CVS

Cardiac: 

Heart Anatomy and Circulation

  1. Heart Anatomy:

    • The heart has four chambers: two atria (upper chambers) and two ventricles (lower chambers).

    • It has four main valves:

      • Tricuspid Valve: Between the right atrium and right ventricle.

      • Pulmonary Valve: Between the right ventricle and pulmonary artery.

      • Mitral Valve: Between the left atrium and left ventricle.

      • Aortic Valve: Between the left ventricle and aorta.

GREAT VESSELS:

-inferior vena cava: carries deoxygenated blood from the lower extremities to the right side of the heart.

-superior vena cava: drains deoxygenated blood from the head and upper extremities and carries it to the right side of the heart

-pulmonary arteries: leaves the right ventricle and carries venous blood to the lungs

-pulmonary veins: returns oxygenated blood from the lungs to the left side of the heart

  1. -aorta: carries blood to the body

  2. Circulation:

    • Systemic Circulation: Oxygen-rich blood is pumped from the left ventricle into the aorta and then to the rest of the body.

    • Pulmonary Circulation: Oxygen-poor blood is pumped from the right ventricle into the pulmonary arteries, goes to the lungs for oxygenation, and returns to the left atrium via the pulmonary veins.

3.        BLOOD FLOW THROUGH THE BODY:

4.        -The heart receives deoxygenated blood from the systemic circulation from the SUPERIOR and INFERIOR VENA CAVA, then enters the heart through the RIGHT ATRIUM, which delivers deoxygenated blood to the RIGHT VENTRICLE. THEN, blood flows through the

5.        TRICUSPID VALVE into the RIGHT VENTRICLE then leaves and flows through the PULMONIC VALVE to the PULMONARY ARTERIES and enters the lungs to be oxygenated. Next, blood returns to the LEFT ATRIUM through the PULMONARY VEINS. Then, blood flows through the MITRAL VALVE into the LEFT VENTRICLE. This oxygenated blood enters the AORTA through the AORTIC VALVE and perfuses the body.

  1.  

Normal Heart Sounds

  1. S1 (First Heart Sound):

    • Created by the closure of the mitral and tricuspid valves at the beginning of systole (ventricular contraction).

    • It is often described as a "lub" sound.

  2. S2 (Second Heart Sound):

    • Created by the closure of the aortic and pulmonary valves at the end of systole (start of diastole, when the ventricles relax).

    • It is often described as a "dub" sound.

Abnormal Heart Sounds

  1. Murmurs:

    • Cause: Turbulent blood flow through the heart or great vessels due to valve stenosis (narrowing) or regurgitation (leakage).

    • Timing:

      • Systolic Murmurs: Occur between S1 and S2 (e.g., aortic stenosis, mitral regurgitation).

      • Diastolic Murmurs: Occur between S2 and the next S1 (e.g., aortic regurgitation, mitral stenosis).

  2. Other Abnormal Sounds:

    • S3 (Third Heart Sound): Can be normal in young people or athletes but may indicate heart failure in older adults. Occurs just after S2 (early diastole) and is often described as a "ventricular gallop."

    • S4 (Fourth Heart Sound): Often indicates a stiff or hypertrophied ventricle. Occurs just before S1 (late diastole) and is often described as an "atrial gallop."

Heart Failure Signs and Symptoms: Signs and symptoms of heart failure include SOB, edema, coughing, fatigue, rapid or irregular heartbeat, dilated pupils, pallor skin, crackles, JVD, weak pulse, and enlarged spleen and liver. This comes from two basic mechanisms: (1) the heart’s inability to pump enough blood to meet the metabolic demands of the body; and (2) the kidney’s compensatory mechanisms of abnormal retention of sodium and water to compensate for the decreased cardiac output. This increases blood volume and venous return, which causes further congestion. Crackles and wheezing are adventitious lung and breathing sounds heard in a patient with HF.

 

  1. Right-Sided Heart Failure:

    • Signs/Symptoms:

      • JVD (Jugular Venous Distention): Increased pressure in the jugular veins due to backup of blood.

      • Peripheral Edema: Swelling of the legs and feet due to fluid accumulation.

      • Ascites: Fluid accumulation in the abdominal cavity.

  2. Left-Sided Heart Failure:

    • Signs/Symptoms:

      • DOE (Dyspnea on Exertion): Shortness of breath with activity.

      • Orthopnea: Difficulty breathing when lying flat, often requiring multiple pillows to sleep.

Lung Sounds in Heart Failure

  1. Right-Sided Heart Failure:

    • Peripheral Edema: Fluid may also lead to crackles or wheezes if it causes pulmonary congestion.

  2. Left-Sided Heart Failure:

    • Crackles/Rales: Heard on auscultation of the lungs, particularly in the bases, due to fluid in the alveoli.

    • Wheezes: May also be present if there is significant bronchoconstriction or fluid accumulation.