1. MSN II: CVS DISORDERS
BY
Nr. BELLO, SA’AD MOHD
RN, RPON, RNE, BNSC, PDNE
2. OUTLINE
• Introduction
• Anatomic and physiologic review
• General assessment of patient with CVS disorders
• Conditions affecting the CVS –
• Vascular disorders and problems of peripheral circulation
• Coronary artery diseases
• Infectious and inflammatory cardiac diseases
• Structural cardiac diseases
• Cardiac arrhythmias
• Heart/cardiac failures
• Disorder of blood pressure – hypertension/hypotension
• Management of patient with CVS problems
• Nurses role in prevention of CVS problems
• Conclusion/evaluation
3. Introduction
• The cardiovascular system is one of the systems of the body that
consists of the heart and blood vessels,
• the heart act as a pump and the blood vessels serves as network
through which blood circulate.
• It is otherwise known as circulatory system or transport system.
• The cardiovascular system disorders are problems, abnormalities and
conditions affecting the cardiovascular system.
• CVS disorders are common diseases affecting young adult and old age
• Thorough understanding of these conditions would help nurses in
providing optimal nursing care.
4. Anatomic and physiologic review
• The heart is a roughly cone shaped, hollow, muscular organ situated
in the thoracic cavity, specifically in the mediastinum (space between
the lungs).
• It lies obliquely a little more to the left than the right. It is about 10cm
long and about the size of the owner’s fist.
• It is heavier in men than in women, weighing about 310g in men and
225g in women. It present with a base above and an apex below.
• The apex of the heart is about 9cm to the left of the midline at the
level of the 5th intercostals space i.e a little below the nipple and
slightly nearer the midline.
• The base extend upward to the level of the 2nd rib.
5. Anatomy of the heart
• The heart consists of three (3) layers of tissues and these are; Pericardium,
Myocardium and Endocardium.
• PERICARDIUM: This is the outermost layer of the heart consisting of two
(2) sacs.
• The outer sac (fibrous pericardium) and the inner sac (serous pericardium)
• The fibrous pericardium is the outermost layer of the pericardium that is
made up of fibrous tissue which is a continuation of a fibrous tissue of
tunica adventitia of the great blood vessels.
• It is inelastic fibrous nature prevent over distention of the heart.
• The serous pericardium is the inner layer of the pericardium
consisting of serous membrane lining.
• The parietal layer lines the fibrous pericardium while the visceral layer is
adherent to the muscle of the heart.
• In between the two layers i.e the parietal and visceral layer is a potential
space containing a fluid known as pericardial fluid which prevent friction
between them.
6. • MYOCARDIUM: This is the middle layer of the heart that consists of
specialized cardiac muscle that are exclusively found in the heart.
• The cardiac muscle is a type of muscle tissue that is striated just like
skeletal muscle but not under the voluntary control.
• Myocardium is thicker in the apex of the heart and thinner in the
base.
• It is also thickest in the left ventricle than the right ventricle due to
the amount of work it performed.
• ENDOCARDIUM: This is the inner layer of the heart consisting of a
single layer of flattened epithelial tissue that ensure smooth running
of blood through the heart.
• It is also known as endothelium. It lines the chamber and valves of
the heart. It continues with the lining of the blood vessels.
7. • The heart is divided into a right and left by the septum which is a partition
consisting of myocardium covered by endocardium.
• Each side is divided into upper atrium and lower ventricle by
atrioventricular valves.
• The right atrioventricular valves are formed by double folds of
endocardium strengthened by a little fibrous tissue.
• The right atrioventricular valves (tricuspid valve) has three (3) cusps and
the left atrioventricular valve (bicuspid valve) has two (2) cusps.
• The valve between the atria and ventricles open and closes passively
according to change in pressure in the chambers.
• They open when the pressure in the atria is greater than that in the
ventricles.
• The valves are prevented from opening upwards into the atria by the
tendinious cords called chordae tendinae which extend from the inferior
surface of the cusps to a little projection of myocardium into the ventricles
covered with endothelium called papillary muscles.
8.
9.
10. • The arterial blood supply to the heart is by right and left coronary
arteries which branched from the aorta immediately distal to the
aortic valve.
• The venous drainage is collected into a number of cardiac veins that
joins to form the coronary sinuses which opens into the right atrium.
Others area that need to be reviewed are
• Blood flow through the heart
• Conducting system of the heart
• Cardiac cycle
• Blood pressure and its regulations
11. General assessment of patient with CVS disorders
• The general approach for assessment of patient with CVS
disorders is as follows
• History taking
• Present health history – onset of cardiac signs & symptoms
• Past health history – previous hx of CVS disorders
• Family/social history – hx of CVS disorder in the family, hx of any
genetic dxs in the family
• Physical examinations
• General appearance and cognition
• Skin – pallor, cyanosis, ecchymosis, reduced skin tugor etc
• Blood pressure measurement
• Arterial pulse – rate, rhythm and quality
• Jugular vein venous pulsation ad pressure
• Cardiac auscultation/Heart sound – S1 & S2 only and note any
abnormal sounds
