Cardiovascular System

1. Cardiovascular System Chapter 17

2. Cardiovascular System • Cardiovascular System – circulates blood continuously thought the body to deliver oxygen and nutrients to the body’s organs and tissue and to dispose of waste. • Heart (pump) and vasculature (plumbing) • The heart is composed of: • Cardiac muscle • Atria • Ventricles • Valves • Cardiac arteries and veins • Electrical conduction system • Cardiac Nerves • Problems or failure of any of these system can lead to serious health concerns. • Review Anatomy

3. Figure 17.3 Structural components of the heart.

4. Heart • Heart – pump composed of synchronized structures • Cardiac Vessels • Coronary Arteries – extensive network of arteries supplying the heart • Coronary Veins – network for venous blood drainage • Conduction system – heart has it own conduction system which can initiate and transmit an electrical impulse via cardiac muscle fibers • This electrical charge stimulates muscular contraction of the heart • SA node, AV node, Bundle of His, Right and Left Bundle Branch Block, and Purkinje fibers • Nerves • Sympathetic – stimulate the heart, increases heart rate, force of contraction, and dilation of coronary arteries. • Parasympathetic – opposite effect • CNS – influences the activation and interaction of nerves through information supplies by the cardiac plexus.

5. Cardiac Musculature • Heart Muscle • Base • Apex – point of maximum impulse so heart beat is more easily palpated over the apex – 5th intercostal space • Three Layers: • Epicardium – outer layer • Myocardium – thick muscular layer • Endocardium - smooth inner lining of chambers

6. Chambers • Chambers in the Heart – 4 chambers • Left and right atria – receiving chambers for blood and pump blood into the ventricles • Left and right ventricles – eject blood into vessels

7. Valves • Valves - Permit the Flow of Blood Between Chambers and into Blood Vessels • Atrioventricular (AV) • Tricuspid • Mitral • Semilunar • Pulmonary • Aortic

8. Heart Sounds • Heart Sounds – Closure of valves which are associated with the contraction and relaxation phases of the heart. • Systole – refers to ventricular contraction and begins with closure of the AV valves (S1) and ends with the closure of the aortic and pulmonic valve (S2) • Diastole – refers to ventricular relaxation and begins with closure of the aortic and pulmonic valve (S2) and ends with closure of AV valves (S1). • S1 (lub) • S2 (dub)

9. Figure 17.5 Heart sounds in systole and diastole.

10. Table 17.3Distinguishing Heart Murmurs

11. Table 17.3 (continued)Distinguishing Heart Murmurs

12. Table 17.4 (continued)Classifications of Heart Murmurs

13. Circulation of Heart • Pulmonary Circulation – carries deoxygenated blood to the lungs, where carbon dioxide is exchanged for oxygen. • Systemic Circulation – supplies freshly oxygenated blood to the body’s periphery carrying oxygen and nutrients to cells.

14. Electrocardiogram • Electrocardiogram (EKG) - Paper Recording of Deflections That Represent the Cardiac Cycle – Signifies electrical conduction • Electrical deflections • P wave • PR interval • QRS interval • T wave

15. Figure 17.11 Electrocardiogram wave.

16. Cardiac Function • Stroke volume - Amount of blood that is ejected with each heartbeat • Cardiac output - Amount of blood ejected from the left ventricle over one minute • Cardiac index - Measurement accounting for an individual’s weight when evaluating the pumping action of the heart

17. Landmarks for Cardiac Assessment • Landmarks for Cardiac Assessment • Sternum • Clavicles • Ribs • Second through fifth intercostal spaces • Correlating assessment findings over body landmarks provides vital information related to underlying pathologic mechanisms.

18. Figure 17.18Landmarks in precordial assessments.

19. Inteview • General Questions • Specific Questions • Illness • Symptoms • Behaviors • Infants and children • Pregnant female • Older adult • Environment

20. Equipment • Examination gown • Examination drape • Stethoscope • Metric rulers • Doppler

21. Techniques • Physical Assessment of the Cardiovascular System • Techniques • Inspection • Palpation • Percussion • Auscultation

22. Specific Areas • Specific Areas of the Cardiovascular Assessment • Inspection of the face, lips, ears, and scalp • Skin color • Movement • Earlobe creases • Inspection of the jugular veins • Pulsations • Distention • Inspection of the carotid arteries • Pulse characteristics • Inspection of the hands and fingers • Color • Shape of fingers

23. Figure 17.17Splinter hemorrhage.

24. Specific Areas • Inspection of the chest, abdomen, legs, and skeletal structure • Landmarks • Right sternal border, 2nd intercostal space • Left sternal border, 2nd intercostal space • Left sternal border, 3rd – 5th intercostal space • Heaves and lifts

25. Palpation • Palpation of the chest, including the following • Precordium at the right and left second intercostal spaces • Left third intercostal space • Left fourth intercostal space • Left fifth intercostal space at the midclavicular line • Position patient at a 30 degree angle or less • No thrills, heaves or lifts should be palpated in any of the five locations

26. Figure 17.19Landmarks for palpation of the chest.

27. Palpation • Carotid pulses (sequentially) • Client may be supine or sitting upright • Asses: • Presence – diminished or absent may indicate carotid disease or dissecting aortic aneurysm • Strength – should be strong but not bounding • Rhythm – regular pattern • Equality – consistent bilaterally • Palpate each artery separately – may obstruct blood flow to the brain, resulting in severe bradycardia or asystole

28. Figure 17.20Palpating the carotid artery.

29. Percussion • Percussion of the chest for cardiac border • 5th intercostal space at the left anterior axillary line • Normal findings would be resonance because you will be over lung tissue • Next, percuss the mid clavicular line and the left sternal border • Should change to dull as you percuss over the heart • Advance to the 3rd and 2nd intercostal space on the left side. • Should change from resonnance to dullness as you percuss over the heart

30. Figure 17.21Percussing the chest.

31. Auscultation • Auscultation of the chest using the diaphragm and bell in various positions to include the following locations • Aortic area at the right second intercostal space—S2 is louder than S1 • Pulmonic area at the left second intercostal space—S2 is louder than S1 • Erb’s point at the left third intercostal space—S1 and S2 are heard equally • Tricuspid area at the left fourth intercostal space—S1 is louder than S2 • Apex at the left fifth intercostal space at the midclavicular line—S1 is louder than S2

32. Figure 17.22 Auscultating the chest over five key landmarks.

33. Figure 17.24APositions for auscultation of the heart. A. Supine.

34. Figure 17.24BPositions for auscultation of the heart. B. Lateral

35. Figure 17.24CPositions for auscultation of the heart. C. Sitting.

36. Auscultation of Apical Pulse • Specific Areas of the Cardiovascular Assessment • Auscultation of the carotid arteries using the diaphragm and bell • Comparison of the apical pulse to a carotid pulse

37. Figure 17.23Comparing the carotid and apical pulses.

38. Abnormal Findings • Abnormal Findings in the Cardiovascular System • Myocardial and pump disorders • Valvular disease • Septal defects • Congenital heart disease • Electrical rhythm disturbances

39. Muscular and Pump Disorders • Myocardial and Pump Disorders • Myocardial ischemia • Myocardial infarction • Congestive heart disease • Ventricular hypertrophy

40. Valvular Disorders • Valvular Diseases • Mitral, aortic, tricuspid, and pulmonic stenosis • Mitral and aortic regurgitation • Mitral valve prolapse

41. Figure 17.25Mitral stenosis.

42. Figure 17.26Aortic stenosis.

43. Figure 17.27Mitral regurgitation.

44. Figure 17.28Pulmonic stenosis.

45. Figure 17.29Tricuspid stenosis.

46. Figure 17.30Mitral valve prolapse.

47. Figure 17.31Aortic regurgitation.

48. Setal Defects • Septal Defects • Openings between the right and left atria or right and left ventricles

49. Figure 17.32Ventricular septal defect.

50. Figure 17.33Atrial septal defect.