Cardiovascular System

Chapter 17


Cardiovascular System
Cardiovascular System circulates blood continuously
thought the body to deliver oxygen and nutrients to the bodys
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


Figure 17.3 Structural components of the heart.
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.
Cardiac Musculature
Heart Muscle
Base
Apex point of maximum impulse so heart beat is more
easily palpated over the apex 5
th
intercostal space
Three Layers:
Epicardium outer layer
Myocardium thick muscular layer
Endocardium - smooth inner lining of chambers
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
Valves
Valves - Permit the Flow of Blood Between
Chambers and into Blood Vessels
Atrioventricular (AV)
Tricuspid
Mitral
Semilunar
Pulmonary
Aortic
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)
Figure 17.5 Heart sounds in systole and diastole.
Table 17.3 Distinguishing Heart Murmurs
Table 17.3 (continued) Distinguishing Heart Murmurs
Table 17.4 (continued) Classifications of Heart Murmurs
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 bodys periphery
carrying oxygen and nutrients to cells.

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
Figure 17.11 Electrocardiogram wave.
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
individuals weight when evaluating the pumping
action of the heart
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.
Figure 17.18 Landmarks in precordial assessments.
Inteview
General Questions
Specific Questions
Illness
Symptoms
Behaviors
Infants and children
Pregnant female
Older adult
Environment
Equipment
Examination gown
Examination drape
Stethoscope
Metric rulers
Doppler
Techniques
Physical Assessment of the Cardiovascular System
Techniques
Inspection
Palpation
Percussion
Auscultation
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
Figure 17.17 Splinter hemorrhage.
Specific Areas
Inspection of the chest, abdomen, legs, and
skeletal structure
Landmarks
Right sternal border, 2
nd
intercostal space
Left sternal border, 2
nd
intercostal space
Left sternal border, 3
rd
5
th
intercostal space
Heaves and lifts


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
Figure 17.19 Landmarks for palpation of the chest.
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
Figure 17.20 Palpating the carotid artery.
Percussion
Percussion of the chest for cardiac border
5
th
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 3
rd
and 2
nd
intercostal space on the left
side.
Should change from resonnance to dullness as you
percuss over the heart
Figure 17.21 Percussing the chest.
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 spaceS2 is louder than S1
Pulmonic area at the left second intercostal spaceS2 is louder than S1
Erbs point at the left third intercostal spaceS1 and S2 are heard
equally
Tricuspid area at the left fourth intercostal spaceS1 is louder than S2
Apex at the left fifth intercostal space at the midclavicular lineS1 is
louder than S2
Figure 17.22 Auscultating the chest over five key landmarks.
Figure 17.24A Positions for auscultation of the heart. A. Supine.
Figure 17.24B Positions for auscultation of the heart. B. Lateral
Figure 17.24C Positions for auscultation of the heart. C. Sitting.
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
Figure 17.23 Comparing the carotid and apical pulses.
Abnormal Findings
Abnormal Findings in the Cardiovascular System
Myocardial and pump disorders
Valvular disease
Septal defects
Congenital heart disease
Electrical rhythm disturbances
Muscular and Pump Disorders
Myocardial and Pump Disorders
Myocardial ischemia
Myocardial infarction
Congestive heart disease
Ventricular hypertrophy
Valvular Disorders
Valvular Diseases
Mitral, aortic, tricuspid, and pulmonic stenosis
Mitral and aortic regurgitation
Mitral valve prolapse
Figure 17.25 Mitral stenosis.
Figure 17.26 Aortic stenosis.
Figure 17.27 Mitral regurgitation.
Figure 17.28 Pulmonic stenosis.
Figure 17.29 Tricuspid stenosis.
Figure 17.30 Mitral valve prolapse.
Figure 17.31 Aortic regurgitation.
Setal Defects
Septal Defects
Openings between the right and left atria or right and left
ventricles
Figure 17.32 Ventricular septal defect.
Figure 17.33 Atrial septal defect.
Congenital Heart Diseases
Congenital Heart Diseases
Coarctation of the aorta
Patent ductus arteriosus
Tetralogy of Fallot
Figure 17.34 Coarctation of the aorta.
Figure 17.35 Patent ductus arteriosus.
Figure 17.36 Tetralogy of Fallot.
Figure 17.36 (continued) Tetralogy of Fallot.
Rhythm Disturbances
Electrical Rhythm Disturbances
Ventricular tachycardia
Ventricular fibrillation
Figure 17.37 Ventricle tachycardia.
Figure 17.38 Ventricular fibrillation.
Figure 17.39 Heart block.
Figure 17.40 Atrial flutter.
Figure 17.41 Atrial fibrillation.
Developmental Considerations
Pediatric
Fetus receives oxygen and nutrients from the mother
Changes occur in the newborns cardiovascular system
Infants heart rate
Developmental Considerations
Pregnant Female
Heart is displaced to the left and upward
Blood volume increases 30 to 50 percent
Cardiac output and stroke volume increase
Resting pulse may increase
Murmurs may be auscultated
Developmental Considerations
Geriatric
Loss of ventricular compliance and vascular rigidity
Conduction system loses automaticity
Psychosocial Considerations

Stress and workload of the heart
Cultural and Environmental
Considerations

Race
Ethnicity
Diet
Substance abuse
Healthy People 2010
Focus Areas Outlined in the Healthy People 2010
Coronary heart disease
High blood cholesterol
Healthy People 2010
Key Objectives for Coronary Heart Disease
Reduce deaths
Increase awareness of symptoms of heart attack and
the need for rapid emergency care
Increase the numbers of adults who can administer
cardiopulmonary resuscitation
Reduce the number of obese individuals
Increase physical activity
Increase the number of adults who are aware of risk
factors and take action to reduce risks
Healthy People 2010
Key Objectives for High Blood Cholesterol
Reduce the number of adults with elevated cholesterol
levels
Increase the number of adults who have cholesterol
levels measured