Cardiovascular System

Arteries vs. Veins

  • Arteries: Supply oxygen-rich blood.

  • Veins: Bring deoxygenated blood back to the heart.

Assessing Perfusion

  • Capillary Refill: Aim for 2+ (or 2-3 depending on the facility).

    • 1+ : Weak.

    • Non-detectable: Reassess and consult with another healthcare professional.

  • Pulses: Palpate and grade pulses.

  • Pallor: Observe skin color.

  • Poikilothermia: Assess temperature using the back of the hand.

Assessing Cardiovascular Health

  • EKG

  • Blood pressure

  • Heart rate

Blood Flow Through the Heart

  • Deoxygenated blood enters the heart via the Superior Vena Cava (SVC) and Inferior Vena Cava (IVC).

  • Flows into the right atrium.

  • Passes through the tricuspid valve into the right ventricle.

  • Goes through the pulmonic valve to the pulmonary artery, where gas exchange occurs, and the blood becomes oxygenated.

  • Oxygen-rich blood then enters the left atrium.

  • Passes through the mitral valve to the left ventricle.

  • The left ventricle pumps the oxygen-rich blood out through the aorta to the body.

  • Left-Sided Heart Failure:

    • Blood backs up into the lungs causing crackles and shortness of breath.

  • Right-Sided Heart Failure:

    • Blood backs up into the body causing edema.

Heart Valves

  • Prevent regurgitation (backflow of blood).

  • Maintain pressure to propel blood forward.

  • Mitral valve: Located on the left side.

  • Tricuspid valve: Located on the right side.

  • Pulmonic valve: Separates oxygenated blood from the pulmonary artery.

  • Aortic valve: Pushes blood to the body via the aorta.

  • Mitral valve dysfunction: a type of heart failure.

Coronary Arteries

  • Supply oxygen-rich blood to the heart muscle itself.

  • Left main coronary artery: Supplies blood to the left side of the heart.

  • Right main coronary artery: Supplies blood to the right side of the heart.

  • Blockage in coronary arteries can lead to angina (chest pain).

  • LAD (Left Anterior Descending Artery): A common site for blockage.

  • Treatment:

    • Stent placement to allow blood flow.

    • Vasodilating medications: Nitroglycerin (Nitro).

  • Nitroglycerin:

    • Sublingual tablets taken every five minutes, up to three times.

    • If pain persists, seek medical attention.

    • Common side effect: Headache. Treat with acetaminophen.

    • Transdermal options: Ointments or creams applied to the chest.

Mean Arterial Pressure (MAP)

  • Formula: MAP = \frac{(Systolic Blood Pressure + 2 \times Diastolic Blood Pressure)}{3}

  • Normal MAP: 60-100 mmHg.

    • Less than 60 mmHg: Inadequate perfusion, potential organ damage (kidneys, brain).

    • Greater than 100 mmHg: Vasoconstriction, impaired tissue perfusion.

Example Calculation:$
MAP = \frac{(118 + 2 \times 76)}{3} = 90 mmHg

Cardiovascular Vocabulary

  • Cardiac Output (CO): Heart rate (HR) × Stroke Volume (SV).

    • Normal: 4-6 liters per minute (may vary based on weight).

  • Stroke Volume (SV): Amount of blood ejected by the left ventricle with each heartbeat.

  • Cardiac Index (CI): Accounts for body size.

  • Preload: Amount of stretching in the ventricles during filling (rest phase).

  • Afterload: Pressure the left ventricle must exert to eject blood.

  • Contractility: Strength of heart muscle contraction.

    • Medication to improve contractility: Digoxin (check apical pulse; must be 60 or greater before administering).

Hypertension

  • Autonomic Nervous System

    • Baroreceptors

      • Vasodilation: Decreases blood pressure

      • Vasoconstriction: Increases blood pressure

    • Chemoreceptors

      • Vasoconstriction: Increases blood pressure

      • Respond in times of hypercapnia (increased CO2) or low O2 stat.

  • Renal System

    • Kidneys help manage blood pressure by causing the renin to be secreted

      • Release renin, leading to angiotensin I, angiotensin II, and aldosterone secretion, causing sodium and water retention, leading to elevated blood pressure.

  • Endocrine System

    • Hormones

      • Catecholamines, kinins, and histamine

        • Cause a raise of blood pressure

      • Antidiuretic hormone (ADH)

        • Hold onto fluid

        • Cause volume retention, increase blood pressure (more volume, more pressure).

  • External Factors

    • Excitement can cause blood pressure to go up.

    • If super mad about something, it can make our blood pressure go up.

    • Exercise

      • Temporarily raises your blood pressure. We want to encourage routine exercise to help maintain regular blood pressure levels.

  • Assessment

    • Pallor (skin color): Skin could be cyanotic (port perfusion). sign of cyanosis (the first finger right there with a little blue tint on the fingers).

    • Check the extremities to find the clubbing.

      • The fingernails have that curvature to them.

    • Looking for Edema: Cardiovascular issue (venous problem)
      hypotension: 86/45.
      one forty over 95: hypertensive.

    • Orthostatic Hypotension

      • Systolic drops to about 20 and diastolic drops to about 10 is considered orthostatic hypotension.

      • Check them first, laying down on the supine position, then we'll get them in a sitting position, and then we'll get them when they're standing.

      • We actually want their blood pressure to be less than one twenty. We want their diopause less than 80, technically.

Classifications of Hypertension

Hypertension is not truly confirmed until two separate doctor visits

  • Elevated: between one twenty and 80 we'll talk to them about exercise and diet stuff

  • Stage One: can start causing some perfusion issues. those patients, definitely want to educate them on diet. They might be put on some medication if it's consistently high

  • Stage Two: high, they can start to have really big complications like kidney damage, brain damage

Types of Hypertension

Primary (Essential) Hypertension

  • Not caused by a pre-existing medical condition.

  • Factors:

    • Family history.

    • Race (African American).

    • Hyperlipidemia.

    • Smoking.

    • Age (older than 60 years old).

    • Sodium and caffeine intake.

Secondary Hypertension

  • Caused by a disease process.

  • Examples:

    • Kidney disease.

    • Endocrine disorders.

    • Pheochromocytoma (tumor).

    • Drugs that affect blood pressure
      *Estrogen
      *Glucose
      *Cortisol
      *Steroids
      So those medicines right here can cause an elevation in blood pressure
      Primary
      Diet (Lifestyle Changes)

Assessing Blood Pressure & Cardiovascular System

What can we assess?
History of Drugs and Food
Smoking?
Family History?
Known as "The silent killer"
Symptoms
(Those can be attributed to other things):
headache after the HAE is headache, dizziness, facial flushing, fatigue, syncope