2. 2
Cardiology
1. Describe the anatomy of the cardiovascular system.
2. Explain the pulmonary and systemic circulations.
3. Describe coronary circulation, hepatic portal circulation,
and fetal circulation.
4. Explain the components in blood, and discuss blood
types.
5. Describe life span changes related to the cardiovascular
system.
6. Describe the conduction system of the heart,
including the three states of a cardiac cell.
3. 3
7. Describe factors that influence blood pressure.
8. List common signs and symptoms of cardiovascular
disorders.
9. Identify disorders of the cardiovascular system, list risk
factors for heart disease, and describe the types of shock.
10. Discuss the medical assistant’s role in assisting with
the cardiology examination.
11. Describe diagnostic procedures, including
angiography, cardiac catheterization, Doppler
ultrasound, and echocardiography.
12. Describe cardiovascular treatments, including a
pacemaker and an implantable cardioverter-defibrillator.
Cardiology
4. 4Anatomy of the Heart
From Applegate EJ: The anatomy and physiology learning system, ed 4, St Louis, 2010, Saunders.
5. Cardiovascular System
Brings oxygen, nutrients, water, and other substances to body’s
cells
Also carries waste products away from cells to be excreted
Includes:
Blood vessels, consisting of arteries, arterioles, capillaries, venules, and
veins
Heart, which pumps blood
Blood, which contains nutrients for cells and the waste products to be
excreted
Know the system
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6. Blood Vessels
Arteries: Carry blood from heart
Arterioles: Smaller arteries that move blood to
capillaries; involved with maintaining blood
pressure
Capillaries: Allow for exchange of oxygen, nutrients,
waste products, and other substances
Venules: Vessels that collect blood from capillaries
and begin return journey to heart
Veins: Collect blood from venules and return blood
to heart
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7. The Heart
Chambers
Atria: Upper chambers
Ventricles: Lower chambers
Septum: Thick muscular wall that divides heart into right and left
sections
Heart wall has three layers:
Endocardium
Myocardium
Epicardium (visceral pericardium)
***pay attention to this
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9. The Heart
Valves
Allow blood to flow in one direction
Two sets of valves:
Atrioventricular (AV): When closed, prevents backflow of blood into atrium
Semilunar (SL): Allow blood to flow out of heart and prevent backflow of
blood into ventricles
Heartbeat
Lub dup: Normal sound
Complete heartbeat (cardiac cycle) can be divided into diastole and
systole phases
****Know this information!!
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10. Pulmonary and Systemic
Circulations
Pulmonary circulation: Deoxygenated blood is pumped from right
side of heart to lungs
Gas is exchanged
Oxygenated blood returns to heart
Systemic circulation: Oxygenated blood is pumped from left side
of heart and moves through body
Oxygen, nutrients, and other substances are brought to cells while
blood picks up waste products
**this information is important
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13. Coronary Circulation
Right and left coronary arteries are first branches off ascending
aorta
Coronary arteries bring nutrients and oxygen to heart tissue
Coronary arteries have important role of maintaining myocardium
**I would remember this
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14. Hepatic Portal Circulation
Veins from spleen, gallbladder, stomach, and intestines dump
blood into hepatic portal vein, which takes blood to liver
Liver has special role in filtering blood and metabolizes or breaks
down substances
Glucose
Toxic substances like alcohol or medications
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15. Blood
Made up of two components:
Liquid portion: Plasma (55%)
Formed elements: RBCs, WBCs, and platelets (45%)
The average 150-pound person has approximately 5 liters of blood
circulating throughout the body
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16. Life Span Changes
Unborn child receives oxygen and nutrients from mother’s blood
As child grows and matures, heart rate decreases
Resistance for blood flow increases and thus the blood pressure
increases with age
As person ages, the heart and blood vessels undergo changes
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17. Cardiac Muscle
Two kinds of cardiac cells
Electrical or conduction system cells
Myocardial cells
Electrical cells have three unique characteristics:
Automaticity
Excitability
Conductivity
***know the layers of the heart ie, myocardium
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18. Conduction System
Structures
Sinoatrial (SA) node
Atrioventricular (AV) node
Bundle of His (also called AV bundle)
Right and left bundle branches
Purkinje fibers
*****know these 5 structures
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20. States of Cardiac Cell
Polarized
”Waiting” stage
Depolarized
When impulse hits cells, cells’ charges charge
Impulse moves through cell, causing action potential
Repolarized
After impulse passes over cell, ions move back to their original
location
****KNOW!!
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21. Conduction System and
Blood Flow
Conduction system is the electrical system in the heart
Recorded on an ECG
Cardiac muscle is different than other muscles in the body
When heart rate needs to change to meet demands of body,
autonomic nervous system automatically kicks in
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22. Blood Pressure (BP)
Blood pressure (BP): Resulting force of blood against the walls of
arteries
Two measurements are taken during cardiac cycle:
Systole: Measured when heart is contracting and pumping out the
blood
Diastole: Relaxation phase
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23. Hypertensive Heart Disease
Chronic hypertension can cause ventricular
hypertrophy, angina, MI, heart failure, stroke, and
nephropathy (kidney disease)
Risk factors include family history, high cholesterol,
smoking, high sodium intake, diabetes, excessive
alcohol intake, sedentary lifestyle, obesity, aging,
stress, and race
Symptoms are few, if any, until permanent damage is
done
Teach the patient to take blood pressure at home and
provide information for changing lifestyle to manage
the condition
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25. Factors that Influence BP
Blood volume
Can be raised by blood/plasma/IV transfusions or increased sodium
intake
Strength of ventricular contractions
Resistance to blood flow
Plaque
Smoking
Constriction of smooth muscles during vasoconstriction
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26. Coagulation and Hemostasis
Damaged vessel will constrict to slow the flow of blood through
vessel
In response to injury, platelets become sticky and clump together
(aggregation)
Platelets then stick to area of injury (adhesion)
Fibrin net traps RBCs and more platelets to form a thrombus
(coagulation)
Hemostasis: When body stops flow of blood through coagulation
**FOR YOUR INFORMATION
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30. Occurs when the myocardium cannot pump
adequate blood to the body, usually due to
weakness in the left ventricle
Heart failure initially occurs on one side of the
heart and then on other side
Nonpharmaceutical treatment: Limit physical
activity, salt, smoking, stress, weight
Drug therapy: Diuretics, ACE inhibitor, potassium
supplement
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34. Deep Vein Thrombosis (DVT)
Phlebitis is an inflammation of a vein, which can lead to a
blood clot (thrombus) forming
DVT is an inflammatory thrombus attached to the deep
venous system of the legs
Pulmonary embolism (PE) occurs if thrombus breaks loose
and travels to the lungs and blocks a pulmonary artery
IV anticoagulant therapy or enoxaparin sodium
subcutaneous injections to prevent clots
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35. Risk Factors for Heart
Disease
Age
Gender
Genetics
Race
Smoking
High cholesterol
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36. Signs and Symptoms
of MI in Women
Abdominal, neck, shoulder, or upper back pain
Jaw pain
Shortness of breath
Vertigo (dizziness)
Sweating
Indigestion or nausea and vomiting
Extreme fatigue
Aching in both arms
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38. Assisting with Examination 38
Cardiovascular examination begins with
medical assistant measuring:
Patient’s weight/height
Patient’s temperature
Patient’s radial pulse and respirations
Patient’s blood pressure in both arms
Large part of provider’s examination focuses on
subjective symptoms
39. Assisting with Diagnostic
Procedures
Angiography: Used to study blood vessels and to detect
occlusions, aneurysms, and structural defects
Arteriography
Cerebral angiography
Coronary angiography
Pulmonary angiography
Cardiac catheterization: Used to diagnose and treat certain heart
diseases
Regular coronary angiography is done during cardiac catheterization
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40. Assisting with Diagnostic
Procedures
Doppler ultrasounds: Provides information on the blood flow in
the arms and legs
Used to diagnose arteriosclerosis, arterial occlusion, peripheral artery
disease, aneurysms, arterial stenosis, and venous insufficiency
Echocardiography: Sonographic test that uses sound waves to
create pictures of heart structures
Most people have transthoracic echocardiogram (TTE)
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41. Assisting with Treatments
Patients with cardiovascular disorders are prescribed a variety of
medications, including:
Antiarrhythmics
Anticoagulants
Antihypertensives
Beta-blockers
Angiotensin-converting
enzyme (ACE) inhibitors
Angiotensin II receptor
antagonists
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Calcium channel blockers
Alpha blockers
Antiplatelets
Cholesterol lowering
agents
Hematopoietics
Hemostatics
42. Holter Monitor
A Holter monitor is a small, wearable device that keeps
track of your heart rhythm. A Holter monitor may be
worn for one to two days. During that time, the device
records all of the patient’s heartbeats.
A Holter monitor test is usually performed after a
traditional test to check the heart rhythm
(electrocardiogram), especially if the electrocardiogram
doesn't give your doctor enough information about
the heart's condition.
The doctor uses information captured on the Holter
monitor to figure out if the patient has a heart rhythm
problem. If standard Holter monitoring doesn't
capture your irregular heartbeat, the doctor may
suggest a wireless Holter monitor, which can work for
weeks.
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43. Pacemakers and Implantable
Cardioverter Defibrillators
Pacemakers use low-energy electrical pulses to assist the heart
Temporary
Permanent
Implantable cardioverter defibrillator (ICD) is similar to pacemaker
but they can also use high-energy pulses when life-threatening
arrhythmia occurs
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45. IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
Cell phone–sized device implanted in the chest
under the skin and attached to the heart with small
wires
Designed to deliver a measured electric shock to
myocardium to correct life-threatening
arrhythmias
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49. Patient Coaching
Provide encouragement, support, and community
resources to help the patient find assistance with these
changes
Provide pictures, brochures, and pamphlets to help
patients learn
Document patient education intervention
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50. Legal and Ethical Issues
You assume responsibility for the accuracy and
precision of any diagnostic procedure that you
perform
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51. Patient-Centered Care
Provide information and education
Patients must know:
Name of medication
Reason for medication
Side effects/adverse reactions to report to provider
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