cardiac

cardiovascular system

• in mediastinum

• left of midline

• above diaphragm

• includes heart and extremities

pericardium

outermost layer

epicardium

thin outermost layer

myocardium

thick muscular middle layer

endocardium

the innermost

two upper chambers

right and left atria at the base of heart, thin walled returning blood from the veins

two lower chambers

right and left ventricles at the apex

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

arteries

carries oxygenated blood from heart to body carries blood away from heart

veins

carries deoxygenated blood towards the heart

pulmonary circulation

right heart pumps deoxygenated blood to the lungs

systematic circulation

left heart pumps oxygenated blood to rest of the body

cardiac cycle

to help ensure proper circulation the heart contracts and relaxes rhythmically creating a 2 phase cardiac cycle

• systole

• diastole

systole

ventricles contract- blood ejected from left ventricle into aorta and from RV into pulmonary artery

• mitral and tricuspid valves close

  • pressure rises

• aortic and pulmonic valved open

  • blood ejected into artiers

  • pressure falls

diastole

mitral and tricuspid valves open

blood moves from atria to ventricles

ventricles dilate an energy requiring effort that draws blood into the ventricles as the atria contract, thereby moving blood from atria to ventricles

atria contract as ventricles almost filled

causes complete emptying of atria

electrical conduction of the heart

intrinsic electrical conduction system enables the heart to contract within itself

coordinates sequence of muscular contractions taking place during cardiac cycle

• sinoatrial node

• atrioventrical node

• bundle of His

• purkinje fibers

conductivity

current flows in orderly sequence first across atria to AV node low in atrial septum → delayed slightly so atria have time to contract b4 ventricles are stimulated → impulse travels to bundle of His right and left bundle branches and then through ventricles

systole (contraction)

pulmonary /aortic valves open

mitral /tricuspid closed

S1 best heard at APEX “lub”

diastole-(relaxation)

diastole blood fills the ventricles

AV valves are open

aortic valve closed

s2 best heard at BASE “dub”

cardiovascular health history

complaints of

• pain

• dyspnea

• palpitations

• dizziness

• medications

• edema

• nocturia

past health history

• HTN (hypertension)

• blood clots

• surgeries

• illnesses

• congenital heart defects/murmur

• rheumatic fever

• diabetes

• EKG

• lipid profile

physical exam

inspection 1st- neck vessels pain discomfort cough fatigue SOB

3 positions- sitting supine left lateral recumbent

no percussion due to potential for complications

inspection

aortic pulmonic erbs point tricuspid mitral

symmetry

deformities of the thoracic cage

visible pulsations or heaves

may see visible impulse at 5th intercostal or medial space

apical impulse or point of maximal impulse

palpatiion

focus on areas found on inspection

feel for pulsations vibrations heaves thrills apical impulse

palpate areas

auscultation -Lub

S1 closure of the AV valves beginning of ventricular systole best heard at the APEX the mitral and tricuspid valves

auscultation- dub

s2 closure of semilunar valves after systole complete beginning of ventricular diastole best heard at base aortic an pulmonic valves

auscultation

note rate rhythm strength of beats

apical pulse count for 1 full minute

focus on S1 and S2 sounds

listen foe extra sounds or deviations from normal atrial fibrillation murmurs rubs

heart murmurs

turbulent flow with a swooshing or blowing sound

conditions that contribute to heart murmurs

• increased blood velocity

• structural valve defects

• valve malfunction

• abnormal chamber openings

neck vessels

carotid artery, jugular veins

carotid artery pulse→ ventricular systole

level of jugular venous pressure reflects right atrial pressure

neck vessels assessment

inspec- observe juglar venous pulse, evaluate pressure

auscult and palp - carotid arteries

hypotension

low BP may not perfuse organ systems asequately

hypertension

BP> 130/80

murmurs

blowing sounds turbulence in blood flow

myocardial infarction

occlusion of arterial blood flow causing tissue damage

congestive heart failure

congestion in pulmonary or systemic circulation related to inadequate pumping

thrombus

blood clot

fluid volume deficit hypovolemia

isotonic fluid loss

fluid becomes hypertonic drawing fluid from the cells into the interstitial space leaving cells depleted of fluid and unable to function properly

fluid volume excess hypervolemia

excess isotonic fluid common cases kidney malfunction and ineffective heart pumping resulting in the accumulation of fluid in lungs and dependent parts of the body