digitalis, beta-blockers </li></ul>2009
  64. 65. AORTIC REGURGITATION <ul><li>Blood propelled into the aorta propels back to the left ventricle through an incompetent valve </li></ul><ul><li>Manifestations: initially asymptomatic, palpitations, murmurs, low BP </li></ul><ul><li>Management: same for aortic stenosis </li></ul>2009
  65. 66. TRICUSPID VALVE DISEASE <ul><li>Tricuspid stenosis or regurgitation usually occurs after rheumatic heart disease </li></ul><ul><li>Causes decreased cardiac output and increased right atrial pressure </li></ul><ul><li>Manifestations: neck distention, peripheral edema, murmurs </li></ul><ul><li>Management: diuretics, digitalis </li></ul>2009
  66. 67. PULMONIC VALVE DISEASE <ul><li>Usually congenital defects </li></ul><ul><li>Causes: mitral stenosis, pulmonary emboli, chronic lung diseases </li></ul><ul><li>Can lead to decreased cardiac output </li></ul><ul><li>Manifestations: murmurs, fatigue, dyspnea </li></ul><ul><li>Management: treat the underlying cause </li></ul>2009
  67. 68. 2009
  68. 69. INFECTIOUS DISORDERS OF THE HEART 2009
  69. 70. INFECTIOUS DISORDERS OF THE HEART <ul><li>1. Pericarditis </li></ul><ul><li>acute or chronic inflammation of the pericardium </li></ul><ul><li>Assessment: </li></ul><ul><li>precordial pain </li></ul><ul><li>pain (inspiration, coughing & swallowing) </li></ul><ul><li>pain worse when supine </li></ul><ul><li>pericardial friction rub </li></ul><ul><li>fever & chills </li></ul><ul><li>elevated WBC ct. </li></ul><ul><li>cardiomegaly </li></ul>2009
  70. 71. 2009
  71. 72. 2. Myocarditis: <ul><li>acute / chronic inflammation of the myocardium </li></ul><ul><li>Etiology: </li></ul><ul><li>Bacterial : staphylococcus / pneumococcal </li></ul><ul><li>Viral : coxsackievirus / mumps / influenza </li></ul><ul><li>Parasitic : Toxoplasmosis </li></ul><ul><li>Radiation / Lead </li></ul><ul><li>Meds: Lithium / Cocaine </li></ul>2009
  72. 73. 3. Endocarditis: <ul><li>Inflammation of the endocardium; platelets and fibrin deposit on the mitral and/or aortic valves causing deformity, insufficiency or stenosis </li></ul><ul><li>Assessment: </li></ul><ul><li>fever, anorexia, wt loss, fatigue </li></ul><ul><li>cardiac murmurs </li></ul><ul><li>Janeway’s lesions </li></ul><ul><li>Ossler’s nodes </li></ul><ul><li>Petechiae, splinter hemorrhages in nailbeds </li></ul><ul><li>Splenomegaly </li></ul>2009
  73. 74. 2009
  74. 75. RHEUMATIC FEVER/RHD <ul><li>A pancarditis that follows exposure of child to throat and skin infection caused by Group A B-hemolytic organisms </li></ul><ul><li>Repeated bouts with permanent scarring of the valves  RHD  heart failure </li></ul>2009
  75. 76. Erythema marginatum Subcutaneous Nodules 2009
  76. 77. CARDIAC TAMPONADE <ul><li>pericardial effusion occurs when the space bet. the parietal & visceral layers of the pericardium fill with fluid. </li></ul><ul><li>Etiology: </li></ul><ul><li>stab wound </li></ul><ul><li>tumor </li></ul><ul><li>surgery </li></ul>2009
  77. 78. Cardiac tamponade 2009
  78. 79. 2009
  79. 80. 2009
  80. 81. CORONARY ARTERY DISORDERS 2009
  81. 82. CORONARY ARTERY DISEASE <ul><li>Narrowing or obstruction of one or more coronary arteries as a result of: </li></ul><ul><ul><li>Atherosclerosis </li></ul></ul><ul><ul><li>Arteriosclerosis </li></ul></ul>2009
  82. 83. 2009
  83. 84. 2009
  84. 85. 2009
  85. 86. 2009
  86. 87. 2009
  87. 88. 2009
  88. 89. 2009
  89. 90. 2009
  90. 91. 2009
  91. 92. <ul><li>CORONARY ARTERY BYPASS GRAFTING (CABG) </li></ul>2009
  92. 93. 2009
  93. 94. 2009
  94. 95. ANGINA PECTORIS 2009
  95. 96. ANGINA PECTORIS <ul><li>chest pain resulting from myocardial ischemia; a symptom of an existing disease; no necrosis </li></ul>2009
  96. 97. 2009
  97. 98. MYOCARDIAL INFARCTION 2009
  98. 99. 2009
  99. 100. MYOCARDIAL INFARCTION <ul><li>sudden decrease of oxygenation due to reduced coronary blood flow that results to destruction of myocardial tissue in regions of the heart </li></ul><ul><li>after 15 mins. = necrosis </li></ul>2009
  100. 101. 2009
  101. 102. 2009
  102. 103. 2009
  103. 104. 2009
  104. 105. VASCULAR DISORDERS 2009
  105. 106. HYPERTENSION 2009
  106. 107. HYPERTENSION <ul><li>abnormal elevation of BP above 140/90 mmHg based on at rest </li></ul><ul><li>least 2 readings on same conditions. </li></ul>2009
  107. 108. Hypertension 2009
  108. 109. ARTERIAL ULCERS 2009
  109. 110. ARTERIAL ULCERS <ul><li>Skin breakdown due to local pressure or minor trauma in an ischemic extremity </li></ul><ul><li>Painful and heals poorly; forced to undergo limb amputation if untreated </li></ul><ul><li>Management: revascularization (arterial bypass surgery), skin grafting to cover the ulcer, keep area free from pressure and irritation, bed rest, debridement </li></ul>2009
  110. 111. ANEURYMS 2009
  111. 112. ANEURYSMS <ul><li>Permanent localized dilation of an artery that enlarges gradually </li></ul><ul><li>Causes: atherosclerosis, congenital malformations, infection, connective tissue disorders, hypertension </li></ul><ul><li>Complications: rupture, pressure on surrounding structures, thrombosis and embolization </li></ul>2009
  112. 113. 2009
  113. 114. RAYNAUD’S SYNDROME 2009
  114. 115. RAYNAUD’S SYNDROME <ul><li>- vasospasm of the arterioles & arteries of extremities. </li></ul><ul><li>Etiology: </li></ul><ul><li>cold </li></ul><ul><li>stress </li></ul><ul><li>Smoking </li></ul><ul><li>caffeine </li></ul>2009
  115. 116. BueRGER’S DISEASE 2009
  116. 117. BUERGER’S DISEASE <ul><li>Also called “Thromboangitis obliterans” </li></ul><ul><li>occlusive disease of the median & small arteries & veins accompanied by clot formation. </li></ul><ul><li>Etiology: </li></ul><ul><li>unknown </li></ul><ul><li>smoking </li></ul><ul><li>males </li></ul>2009
  117. 118. VARICOSE VEINS 2009
  118. 119. VARICOSE VEINS <ul><li>Permanently distended veins that develop due to loss of valvular competence maybe due to prolonged standing </li></ul><ul><li>Common sites: greater and lower saphenous veins and perforator veins </li></ul><ul><li>Incidence: higher in females </li></ul><ul><li>Types: </li></ul><ul><ul><li>Primary – congenital/familial origin </li></ul></ul><ul><ul><li>Secondary – from trauma, obstruction, DVT or inflammation </li></ul></ul>2009
  119. 120. CHRONIC VENOUS INSUFFICIENCY 2009
  120. 121. CHRONIC VENOUS INSUFFICIENCY <ul><li>Group of disorders resulting from faulty venous valves </li></ul><ul><li>Manifestations: swollen limbs, thick and brownish skin, venous stasis ulcerations, itchy scaly skin </li></ul>2009
  121. 122. LYMPHEDEMA 2009
  122. 123. LYMPHEDEMA <ul><li>Swelling caused by impaired transcapillary fluid transport and transportation of lymph </li></ul><ul><li>Classification </li></ul><ul><ul><li>Primary – according to age of onset </li></ul></ul><ul><ul><ul><li>Congenital (Milroy’s disease) </li></ul></ul></ul><ul><ul><ul><li>Praecox (before age 35) </li></ul></ul></ul><ul><ul><ul><li>Tarda (after age 35) </li></ul></ul></ul><ul><ul><li>Secondary – due to damage of the lymphatic system by another disease process (filariasis, inflammation, neoplasms, surgical excision) </li></ul></ul>2009
  123. 124. THE END

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