2Cardiovascular System Cardiovascular System – circulates blood continuously thought the body to deliver oxygen and nutrients to the body’s organs and tissue and to dispose of waste.Heart (pump) and vasculature (plumbing)The heart is composed of:Cardiac muscleAtriaVentriclesValvesCardiac arteries and veinsElectrical conduction systemCardiac NervesProblems or failure of any of these system can lead to serious health concerns.Review Anatomy
4Heart Heart – pump composed of synchronized structures Cardiac Vessels Coronary Arteries – extensive network of arteries supplying the heartCoronary Veins – network for venous blood drainageConduction system – heart has it own conduction system which can initiate and transmit an electrical impulse via cardiac muscle fibersThis electrical charge stimulates muscular contraction of the heartSA node, AV node, Bundle of His, Right and Left Bundle Branch Block, and Purkinje fibersNervesSympathetic – stimulate the heart, increases heart rate, force of contraction, and dilation of coronary arteries.Parasympathetic – opposite effectCNS – influences the activation and interaction of nerves through information supplies by the cardiac plexus.
5Cardiac Musculature Heart Muscle Base Apex – point of maximum impulse so heart beat is more easily palpated over the apex – 5th intercostal spaceThree Layers:Epicardium – outer layerMyocardium – thick muscular layerEndocardium - smooth inner lining of chambers
6Chambers Chambers in the Heart – 4 chambers Left and right atria – receiving chambers for blood and pump blood into the ventriclesLeft and right ventricles – eject blood into vessels
7ValvesValves - Permit the Flow of Blood Between Chambers and into Blood VesselsAtrioventricular (AV)TricuspidMitralSemilunarPulmonaryAortic
8Heart SoundsHeart Sounds – Closure of valves which are associated with the contraction and relaxation phases of the heart.Systole – refers to ventricular contraction and begins with closure of the AV valves (S1) and ends with the closure of the aortic and pulmonic valve (S2)Diastole – refers to ventricular relaxation and begins with closure of the aortic and pulmonic valve (S2) and ends with closure of AV valves (S1).S1 (lub)S2 (dub)
9Figure 17.5 Heart sounds in systole and diastole.
12Table 17.4 (continued) Classifications of Heart Murmurs
13Circulation of HeartPulmonary Circulation – carries deoxygenated blood to the lungs, where carbon dioxide is exchanged for oxygen.Systemic Circulation – supplies freshly oxygenated blood to the body’s periphery carrying oxygen and nutrients to cells.
14ElectrocardiogramElectrocardiogram (EKG) - Paper Recording of Deflections That Represent the Cardiac Cycle – Signifies electrical conductionElectrical deflectionsP wavePR intervalQRS intervalT wave
16Cardiac FunctionStroke volume - Amount of blood that is ejected with each heartbeatCardiac output - Amount of blood ejected from the left ventricle over one minuteCardiac index - Measurement accounting for an individual’s weight when evaluating the pumping action of the heart
17Landmarks for Cardiac Assessment SternumClaviclesRibsSecond through fifth intercostal spacesCorrelating assessment findings over body landmarks provides vital information related to underlying pathologic mechanisms.
18Figure 17.18 Landmarks in precordial assessments.
19Inteview General Questions Specific Questions Illness Symptoms BehaviorsInfants and childrenPregnant femaleOlder adultEnvironment
21Techniques Physical Assessment of the Cardiovascular System Techniques InspectionPalpationPercussionAuscultation
22Specific Areas Specific Areas of the Cardiovascular Assessment Inspection of the face, lips, ears, and scalpSkin colorMovementEarlobe creasesInspection of the jugular veinsPulsationsDistentionInspection of the carotid arteriesPulse characteristicsInspection of the hands and fingersColorShape of fingers
24Specific AreasInspection of the chest, abdomen, legs, and skeletal structureLandmarksRight sternal border, 2nd intercostal spaceLeft sternal border, 2nd intercostal spaceLeft sternal border, 3rd – 5th intercostal spaceHeaves and lifts
25PalpationPalpation of the chest, including the followingPrecordium at the right and left second intercostal spacesLeft third intercostal spaceLeft fourth intercostal spaceLeft fifth intercostal space at the midclavicular linePosition patient at a 30 degree angle or lessNo thrills, heaves or lifts should be palpated in any of the five locations
26Figure 17.19 Landmarks for palpation of the chest.
27Palpation Carotid pulses (sequentially) Client may be supine or sitting uprightAsses:Presence – diminished or absent may indicate carotid disease or dissecting aortic aneurysmStrength – should be strong but not boundingRhythm – regular patternEquality – consistent bilaterallyPalpate each artery separately – may obstruct blood flow to the brain, resulting in severe bradycardia or asystole
29Percussion Percussion of the chest for cardiac border 5th intercostal space at the left anterior axillary lineNormal findings would be resonance because you will be over lung tissueNext, percuss the mid clavicular line and the left sternal borderShould change to dull as you percuss over the heartAdvance to the 3rd and 2nd intercostal space on the left side.Should change from resonnance to dullness as you percuss over the heart
31AuscultationAuscultation of the chest using the diaphragm and bell in various positions to include the following locationsAortic area at the right second intercostal space—S2 is louder than S1Pulmonic area at the left second intercostal space—S2 is louder than S1Erb’s point at the left third intercostal space—S1 and S2 are heard equallyTricuspid area at the left fourth intercostal space—S1 is louder than S2Apex at the left fifth intercostal space at the midclavicular line—S1 is louder than S2
32Figure 17.22 Auscultating the chest over five key landmarks.
33Figure 17.24A Positions for auscultation of the heart. A. Supine.
34Figure 17.24B Positions for auscultation of the heart. B. Lateral
35Figure 17.24C Positions for auscultation of the heart. C. Sitting.
36Auscultation of Apical Pulse Specific Areas of the Cardiovascular AssessmentAuscultation of the carotid arteries using the diaphragm and bellComparison of the apical pulse to a carotid pulse
37Figure 17.23 Comparing the carotid and apical pulses.
38Abnormal Findings Abnormal Findings in the Cardiovascular System Myocardial and pump disordersValvular diseaseSeptal defectsCongenital heart diseaseElectrical rhythm disturbances
39Muscular and Pump Disorders Myocardial and Pump DisordersMyocardial ischemiaMyocardial infarctionCongestive heart diseaseVentricular hypertrophy
40Valvular Disorders Valvular Diseases Mitral, aortic, tricuspid, and pulmonic stenosisMitral and aortic regurgitationMitral valve prolapse
62Developmental Considerations PediatricFetus receives oxygen and nutrients from the motherChanges occur in the newborn’s cardiovascular systemInfant’s heart rate
63Developmental Considerations Pregnant FemaleHeart is displaced to the left and upwardBlood volume increases 30 to 50 percentCardiac output and stroke volume increaseResting pulse may increaseMurmurs may be auscultated
64Developmental Considerations GeriatricLoss of ventricular compliance and vascular rigidityConduction system loses automaticity
65Psychosocial Considerations Stress and workload of the heart
66Cultural and Environmental Considerations RaceEthnicityDietSubstance abuse
67Healthy People 2010 Focus Areas Outlined in the Healthy People 2010 Coronary heart diseaseHigh blood cholesterol
68Healthy People 2010 Key Objectives for Coronary Heart Disease Reduce deathsIncrease awareness of symptoms of heart attack and the need for rapid emergency careIncrease the numbers of adults who can administer cardiopulmonary resuscitationReduce the number of obese individualsIncrease physical activityIncrease the number of adults who are aware of risk factors and take action to reduce risks
69Healthy People 2010 Key Objectives for High Blood Cholesterol Reduce the number of adults with elevated cholesterol levelsIncrease the number of adults who have cholesterol levels measured