THE CARDIOVASCULAR SYSTEM
3 FUNCTIONS OF THE CARDIOVASCULAR SYSTEM:
1. Delivering oxygen and nutrients to the cells of the body
2. Removing waste products
3. Maintaining perfusion to the organs and tissues
HEART - hollow muscular organ a little larger than the patient’s fist.
It lies in the pericardial cavity in the mediastinum under the sternum and between
the 2nd and 5th intercostal spaces.
Base of heart – Posterior to sternum
Inferior to 2nd rib
Apex of Heart- 5th intercostal space, left of the sternum
PRECORDIUM - The area of the exterior chest that overlays the heart and great vessels.
------- PRECORDIUM
THE HEART WALL
1. EPICARDIUM- outermost layer of the
heart.
2. MYOCARDIUM- is the middle layer and
is the actual contracting muscle of heart.
3. ENDOCARDIUM- is a thin, smooth layer
of endothelial tissue that lines the inner
surface of the chambers and valves of the
heart.
4 HEART CHAMBERS:
RIGHT ATRIUM- receives deoxygenated blood from the body via the superior and inferior
vena cava.
RIGHT VENTRICLE- receives blood from the right atrium and pumps it to the lungs via the
pulmonary artery.
LEFT ATRIUM - receives oxygenated blood from the lungs via 4 pulmonary veins.
LEFT VENTRICLE- is the largest and most muscular chamber ; it receives oxygenated blood
from the lungs via the left atrium and pumps blood into the systemic circulation via the aorta.
SYSTOLE – period of ventricular contraction
DIASTOLE – period of ventricular relaxation
VALVE OPENINGS AND CLOSINGS
* During systole, the left ventricle starts to contract and ventricular pressure
rapidly exceeds left atrial pressure, shutting the mitral valve.
* During diastole, pressure in the blood-filled left atrium slightly exceeds that in
the relaxed left ventricle, and blood flows from left atrium to left ventricle across
the open mitral valve.
HEART SOUNDS
1. The first heart sound (S1) is heard as the atrioventricular valves close (mitral
and tricuspid valve) and is heard loudest at the apex of the heart.
2. The second heart sound (S2) is heard when the semilunar valves close ( aortic
and pulmonic valve) and is heard loudest at the base of the heart.
3. A third heart sound (S3) may be heard if ventricular wall compliance is
decreased and structures in the ventricular wall
vibrate heart; this can occur in conditions such as congestive heart failure or
valvular regurgitation. However, a third
heart sound may be normal in individuals younger than 30 years.
4.A fourth heart sound (S4) may be heard on atrial systole if resistance to
ventricular filling the is present; this is an
abnormal finding, and causes include cardiac hypertrophy, disease, or injury to
the ventricular wall.
AORTIC STENOSIS AND AORTIC REGURGITATION
AORTIC STENOSIS- occurs when the aortic valve narrows and blood cannot flow normally.
AORTIC REGURGITATION- is when your aortic valve doesn't close tightly, so blood leaks
backward with each heartbeat.
CONDUCTION SYSTEM
1. SINOATRIAL (SA) NODE- the main
pacemaker that initiates each heartbeat ;
located at the junction of superior vena cava
and right atrium ; SA nodes generates
electrical impulses at 60 -100 times per minute
and controlled by the SNS (Sympathetic
Nervous System) & PNS ( Parasympathetic
Nervous System).
2. ATRIOVENTRICULAR (AV) NODE-
receives electrical impulses from the SA node ;
located in the lower aspect of the atrial
septum ; if the SA node fails, the AV node can
initiate and sustain a heart rate of 40-60 bpm.
3. BUNDLE OF HIS- a continuation of the AV node ; located at the interventricular
septum; the right and left bundle branches terminate in the Purkinje fibers.
4. PURKINJE FIBERS- are a diffuse network of conducting strands located beneath the
ventricular endocardium ; can act as the pacemaker with a rate between 20 and 40 bpm
when higher pacemakers (such as the SA and AV nodes) fail.
THE HEART AS A PUMP
Cardiac output- the volume of blood ejected from each ventricle during 1 minute, is the
product of heart rate and stroke volume.
Stroke volume- (the volume of blood ejected with each heartbeat) depends in turn on
preload, myocardial contractility, and afterload.
PRELOAD - refers to the load that stretches the cardiac muscle before contraction.
MYOCARDIAL CONTRACTILITY- refers to the ability of the cardiac muscle, when given a
load, to contract or shorten.
AFTERLOAD- refers to the degree of vascular resistance to ventricular contraction.
Arterial Pulses and Blood Pressure
Blood pressure in the arterial system varies during the cardiac cycle, peaking in systole and
falling to its lowest trough in diastole. These are the levels that are measured with the blood
pressure cuff, or sphygmomanometer.
Pulse pressure- the difference between systolic and diastolic pressures.
JUGULAR VENOUS PRESSURE
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the
indirectly observed pressure over the venous system via visualization of the internal jugular
vein. The desired outcome of measuring JVP is to establish the patient’s JVP within the normal
range or for abnormal JVP to be identified so that appropriate treatment may be initiated.
* Measure the height of the bulge or distention of the jugular vein. Ask the patient to lie down on the
exam table with the head at 45 degrees. Ask him/her to turn his/her head to the side to measure the
central venous pressure (CVP). The physician will measure the height of the bulge of JVD to indicate CVP.
COMMON OR CONCERNING SYMPTOMS:
Chest pain
Pain or discomfort radiating to the neck, left shoulder or arm, and back
Nausea
Diaphoresis
Arrhythmias
Dyspnea
Orthopnea or paroxysmal nocturnal dyspnea
Cough
Edema
Nocturia, fatigue, cyanosis or pallor.
Patent ductus arteriosus (PDA) is an extra blood vessel found in babies before birth and
just after birth. In most babies who have an otherwise normal heart, the PDA will shrink and
close on its own in the first few days of life. If it stays open longer, it may cause extra blood to
flow to the lungs.
Ventricular septal defect (VSD) is a birth defect of the heart in which there is a hole in
the wall (septum) that separates the two lower chambers (ventricles) of the heart. This wall
also is called the ventricular septum.
Dextrocardia is a condition in which the heart is pointed toward the right side of the chest.
Normally, the heart points toward the left. The condition is present at birth (congenital).
Situs inversus is a condition in which the arrangement of the internal organs is a mirror
image of normal anatomy.
A client with three or more of these findings may have metabolic syndrome:
-Large waist circumference (abdominal obesity)
Men: waist circumference of 40 inches or more
Women: waist circumference of 35 inches or more
-High blood pressure—130/85 mm Hg or higher
-High fasting blood sugar—fasting glucose of 100 mg/dL or higher
-High triglycerides—150 mg/dL or higher
-Low high-density lipoprotein (HDL; good) cholesterol
Men: 40 mg/dL
Women: 50 mg/dL
-Smoking is also a risk factor for metabolic syndrome.
