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The Cardiovascular System

The Cardiovascular System. Chapters 15-18. The Heart. Location: Thoracic cavity Behind sternum Between the lungs. The Heart:. Protective sac PERICARDIUM Layers of heart tissue Epicardium Myocardium Endocardium. The Heart. Function Double pump Right 

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The Cardiovascular System

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  1. The Cardiovascular System Chapters 15-18

  2. The Heart • Location: • Thoracic cavity • Behind sternum • Between the lungs

  3. The Heart: • Protective sac • PERICARDIUM • Layers of heart tissue • Epicardium • Myocardium • Endocardium

  4. The Heart • Function • Double pump • Right  • Receives blood from the body (pumps blood to) • Lungs • Left  • Receives blood from the lungs  • body

  5. The Heart: Blood flow • Inferior & Superior Vena cava  • Right Atrium  • Tricuspid valve • Right Ventricle  • Pulmonary valve • Pulmonary Arteries  • Pulmonary arterioles  • Pulmonary capillaries  • Pulmonary venules  • Pulmonary veins 

  6. The Heart: Blood flow • Pulmonary veins  • Left Atrium  • Bicuspid (mitral) valve  • Left ventricle  • Aorta  • Aortic Valve • (body) • Arteries • Capillaries  • Vein 

  7. The Heart: Blood flow • Veins  • Inferior & Superior Vena cava  • Right Atrium  • Tricuspid valve • Right Ventricle  • Pulmonary Arteries  • Pulmonary arterioles  • Pulmonary capillaries  • Pulmonary venules  • Pulmonary veins 

  8. Heart Beat • Lub-dub; lub-dub • First sound • S1 (lub) • “AV valves” close • (valves between the atriums & ventricles) • Tricuspid • Bicuspid • Second sound • S2 (dub) • “semilunar valves” close • Aortic valve • Pulmonary valve

  9. Conduction System • Cardiac muscle does not need the nervous system to generate an electrical impulse

  10. Cardiac Cycle • Contraction & relaxation of the heart = • One heart beat • Diastole • Ventricles relax • Systole • Ventricles contact

  11. Normal Heart Rate • 70-90 / minute • > tachycardia • < bradycardia

  12. Cardiac output • Stroke Volume (SV) • Amount of blood pushed from the heart with each heart beat (ventricle contraction) • @ 70 mL • Cardiac Output (CO) • Amount of blood pumped by the ventricles in 1 minute • CO = HR (pulse) x SV • @4-8 L/min

  13. Peripheral Vascular System • Network of blood vessels that carry blood to peripheral tissues and then return it to the heart • Arteries • carry blood away from the heart • Capillaries • Veins • carry blood towards the heart

  14. Arteries & Veins • Aorta  • Arteries  • Arterioles • Capillaries • Venules • Veins  • Superior & Inferior Vena Cava

  15. Capillaries • Where Oxygen & nutrients are exchanges • Very permeable

  16. Blood vessel structure • Inner layer • Slick surface • Middle layer • Smooth muscle • Out layer • Protection

  17. Blood Vessel Structure • Smooth muscle function • Constriction • Narrowing • Dilation • Widening

  18. Blood Vessel Structure • Veins have something Arteries don’t have! • Valves

  19. Blood Pressure (BP) • Force exerted by blood against the walls of the arteries • SYSTOLIC • Pressure exerted when the heart contracts • DYASTOLIC • Pressure when the heart is filling

  20. Blood Pressure (BP) • Optimal Blood Pressure • <120 / 80

  21. Blood • Oxygenated • Blood that is carrying oxygen • Deoxygenated • Blood that is not carrying oxygen • Carrying CO2

  22. Oxygenated &Deoxygenated • Inferior & Superior Vena cava  • Right Atrium  • Tricuspid valve • Right Ventricle  • Pulmonary valve • Pulmonary Arteries  • Pulmonary arterioles  • Pulmonary capillaries  • Pulmonary venules  • Pulmonary veins 

  23. Oxygenated & Deoxygenated • Pulmonary veins  • Left Atrium  • Bicuspid (mitral) valve  • Left ventricle  • Aorta  • Aortic Valve • (body) • Arteries • Capillaries  • Vein 

  24. The Heart: Blood flow • Veins  • Inferior & Superior Vena cava  • Right Atrium  • Tricuspid valve • Right Ventricle  • Pulmonary Arteries  • Pulmonary arterioles  • Pulmonary capillaries  • Pulmonary venules  • Pulmonary veins 

  25. Small Group Questions • Fill in the chart. • Describe blood flow through the heart & body. • Where is oxygenated blood and deoxygenated blood found?

  26. Cardiac Assessment • Health History • Chest pain • Breathing problems • Short of breath • Changes in energy levels • Medication • Life style • Alcohol intake • Exercise • Smoking • Illicit drugs

  27. Cardiac Assessment • Skin Color • Pallor • Pale • Cyanosis • Blue

  28. Cardiac Assessment • Vital Signs • Peripheral pulses • Capillary refill • Edema? • Auscultate the heart

  29. Diagnostic Tests • Lipid profile • Cholesterol • Triglycerides • High-density lipoproteins (HDL’s) • Low-density lipoproteins (LDL’s) • Assess risk for atherosclerosis & coronary heart disease

  30. Diagnostic Tests • Serum Cardiac Markers (Cardiac enzymes) • Creatinephosphokinase • CK-MB • cTnT • cTn1 • Heart muscle cells that are dead or damaged release these proteins. • Increased levels = heart damage

  31. Diagnostic Test • Electrocardiogram (ECG) • Record of the electricity of the heart

  32. Imaging Techniques • CT scan • 3-D X-ray machine

  33. Imaging Techniques • MRI scan • Magnetic resonance imaging

  34. MRI: Rules • No METAL in the room with the machine • Assess for • Metal implants • Claustraphobia • http://www.youtube.com/watch?v=7g5UVrOt2CI • http://www.youtube.com/watch?v=6BBx8BwLhqg&NR=1

  35. Imaging Techniques • Angiography • INVASIVE • Insertion into an artery • X-rays + fluoroscopy

  36. Imaging Techniques • Angiography • INVASIVE • Risks – • Bleeding • Clot  • Assess: • Insertion site • Pedal pulses

  37. WARNING: Angiography • Closely monitory the client, the insertion site, the extremity after the procedure. Immediately report evidence of bleeding, pain or a pale pulseless extremity to the charge nurse & physician

  38. Coronary Heart Disease • AKA • Coronary Artery Disease • Definition • Narrowing of the arteries that supply blood to the heart muscles

  39. Arteriosclerosis & Atherosclerosis Arteriosclerosis Atherosclerosis Plaque buildup in the arteries #1 cause of CHD • Arteries that are • Thick • Non-elactic

  40. CHD: Risk Factors Changeable Non-changeable Age Gender Race Heredity • Smoking • Obesity • Physical inactivity • High fat diet • High blood pressure • Hypertension / HTN • High blood lipids • Hyperlipidemia • Diabetes Mellitus

  41. Atherosclerosis: Pathophysiology • Narrow arteries  • i blood flow  • ISCHEMIA • Not enough blood or oxygen for their metabolic needs • Infarction • Tissue death

  42. S&S of atherosclerosis • No symptoms until 75% of the lumen is occluded • Symptoms are due to ISCHEMIA

  43. Atherosclerosis: IDT Interventions • Quit smoking • Diet • Low fat • Exercise • Control BP • Control DM

  44. Atherosclerosis: IDT Interventions • Medications • Cholesterol-Lowering Drugs • Statins • Lipitor • Lescol • Mevacor • Pravachol • Crestor • Zocor • Nursing Implications • Monitor serum lipid levels • Assess liver

  45. Angina Pectoris • “Chest pain when there is a temporary imbalance between myocardial blood supply and demand”. • Chest pain due to i blood/ oxygen to the heart muscle

  46. Angina Pectoris: S&S • Pain • Chest • Radiating to • Neck • Shoulder • Arm • Jaw • Tight, squeezing, heavy • Shortness of Breath (SOB)

  47. IDT: Angina Pectoris • WARNING!!!!

  48. IDT: Angina Pectoris • Medications • Nitrates • Beta Blockers • Calcium Channel blockers

  49. Nitrates • Action: • Dilate blood vessels  • h blood flow to the heart • E.G. • Nitroglycerin • Route • Sub-lingual • Patches • Ointment

  50. Beta-Blockers • Decrease workload of the heart • Nrs Implications • Take BP & pulse before • Hold if <50/min

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