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Cardiac Anatomy and Physiology


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Presentation to participants undertaking the: Critical Care Transition Program at ACT Health, 2008

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Cardiac Anatomy and Physiology

  1. 1. Cardiac Anatomy and Physiology
  2. 2. Overview <ul><li>Anatomy and Physiology </li></ul><ul><li>Terms </li></ul>
  3. 3. Anatomy and Physiology <ul><li>The body needs O 2 to support daily activity blood is that delivery system the heart is the medium to supply the blood </li></ul><ul><li>100,000 beats in 24 hours </li></ul><ul><li>5-20 litres per minute </li></ul><ul><li>Responds to activity </li></ul>
  4. 4. Anatomy and Physiology
  5. 5. Anatomy and Physiology <ul><li>Positioned behind sternum </li></ul><ul><li>Apex at 5 th intercostal space mid-clavicular </li></ul><ul><li>Base 1.5cms left of sternum </li></ul><ul><li>Approx 10cms long </li></ul><ul><li>Weights 270gms </li></ul>
  6. 6. Anatomy and Physiology
  7. 7. Anatomy and Physiology
  8. 8. Anatomy and Physiology
  9. 9. Anatomy and Physiology <ul><li>Pericardium </li></ul><ul><ul><li>Layered fluid filled sac surrounds heart </li></ul></ul><ul><li>Epicardium </li></ul><ul><ul><li>Single layer </li></ul></ul><ul><li>Myocardium </li></ul><ul><ul><li>Muscular wall of heart </li></ul></ul><ul><li>Endocardium </li></ul><ul><ul><li>Inner surface of heart forms valves </li></ul></ul>
  10. 10. Anatomy and Physiology <ul><li>Aortic </li></ul><ul><li>Mitral </li></ul><ul><li>Pulmonary </li></ul><ul><li>Tricuspid </li></ul><ul><li>Control one-way flow of blood </li></ul><ul><li>Formed from folds of endocardium and fibrous tissue </li></ul>
  11. 11. Anatomy and Physiology
  12. 12. Anatomy and Physiology
  13. 13. Anatomy and Physiology
  14. 14. Terms <ul><li>Atrial kick </li></ul><ul><li>Pre-load </li></ul><ul><li>After-load </li></ul><ul><li>Contractility </li></ul><ul><li>Stroke Volume </li></ul><ul><li>Cardiac output </li></ul><ul><li>Cardiac reserve </li></ul>
  15. 15. Terms: atrial kick <ul><li>The amount of blood pumped into the ventricles resulting from atrial contraction. </li></ul>
  16. 16. Terms: pre-load <ul><li>The stretch of the myocardial fibres at end diastole, </li></ul><ul><li>The ventricle end diastolic pressure and volume. </li></ul>
  17. 17. Terms: after-load <ul><li>The resistance, against which the ventricle must eject its volume of blood during contraction. </li></ul><ul><li>The resistance is produced by the volume blood already in the vascular system and the vessel walls. </li></ul>
  18. 18. Terms: contractility <ul><li>The ability of the cardiac muscle fibres to contract or shorten </li></ul><ul><li>Frank-starlings law </li></ul>
  19. 19. Terms: stroke volume <ul><li>The amount blood ejected by ventricle during contraction, </li></ul><ul><li>Ejection fraction proportion of blood expelled in contraction compared to filling volume, </li></ul><ul><li>Normally 65% used as measure of normal LV function, </li></ul>
  20. 20. Terms: cardiac output <ul><li>CO = HR x SV </li></ul><ul><li>BP = CO x SVR </li></ul><ul><li>Cardiac Index = cardiac output of pt per square metre of body surface area </li></ul>
  21. 21. Terms: cardiac reserve
  22. 22. Cardiac Assessment
  23. 23. Overview <ul><li>Physical Assessment </li></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><li>Palpation </li></ul></ul><ul><ul><li>(Percussion) </li></ul></ul><ul><ul><li>Auscultation </li></ul></ul><ul><li>History </li></ul>
  24. 24. Assessment <ul><li>Inspection </li></ul><ul><li>Palpation </li></ul><ul><li>(Percussion) </li></ul><ul><li>Auscultation </li></ul>
  25. 25. Assessment <ul><li>Inspection </li></ul><ul><ul><li>JVP </li></ul></ul><ul><ul><li>Oedema </li></ul></ul><ul><ul><li>Colour </li></ul></ul>
  26. 26. Assessment <ul><li>Palpation </li></ul><ul><ul><li>Pulse </li></ul></ul><ul><ul><li>Oedema </li></ul></ul><ul><ul><li>Capillary refill </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul>
  27. 27. Assessment <ul><li>Auscultation </li></ul><ul><ul><li>Normal </li></ul></ul><ul><ul><ul><li>S1 </li></ul></ul></ul><ul><ul><ul><li>S2 </li></ul></ul></ul><ul><ul><li>Abnormal </li></ul></ul><ul><ul><ul><li>S2 split </li></ul></ul></ul><ul><ul><ul><li>S3 </li></ul></ul></ul><ul><ul><ul><li>S4 </li></ul></ul></ul>
  28. 28. Assessment
  29. 29. Assessment
  30. 30. Assessmen t
  31. 31. Pneumothorax Myocardial Infarction Respiratory Infection Angina Musculoskeletal Pericarditis Aortic Dissection Trauma Anxiety Pulmonary Embolism Oesophageal Reflux / Spasm Causes of chest pain
  32. 32. <ul><li>Case 1: </li></ul><ul><li>40 year old man </li></ul><ul><li>2 hours central chest pain </li></ul><ul><li>Radiating to (L) arm </li></ul><ul><li>Pale, cold, clammy </li></ul><ul><li>Case 2: </li></ul><ul><li>55 year old woman </li></ul><ul><li>1 hour generalised weakness and unwell </li></ul><ul><li>Discomfort in throat </li></ul>Who is having a MI?
  33. 33. Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Family History Unhealthy Dietary Habits Risk Factors
  34. 34. <ul><li>Early Recognition and Assessment </li></ul><ul><li>Early Access </li></ul><ul><li>Early CPR </li></ul><ul><li>Early Defibrillation </li></ul><ul><li>Early Advanced Cardiac Life Support </li></ul>Chain of Survival
  35. 35. <ul><li>Case 1: </li></ul><ul><li>40 year old man </li></ul><ul><li>2 hours central chest pain </li></ul><ul><li>Radiating to (L) arm </li></ul><ul><li>Pale, cold, clammy </li></ul><ul><li>Triage: </li></ul><ul><li>Rapid Assessment </li></ul><ul><li>Prioritise Injury / Illness </li></ul><ul><li>Allocate Triage Category </li></ul>Scenario
  36. 36. <ul><li>Primary Assessment </li></ul><ul><li>A – clear and open </li></ul><ul><li>B – spontaneous, AE R=L o added sounds </li></ul><ul><li>C – tachycardic - weak, diaphoretic </li></ul><ul><li>D – GCS 15, PEARL, full ROM / Strength / Sensation all limbs </li></ul><ul><li>Secondary Assessment </li></ul><ul><li>E – Change into patient gown </li></ul><ul><li>F – Observations: R: 28, P: 120, BP: 149/66, T: 37 2 , </li></ul><ul><li>(monitor) BSL: 6.9, Pain 5/10, SpO 2 99% RA </li></ul><ul><li>G – Comfort measures </li></ul><ul><li>H – Detailed history / Family History / heat-to-toe assessment </li></ul>Time = Muscle Assessment
  37. 37. lleregies A M P L E edications revious medical, surgical and family history ast meal vents Assessment
  38. 38. osition: Where is the Pain? P Q R S T A A A uality: What does the pain feel like? [sharp, dull, burning] adiation: Does the pain move anywhere? everity: Rate the pain on a scale between 0 and 10 iming: When did the pain start? Is it continuous? lleviating factors: What makes it better? ggravating factors: What makes it worse? ssociated symptoms: e.g., nausea / pins and needles Assessment
  39. 39. Inspect Palpate Percussion Auscultation Assessment
  40. 40. <ul><li>Notify Nursing Team Leader and Senior Doctor </li></ul><ul><li>Primary </li></ul><ul><li>B – Supplementary Oxygen </li></ul><ul><li>C – ECG </li></ul>Nursing Intervention
  41. 41. Nursing Intervention
  42. 42. <ul><li>Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow </li></ul><ul><li>Notify Nursing Team Leader and Senior Doctor </li></ul><ul><li>Primary </li></ul><ul><li>B – Supplementary Oxygen </li></ul><ul><li>C – ECG </li></ul><ul><li>IVC 18g </li></ul><ul><li>Bloods to pathology (FBC, UEC, CP, CK, Troponin, ABG) </li></ul><ul><li>Secondary </li></ul><ul><li>F – Observations </li></ul><ul><li>G – Analgesia / Medications </li></ul><ul><li>Reassurance, bed rest, patient and family education </li></ul>Nursing Intervention
  43. 43. <ul><li>Interpretation of ECG </li></ul><ul><li>Chest X-Ray </li></ul><ul><li>IVC  bloods to pathology </li></ul><ul><li>Medications </li></ul><ul><ul><li>Anginine </li></ul></ul><ul><ul><li>Aspirin </li></ul></ul><ul><ul><li>Morphine </li></ul></ul><ul><ul><li>GTN infusion </li></ul></ul><ul><ul><li>Clopidogrel </li></ul></ul><ul><ul><li>Heparin </li></ul></ul><ul><ul><li>Cardiology Review </li></ul></ul><ul><li>Treatment Options </li></ul><ul><ul><li>PTCA </li></ul></ul><ul><ul><li>Thrombolysis </li></ul></ul>Medical Intervention