Cardiovascular System

Cardiovascular

includes the heart and the extremities (peripheral)

pump for circulation to and from the heart throughout the body through the veins and arteries

Pericardium

outermost covering

Epicardium

thin outermost layer

Myocardium

thick muscular middle layer

Endocardium

innermost layer

Two Upper Chambers

right and left atria at the base of the heart (ear like shape)

thin walled reservoirs for returning blood from the veins

Two Lower Chambers

right and left ventricles at the apex

thick walled and pumps the blood to the lungs and throughout the body

Left Heart

the left atrium and left ventricle

Right Atrium

the right atrium and right ventricle

Cardiac Septum

blood tight partition that divides the left and right heart

Atrioventricular Valves

tricuspid (right) and mitral (left) valves

separate atrium and ventricles

Semilunar Valves

between ventricles and great vessels, organ system

pulmonic and aortic valves

Heart

functions with arteries and veins to circulate to the pulmonary and systemic systems

Arteries

carry oxygenated blood from the heart to the body

carries blood away from the heart

Veins

carries deoxygenated blood towards the heart

Systemic Circulation

left heart pumps oxygenated blood to the rest of the body

Pulmonary Circulation

right heart pumps deoxygenated blood to the lungs

Conduction Flow

SA node (sinus atrial) to AV node (atrial ventricular) to bundle of HIS to purkinje fibers

depolarization and repolarization

waves and segments (P, QRST, ST)

Systole

contraction work phase

pulmonary and aortic valves are open

mitral and tricuspid valves are closed

S1 best heard at the apex (bottom) → lub

Diastole

relaxation phase

diastolic blood fills the ventricles

atrioventricular valves are open

aortic valve is closed

S2 best heard at the base (top) → dub

Health History

subjective data → the chief complaint

any complaints of pain/COLDSPA (leg, arm, or chest), dyspnea (SOB) on exertion or rest, palpitations, dizziness, medications, edema, or nocturia (nighttime urination)

Past Medical History

HTN (hypertension), blood clots, surgeries, illnesses, congenital heat defects or murmurs, rheumatic fever, diabetes, EKG, and lipid profile

Nonmodifiable Risks

increasing age especially over 65

gender (male)

hereditary

Modifiable Risks

smoking tobacco or second hand smoke exposure

high blood cholesterol (total, high-low density, low-high density levels) and high triglycerides

hypertension

physical inactivity

obesity and being overweight

diabetes mellitus

Heart Disease Factors

stress, excessive alcohol consumption, diet and nutrition, and diabetes mellitus

Physical Exam

inspection, palpation, and auscultation → never percussion

pallor (pale) or cyanosis (blue)

vital signs

auscultation of HR

palpation of HR

cough

edema of extremities

Exam

inspection → 1st neck vessels, pain, discomfort, cough, fatigue, or SOB

performed in sequence comfortable for you and the patient

no system can be effectively evaluated without a complete evaluation of the entire system

three positions → sitting, supine, left lateral recumbent

head of bed 30-40 degrees while supine

generally do not percuss due to potential for complications especially in advanced diagnosis - reserved for advanced practice nurses

Inspection

aortic, pulmonic (S2), erbs point, tricuspid (S1), mitral

symmetry

deformities of the thoracic cage (barrel chest)

visible pulsations or heaves

may see visible impulse at the 5th intercostal or medial space (left) especially in thin people

apical impulse or point of maximal impulse (PMI)

Palpation

focus on areas found on inspection

feel for pulsations, vibrations, heaves, thrills, and apical impulse

palpate areas → aortic, pulmonic, erbs point, tricuspid, mitral (PMI) apical sit

epigastric area → abdominal aorta

Auscultation

with stethoscope

bell for low pitched light pressure

diaphragm for high pitched

listen for 2 hearts sounds → lub dub

note rate, rhythm, and strength of beats

count apical pulse for 60 seconds → normal is 60-100

focus on S1 and S2 sounds

listen for extra sounds or deviations from normal like atrial fibrillation, murmurs, or rubs

Lub

S1 sound

closure of the AV valves at the beginning of ventricular systole

best heard at the apex also the mitral and tricuspid valves

Dub

S2 sound

closure of the semilunar valves after systole is complete

beginning of ventricular diastole best heard at the base or aortic and pulmonic valves

S1 S2 Split

sound that occurs when one valve closes before the other

S3

lub dub tuh heard using the bell

heave after S2 thats common with fluid overload like heart failure

S4

tub lub dub heard using the bell

heard before S1 caused by atria trying to push blood into the resisting ventricle

Murmurs

blow whoosh noise heard using bell

wall/valve defect or regurgitation of blood

1 → hard to hear but heard

2 → faint but heard

3 → easy to hear

4 → loud and with thrill (vibration felt with hands)

5 → super loud with thrill and can be heard without stethoscope

Teaching Smoking

status 5 A’s

ask about current smoking status

advise to quit and provide information on how beneficial quitting is

assess willingness to quit

assist with finding resources and making a plan to quit

Teach Clients

diet education

reduce elevated cholesterol

lower blood pressure

increase physical activity

maintain healthy weight

management of diabetes

limit alcohol intake

stress reduction techniques