1. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.1 CHAPTER 11 CARDIOVASCULAR SYSTEM

2. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.2 Chapter 11 Learning Objectives  Define at least 10 terms relating to the cardiovascular system.  Describe the function of the cardiovascular system.  Identify at least 10 cardiovascular system structures and the function of each.

3. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.3 Chapter 11 Learning Objectives  Identify at least three methods of assessment used to evaluate the cardiovascular system.  Describe at least five disorders of the cardiovascular system.

4. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.4 Structures of the Cardiovascular System  Cardiovascular system structures  Heart Beats more than 100,000 times each day Beats more than 100,000 times each day  Blood vessels

5. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.5 Functions of the Cardiovascular System Cardiovascular system functions Cardiovascular system functions  Transports nutrients and oxygen to the body  Transports waste products from the cells to the kidneys for excretion  Distributes hormones and antibodies throughout the body  Helps control body temperature and maintain electrolyte balance

6. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.6 Heart  Two-sided, double pump  Weighs less than a pound  Slightly bigger than a fist  Located between the lungs in the thoracic cavity  Positioned slightly to the left of the sternum

7. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.7 Heart  Pulmonary circulation  Right side of heart pumps deoxygenated blood to the lungs.  Systemic circulation  Left side of the heart pumps oxygenated blood to rest of the body.  Blood returns to the right side of the heart from the body to complete the cycle.  Hepatic circulation  Path of the blood from the intestines, gallbladder, pancreas, stomach, and spleen through the liver.

8. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.8 Heart Four chambers of the heart Four chambers of the heart  Atria Top two chambers Top two chambers Blood enters the heart through the atria. Blood enters the heart through the atria.  Ventricles Lower two chambers Lower two chambers Blood leaves the heart through the ventricles. Blood leaves the heart through the ventricles.  Septum  Divides the right and left sides of the heart

9. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.9 Blood Flow Through the Cardiovascular System FIGURE 11-1 Blood flow through the cardiovascular system. (From Patton KT, Thibodeau GA: Anatomy & physiology, ed 7, St. Louis, 2010, Mosby.)

10. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.10 Heart Valves Four valves of the heart Four valves of the heart  Prevent blood from flowing back into heart  Atrioventricular valves (2) Separate the atria and ventricles Separate the atria and ventricles  Semilunar valves (2) Separate the ventricles from the pulmonary artery and aorta Separate the ventricles from the pulmonary artery and aorta

11. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.11 Structures of the Heart FIGURE 11-2 A, Structures of the heart.

12. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.12 Tissue Layers of the Heart  Endocardium  Smooth layer of cells lining the inside of the heart and forming the valves  Myocardium  The thickest layer, consisting of muscle tissue  Pericardium  Double membrane that covers the outside of the heart, providing lubrication between the heart and surrounding structures to prevent tissue damage

13. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.13 Layers of the Heart FIGURE 11-2 B, Layers of the heart.

14. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.14 Heart Function  Activity of the heart muscle is controlled by the nervous system.  Function also is affected by the action of hormones and fluid balance.

15. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.15 Heart Function  The heart is the only muscle that can stimulate its own contractions.  Sinoatrial cells (SA node) in the right atrium start the heart.  Atrioventricular node (AV node) sends an impulse into lower portions of the heart.  AV bundle or bundle of HIS stimulates the Purkinje fibers.  Purkinje fibers cause the ventricles to contract.

16. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.16 Path of Electrical Current in the Heart FIGURE 11-3 Path of electrical conduction in the heart.

17. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.17 Blood Vessels  Arteries  Carry oxygenated blood away from the heart  Have a muscular layer of tissue that helps pump blood through the body  Aorta Largest artery in the body Largest artery in the body Branches into smaller arteries Branches into smaller arteries

18. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.18 Blood Vessels  Veins  Venules join together to form veins.  Veins carry blood from the tissues back to the heart. Blood is deoxygenated except for pulmonary vein. Blood is deoxygenated except for pulmonary vein.  Veins contain valves that prevent blood from flowing back.  Veins have a much thinner muscular layer than arteries.  The superior vena cava and inferior vena cava are the largest veins.

19. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.19 Blood Vessels  Arterioles  Smaller vessels  Blood moves from arterioles to capillaries.  Capillaries  Carry blood between the arterial and venous vessels.

20. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.20 Blood Vessels FIGURE 11-4 Blood vessels.

21. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.21 Principal Arteries and Veins FIGURE 11-5 Principal arteries and veins. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)

22. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.22 Path of the Blood Through the Heart

23. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.23 Assessment Techniques  Measuring pulse and blood pressure  Listening to heart sounds  Determining cardiac output  Measuring muscle activity with electrocardiography  Inserting a cardiac catheter  Using echocardiography

24. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.24 Assessment Techniques  Pulse  Surge of blood against the walls of the arteries  Eight pulse points on the body  Normal pulse rate for adults is 60 to 90 beats per minute  Blood pressure  Force of blood against the walls of the arteries  Systolic pressure Ventricles of the heart contract Ventricles of the heart contract  Diastolic pressure Ventricles relax Ventricles relax  Normal blood pressure 120/80 mm Hg 120/80 mm Hg  Blood pressure varies greatly among people.

25. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.25 Peripheral Pulse Points FIGURE 11-6 Peripheral pulse points.

26. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.26 Assessment Techniques  Heart sounds  Lub-dub sound of the heart Results from opening and closing of the valves Results from opening and closing of the valves  Heard through a stethoscope  Murmurs Abnormal or extra sound Abnormal or extra sound Classified by timing, intensity, location, pitch, and quality of the sound Classified by timing, intensity, location, pitch, and quality of the sound May be benign or indicate a disorder May be benign or indicate a disorder  Thrill Vibration felt by touch over an artery Vibration felt by touch over an artery Caused by an abnormal flow of blood Caused by an abnormal flow of blood

27. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.27 Assessment Techniques  Electrocardiogram  The pattern of electrical activity in heart contractions is measured graphically.  Normal and abnormal heart activities have characteristic wave patterns.

28. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.28 Electrocardiography FIGURE 11-7 Electrical activity of the heart is measured with electrocardiography. (From Aehlert BJ: Paramedic practice today, St. Louis, 2010, Mosby.)

29. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.29 Electrocardiogram FIGURE 11-8 A normal electrocardiogram pattern with descriptions. (From Grauer K: A practical guide to ECG interpretation, ed 2, St. Louis, 1998, Mosby.)

30. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.30 Electrocardiogram Patterns FIGURE 11-9 Electrocardiogram patterns. A, Normal sinus rhythm. B, Unifocal premature ventricular contractions. C, Atrial fibrillation. D, Ventricular fibrillation. (From Tait C: EZ ECGs booklet, ed 2, St. Louis, 2001, Mosby.)

31. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.31 Assessment Techniques  Cardiac catheterization  A catheter is used to measure the pressure in the chambers of the heart, to take blood samples, and to view obstructions in the vessels.  A tube is inserted through the blood vessels into the heart.  Dye is then released and traced using x-ray imaging.

32. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.32 Assessment Techniques  Echocardiography (ECHO)  Uses ultrasonic waves to show the structures and motions of the heart  Transducer plots the sound echoes to produce a graphic picture.  Transesophageal echocardiogram Used if the image of the echocardiograph is unclear Used if the image of the echocardiograph is unclear Scope with an ultrasonic device is lowered into the esophagus. Scope with an ultrasonic device is lowered into the esophagus.

33. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.33 Assessment Techniques  Radionuclide imaging (radioisotope scanning)  Uses a gamma camera to create an image after injection of a radioactive material  Single photon emission computed tomography (SPECT)  Generate three-dimensional computerized images of the chest  Myocardial perfusion  Produces images after heart muscle absorbs radionuclides

34. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.34 Disorders of the Cardiovascular System  Aneurysm  Area of a blood vessel that bulges because of a weakness in the wall  Atherosclerosis  Narrowing of blood vessels caused by deposits of fatty material containing calcium and cholesterol  Cardiac arrhythmia  Disturbance of the heart’s rhythm caused by a defect in the heart’s pacemaker cells or by damage to heart tissue

35. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.35 Disorders of the Cardiovascular System  Cardiovascular disease  General term for the combined effects of arteriosclerosis and atherosclerosis Conditions called coronary artery disease Conditions called coronary artery disease  Coronary artery disease (CAD) may manifest as Heart attack Heart attack Peripheral artery disease (PAD) Peripheral artery disease (PAD) Angina Angina Stroke Stroke

36. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.36 Disorders of the Cardiovascular System  Congenital heart disease  A group of disorders that affect about one in eight newborns each year in the United States  Defects include Narrowing of vessels (stenosis) to the heart and atrial or ventricular septal defects Narrowing of vessels (stenosis) to the heart and atrial or ventricular septal defects Coarctation of the aorta and patent ductus arteriosus (opening between the pulmonary artery and aorta that does not close at birth) Coarctation of the aorta and patent ductus arteriosus (opening between the pulmonary artery and aorta that does not close at birth)

37. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.37 Disorders of the Cardiovascular System  Congestive heart failure (CHF)  Inability of the heart to pump blood adequately to meet the body’s needs  Usually caused by disease in another body system  Leads to inadequate respiratory and kidney function

38. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.38 Disorders of the Cardiovascular System  Hypertension  High blood pressure  Primary hypertension Cause of hypertension unknown Cause of hypertension unknown  Secondary hypertension Hypertension caused by other conditions, such as kidney disease and adrenal disorders Hypertension caused by other conditions, such as kidney disease and adrenal disorders

39. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.39 Disorders of the Cardiovascular System  Myocardial infarction  Also known as a heart attack  Results from blockage of the blood vessels to the heart by a clot (embolism)  Cardiac Arrest Occurs when large area of the heart is affected and may stop functioning Occurs when large area of the heart is affected and may stop functioning

40. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.40 Automatic External Defibrillator (AED) FIGURE 11-10 Many lives can be saved using the automatic external defibrillator (AED) device. (From Patton KT, Thibodeau GA: Anatomy & physiology, ed 7, St. Louis, 2010, Mosby.)

41. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.41 Disorders of the Cardiovascular System  Phlebitis  Inflammation of a vein, often with formation of a clot (thrombus)  Results from damage to the vessel wall or prolonged sitting or standing  If thrombus breaks free, it may lodge in a small artery and cause tissue damage or sudden death.

42. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.42 Disorders of the Cardiovascular System  Rheumatic heart disease  A condition in which the heart muscle and valves are damaged by a recurrent bacterial infection that usually begins in the throat Bacteria produces a toxin that causes inflammation and damage to the heart valves Bacteria produces a toxin that causes inflammation and damage to the heart valves  Varicose veins  A condition in which veins become enlarged and ineffective

43. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.43 Issues and Innovations  Heart replacement and transplants  1967 - First heart replacement Approximately 2300 heart transplantations are performed each year in the United States. Approximately 2300 heart transplantations are performed each year in the United States. First artificial heart, the Jarvik-7, was connected to an external power source and pump. First artificial heart, the Jarvik-7, was connected to an external power source and pump.  2001 - AbioCor self-contained artificial heart Designed to extend life for people with end-stage heart failure who had no other clinical options Designed to extend life for people with end-stage heart failure who had no other clinical options Helps provides a good quality of life Helps provides a good quality of life

44. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.44 AbioCor Heart FIGURE 11-11 A, AbioCor heart. B, Placement of AbioCor heart in the body. (Courtesy ABIOMED, Inc., Danvers, Mass.)

45. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.45 AbioCor Heart FIGURE 11-11 A, AbioCor heart. B, Placement of AbioCor heart in the body. (Courtesy ABIOMED, Inc., Danvers, Mass.)

46. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.46 Issues and Innovations  The U.S. Food and Drug Administration (FDA) approved use of the SynCardia Temporary Total Artificial Heart in 2005.  Used in patients with irreversible failure of the ventricles  Designed to support life functions until a transplant becomes available.  More than 3000 people are on a waiting list for a heart transplant.

47. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.47 Issues and Innovations  Cholesterol  Waxlike substance  Used in body to make Cell membranes Cell membranes Hormones Hormones Vitamin D Vitamin D  Carried by proteins (lipoproteins)  Found in two lipoprotein forms High-density lipoprotein (HDL) High-density lipoprotein (HDL)  Takes cholesterol to the liver Low-density lipoprotein (LDL) Low-density lipoprotein (LDL)  Blocks the arteries

48. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.48 Issues and Innovations  Harvard research study: LDL versus HDL cholesterol  Type of fat, not the amount, changes the cholesterol level.  Limit intake of saturated fats, and eliminate trans fats.  Monounsaturated and polyunsaturated fats were determined to lower LDL and raise HDL levels. Olives, canola oil, avocados, fish, and most nuts Olives, canola oil, avocados, fish, and most nuts  Saturated fats raise LDL and HDL levels. Whole milk, butter, cheese, red meat, chocolate, and coconut oil Whole milk, butter, cheese, red meat, chocolate, and coconut oil  Trans fats are the worst fats. Margarines, vegetable oils, shortening, and most fast foods Margarines, vegetable oils, shortening, and most fast foods

49. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.49 Summary  Functions of the cardiovascular system  Transport oxygen, nutrients, waste products, hormones, and antibodies  Control body temperature and maintain homeostasis  Structures of the cardiovascular system include parts of the heart and blood vessels.

50. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.50 Summary  Assessments of the cardiovascular system  Measuring blood pressure and pulse  Listening to heart sounds  Determining cardiac output

51. Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.51 Summary  Disorders of the cardiovascular system  Aneurysms  Atherosclerosis  Congestive heart failure  Phlebitis  Varicose veins