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