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. Conduction System • Heart beat is controlled by special cells in the myocardium • “Conduction system”

11. Conduction Systemhttp://www.youtube.com/watch?v=te_SY3MeWys • Sinoatrial (SA) node  • AKA: Pacemaker • Internodal pathways  • Atrioventricular (AV) node  • Bundle of His  • Purkinje fibers

12. Conduction SystemElectorcardiogram (EKG) • http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000001&ptid=57

13. Cardiac Cycle • Contraction & relaxation of the heart = • 1 heart beat • Diastole • Ventricles relax • Systole • Ventricles contact

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

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

16. 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

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

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

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

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

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

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

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

24. Blood • Oxygenated • Blood that is carrying oxygen O2 • Deoxygenated • Blood that is not carrying oxygen • Carrying CO2

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

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

27. 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 

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

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

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

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

32. 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

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

34. ECG • P-wave • Arial depolarization

35. ECG • QRS complex • Ventricular depolarization

36. ECG • T-wave • Ventricular repolization

37. ECG • P-R interval

38. ECG • P-R interval • Period of time from • SA node to • AV node & Bundle of His

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

40. Imaging Techniques • MRI scan • Magnetic resonance imaging

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

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

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

44. 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

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

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

47. 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

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

49. S&S of atherosclerosis • Due to • ISCHEMIA • Angina • Myocardial Infarction

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