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Cardiovascular Anatomy and Physiology. Daymar College Lisa H. Young, RN, BSN, MAE. Dextrocardia. Skeleton of the heart. Anterior View of the Heart. Walls of the Heart. Heart Valves. Structures of the AV Valves. Heart Valves. http://www.youtube.com/watch?v=39n4XWv7flQ. - PowerPoint PPT Presentation
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Cardiovascular Anatomy and Physiology
Daymar CollegeLisa H. Young, RN, BSN, MAE.
Dextrocardia
Skeleton of the heart
Anterior View of the Heart
Walls of the Heart
Heart Valves
Structures of the AV Valves
Heart Valveshttp://www.youtube.com/watch?v=39n4XWv7flQ
Left Ventricle Wall Surfaces
Heart Chambers
Heart Chambers
Left and Right Atrium Receives un-oxygenated blood from the
body and the lungs. Expands to accommodate
large volumes of blood from the body. Left and Right Ventricles Thick muscular walls to forcefully expel
blood to the body. Does not expand well.
Pressure Differences of the Heart
Blood flows from higher-pressure to lower pressure
Pressure order: highest to lowest◦Left ventricle◦Left atrium◦Right ventricle◦Right atrium
Animation of Blood Flow
http://www.youtube.com/watch?v=FCimR_P9ID0
Blood Flow
Fetal Blood Flow
Heart Rate
Autonomic Nervous System (ANS)
Sympathetic Nervous SystemAdrenergic response
Norepinephrine released Increased heart rate and blood pressure Decreases digestion
Heart Rate
Parasympathetic Nervous System Cholinergic response Acetycholine released Decreases heart rate, blood pressure
Increases digestion
Cardiac Cells
Electrical Cells Automaticity Excitability Conductivity
Mechanical Cells Contractility Extensibility
Chemical Basis for Impulse Formation
Cardiac Action Potential Phases
http://www.youtube.com/watch?v=7EyhsOewnH4
Cardiac Electrolytes
Hypokalemia (low potassium levels)http://www.youtube.com/watch?v=oXaff1v
bFnAHyperkalemia (high potassium levels)http://www.youtube.com/watch?v=xluHUc
QbWXoHypocalcemia (low calcium levels)http://www.youtube.com/watch?v=6_Khrzr
0x_AHypercalcemia (high calcium levels)http://www.youtube.com/watch?v=LIdAVj
WwIFo
Cardiac Electrolytes
Hypomagnesemia (low magnesium)http://www.youtube.com/watch?v=e0APN
C968MYHypermagnesemia (high magnesium)http://www.youtube.com/watch?v=4Gv3JR
4s_Gc
Electrical Conduction Pathway
Cardiac Cycle
Phases of Systole
Ventricular Systole/Diastole
Heart Action during SystoleA B
Atrial Kick
Physiologic Control Mechanisms of Blood Pressure
Compliance
Preload: L Ventricular Wall Stress at End Diastolic Volume
Afterload: L Ventricular Wall Stress During Systole (Ejection out L Ventricle)
Contractility
Pressure differences in the left and right heart
Pressure Volume Loophttp://www.youtube.com/watch?v=AnwPH5yU8rY
Normal Values
Right & Left heart pressures:◦Right atria 2-6 mmHg◦Right ventricle 25/0 mmHg◦Pulmonary arteries 25/8 mmHg◦Pulmonary veins 8 mmHg◦Left atria 6 mmHg◦Left ventricle 120/0 mmHg◦Aorta 120/80 mmHg
Pulmonary Vascular Resistance◦Less 2.5 mmHg/L/min or 200 Dynes
Systemic Vascular Resistance◦less than 20 mmHg/L/ min or 1600 Dynes
Cardiac Cycle (Pressure/Volume)
http://www.youtube.com/watch?v=7w6awkDREQM
http://www.youtube.com/watch?v=PUArUV4VdaY
Cardiac Output
Heart rate X Stroke Volume = CO5 liters / min. (at rest)4- 8 liters / min when pumpingFrank –Starling LawDecreased cardiac output signs and
symptomsEpinephrine, thyroxine, sympathetic
nervous system, fever, fear, exercise, low BP increase CO
Normal Values
Right heart oxygen saturation – 75%Left heart oxygen saturation – 95%Mean arterial pressure – 93 mmHgSystemic blood pressure – 120/80 mmHgAortic pulse pressure – 40 mmHgCardiac output – 5L/minStroke volume – 60 – 130 mL/beat
Carotid Arteries and Aortic Arch
Baroreceptors
◦Specialized nerve tissue (sensors)
◦Detect changes in blood pressure
◦Increase / decrease sympathetic tone
◦Dilation of blood vessels
Carotid Artery and Aortic Arch
Chemoreceptorsspecialized nerve tissue (sensors)
detect changes in concentration of pH, 02, C02
sympathetic or parasympathetic response
Coronary Arteries & Veins
Systemic Vasculature Layers
Vascular Layers & Arterioles
Vascular Circulation
Congenital Heart Disease
Coarctation of the Aorta (CoA)
Patent ductus arteriosus (PDA)
Septal defects
Tetralogy of Fallot
Transposition of the great arteries (TGA)http://www.youtube.com/watch?v=yePivAlbR4A
http://www.youtube.com/watch?v=cgR_XmRJcIg
http://www.youtube.com/watch?v=O83cYwKOKtI
http://www.youtube.com/watch?v=e46jtin-H50
Cardiovascular Assessment
Health HistoryA. Chief complainB. Family HistoryC. Coping and emotional historyD. MedicationsE. SurgeriesF. Activities of daily living
http://www.youtube.com/watch?v=JLLUkiZZfBo
Assessing the Heart
General appearanceInspectionPalpationPercussionAusculatation
http://www.youtube.com/watch?v=MIfmjFG6BTQ
Blood Pressure
Cardiac output X peripheral vascular resistance
Systolic measurement
Diastolic measurement
Korotkoff soundhttp://www.youtube.com/watch?v=ALqdHnD7c18
Pulses
Location
Pressure points
Heave and Thrill
Pulse Pressure
Aortic Pulse Pressure
Mean Arterial Pressure
http://www.youtube.com/watch?v=74v4mEWhOao
Measuring Blood PressureProcess7 important aspects Distal arteriesWhat affects measurementChanges related to cuff sizeClassifications BP
classification
Normal
Pre-hypertensive
Stage 1 Stage 2
SBP (mmHg)
< 120 120 to 139 140 to 159
160
DBP (mmHg)
< 80 80 to 99 90 to 99 > 100
http://www.youtube.com/watch?v=diG519dFVNs
Hypertension
“Silent Killer”Essential HypertensionMalignant HypertensionSecondary HypertensionPseudohypertensionRisk Factors
Hypertension
CauseSigns and symptomsDiagnostic TestsTreatment
Myocardial Infarction
Atherosclerosishttp://www.youtube.com/watch?v=qRK7-DCDKEA
Assessing Chest Pain
P Provokes (Relieves)
QQuality
RRegion / Radiation
S Severity
T Time
•Other associated complaints / Pertinent
Chest Pain
TightnessSqueezingAchingPressureShoulder painJaw painDyspneaSyncopePalpitations
http://www.youtube.com/watch?v=4h80Isb72Xghttp://www.youtube.com/watch?v=H_VsHmoRQKk
Angina Caused by exertion. Result of progressive CAD. Symptoms: typical chest pain.ST segment depression OR T wave
inversionST segment resolves, no elevated
enzymeshttp://www.youtube.com/watch?v=SR8sBJgD7UE
STEMI vs NonSTEMI
Cardiac Enzyme Duration
Test Initial elevation
Peak Return to Normal
CK :Creatinekinase
2 – 6 hours 18-36 hours 3 – 6 days
CKMB :Creatine kinase MB
2-3 hours 24 hours 2 – 3 days
LDH :Lactic dehydrogenase
12-24 hours 24-48 hours 5 -6 days
Myoglobin 1-2 hours 4-6 hours 24 hours
Troponin 4-8 hours 14-18 hours < 10 days
Cardiac Diagnostic Procedures
Cardiac Revascularization
• Percutaneous coronary intervention• Intracoronary Stenting• Directional Atherectomy • Rotational Atherectomy• Extraction techniques• Laser• Cutting balloons
Heart Failure
http://www.youtube.com/watch?v=GnpLm9fzYxU&NR=1&feature=endscreen
http://www.youtube.com/watch?v=JHz_JivtNLc
Congestive Heart Failure
Pulmonary edemaShortness of breath, fatigue, and exercise
intoleranceHTN, CAD, MI, ischemic heart disease,
valvular heart disease and cardiomyopathy
ComplicationsAdaptation
Non-heart Related Causes of CHF
Pregnancy and childbirthIncreased environmental temperature or
humiditySevere physical or mental stressThyrotoxicosisAcute blood lossPulmonary embolismSevere infectionChronic obstructive pulmonary disease (COPD)HypervolemiaSepsis
Classifications of CHF
Acute Decompensated Heart Failure: sudden development of symptoms
Sudden Death
Chronic: symptoms over long period of time with development of compensatory mechanisms
Classification of CHF
Left-side Heart Failure: ineffective left ventricular contraction
Left ventricular dysfunction
Neurohormonal responses: SNS RAAS
Left-ventricular Remodeling
Classifications of CHF
Right-side Heart Failure: ineffective right ventricular contraction
Systolic Dysfunction or Heart Failure: during systole, left ventricle can’t pump blood out
Heart Structure Changes with CHF
Classifications of CHF
Diastolic Dysfunction or Heart Failure: during diastole, left ventricle can’t relax to fill with blood
Systolic dysfunction
2/3 of pts with heart failure
Decreased left ventricular contractility and ejection fraction.
Most common cause is CHD resulting in MI or Chronic ischemia.
Diastolicdysfunction
1/3 of pts with heart failure
Impaired left ventricular relaxation and abnormal filling
Usually related to chronic hypertension or ischemic heart disease.
Clinical Signs & Symptoms
Left-side Heart Failure Right-side Heart FailureDyspnea, initially on
exertionParoxysmal nocturnal
dyspneaCheyne-Stokes
respirationsCoughOrthopena“Cardiac Asthma”TachycardiaFatigue
Edema, initially dependent
Jugular vein distentionHepatomegalyAscites
Tests for Diagnosis of CHF
Blood testsECG changesChest X-rayCardiac catheterizationEchocardiographyTransesophageal echocardiography (TEE)Cardiopulmonary exercise test
Treatment for CHF
MedicationsMedication Class Expected Action
ACE inhibitors / ARBs Interrupt response of RAASReduce mortality and morbidity
Beta-blockers Interrupt response of SNSReduce hospitalizationsNot used in acute decompensated state
DiureticsLoop diuretics with the addition of a thiazide diuretic if needed
Decrease ECF loadMaintain ECF volume status and sodium balanceNo impact on mortality
DigoxinDosage is usually 0.25 mg
Improves symptomsSymptomatic and on more than 3 meds.
Aldosterone antagonists Reserved for moderate to severe heart failure
Treatment for CHF
Lifestyle Changes
Cardiac Resynchronization Therapy
Surgical / devices interventions
Lipoprotein Disorders of CAD
Dyslipidemia
LDL (low-density lipoprotein)
HDL (high-density lipoprotein)
Triglycerides
Management of Lipoprotein Disorders
Dietary changes
Medications
Exercise
Monitor cholesterol levels
Diabetes and CAD/CVD
What is Diabetes?
Diabetes and CAD/CVD
CAD: Coronary Artery Disease
CVD: Cerebral Vascular Disease
Greater risk for heart disease
What causes heart disease in diabetics?
Diabetes and CAD/CVD
Metabolic syndrome Risk Factorsexcessive fat tissue in and around abdomenBlood fat disorders Insulin resistanceHigh fibrinogen inhibitorRaised blood pressureElevated high-sensitivity C-reactive protein
Diabetes and CAD/CVD
Other types of heart disease that occur in people with diabetes:
TIAsHeart FailureCardiomyopathyPeripheral Arterial Disease (PAD)
Cardiac Revascularization
Clinical Procedures - Treatments
Heart Transplant (LVAD)http://www.youtube.com/watch?v=KsAf-tM
mpyg&list=PL6F28DDE8FDC248C3Percutaneous Coronary Intervention (PCI)
Clinical Procedures: Treatment
Cardioversion (defibrillation)Thrombolytic Therapy
Diagnostic Procedure
Cardiac Catheterization