Module5

CardiovascularSystem

IntroductiontoCardiovascularSystem

Cardiovascularsystemconsistsof3maincomponents: Heart Blood Bloodvessels 1.1

1.1.1

Anatomyoftheheart
Typographyoftheheart

Heartisahollow,muscularorganliesinthemediastinumprotectedbysternumandribs Inanadultitmeasure+12cminlength/9cminwidth(atitsthickestpart)/6cmatitsthinnestpast Heartsituatedposteriortosternum,slightleft Weighs+250300g Pumps+70009000Lofbloodaday BroadpartisreferredtoastheBaseoftheheart MorepointedpartiscalledtheApex o Apexusuallyfeltbetween4thand5thribsaboutmidclavicularline o ApexformspartofLeftVentricle Heartfunctionsaspumptosupplyoxygenatedbloodtotissueandremovedeoxygenatedbloodand wasteproductsfromcells

1.1.2 Chamberandvalvesoftheheart

Hearthas4pumpingchambers o Upperchambers:LeftandRightAtrium o LowerChambers:LeftandRightVentricles Atria: o Thinwalledmuscularchambers Ventricles o Muchthickermuscularwalls o Leftventriclewallisthickerthantheright leftventriclepumpsagainsthigherpressure o MuscleoftheVentriclesareknownasMyocardium

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CardiovascularSystem

1.1.3 Muscleoftheheartaremadeupofthreelayers

Endocardium Innermostlayer Myocardium Theheartmuscleitself Pericardium Outermostlayer

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Module5

CardiovascularSystem

2
2.1

Physiologyoftheheart
NerveSupply Theheartiscontrolledbyparasympatheticnervesandthesympatheticnerves Thesenervespartofautonomicnervesystem o Notundervoluntarycontrolbutanautomaticresponse Sympatheticcardiacnervepurpose o Maketheheartbeatfasterandstrongerwhenneeded Parasympatheticcardiacnervepurpose o Istoslowtheheartratedown ParasympatheticcardiacnerveandParasympatheticcardiacnervesuppliesinteracttoproduce responsesappropriatetobodiesneeds

2.2 GreatVessels Theseare ThePulmonaryArtery TheAorta

2.2.1 ThePulmonaryArtery

Risesfromthebaseoftheheart o Fromtheopeninginrightventricle Afterashortdistanceitdividesintotwobranches o Leftandrightpulmonaryarteries Whichsupplyleftandrightlung

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2.2.2 TheAorta

CardiovascularSystem

Risesfromthebaseoftheheart o Adjacenttopulmonaryartery o Fromtheopeninginleftventricle Aortagivesoffimportantcoronaryarterieswhichsupplybloodtoheartmuscle Coronaryarteriessituatedatthebeginningoftheaortaandareclosedoftheaorticvalvesduring ventricularcontraction(systole) Heartthereforereceivesbloodsupplyduringdiastole(whenaorticvalvesclose)

2.3 ConductingSystem

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Module5 2.4 TheHeartasapump

CardiovascularSystem

Theheartisahollowmuscularorganfilledwithblood Afterbloodperfusedvarioustissuesofthebodyitreturnstotherightsideoftheheart Bloodisonlyabletoentertheheartwhentheheartisrelaxed Thisphaseoftheheartscycleasapumpiscalled:Diastole

2.4.1 PressureandFlow

Heartgeneratespressureinorderforthebloodtoflowinaclosedsystem Forceexertedonthewallsofbloodvesselsknownasbloodpressure TheFORCEispulsatilethereforethePRESSUREispulsatile Systolicpressure(high)inarterialwallsduringventricularcontractions Diastolicpressure(low)inarterialwallsduringventricularrelaxation

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Module5 2.5 Superior Vena Right Atrium

CardiovascularSystem

Diastole Left Atrium

CoronaryArteries
Tricuspid Valve

Bicuspid Valve

Inferior Vena Cava Aorta

Pulmonary Valve

AorticValve
Left Ventricl Systole

Right Ventricle

PulmonaryVein PulmonaryArtery

GaseousExchangethroughCapillaries Bloodflowthroughtheheart BloodenterstheRightatriumviaSuperior&InferiorVenaCava PumpedintoRightVentriclethroughTricuspidValve FromRightVentriclethroughPulmonaryValve FromPulmonaryValveintoPulmonaryArteries TotheLungswheregaseousexchangetakesplace FromtheLungsviaPulmonaryVeinsintotheLeftAtrium PumpedintotheLeftVentriclethroughBicuspid/Mitralvalve FromLeftVentriclethroughAorticValve FromAorticValveintotheAorta TotheSystemicCirculationfordistributionthroughthebody

Circulation

Threetypeofcirculation: CardiacCirculation PulmonaryCirculation SystemicCirculation

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Module5 3.1

CardiovascularSystem

CardiacCirculation Myocardium(heartmuscle)needscontinuoussupplyofoxygenandnutrientstofunctionefficiently Rightcoronaryarterysupplybloodtorightventricleandbottompart/inferiorwallofleftventricle Leftcoronaryarterydividesintotwomajorbranchesthatsupplytheleftventricle o +5%ofthebodiesentirebloodsupplyispumpedthroughcoronaryarteriestofeedthe heartwiththehighestamountofoxygenatedblood Coronaryarteryhavetheabilitytodilate o Toincreasesupplyofoxygenatedbloodtoheartmuscleswhenneeded

3.2 PulmonaryCirculation Gaseousexchangetakesplaceatcapillarylevel Pulmonaryarteriessystemishighpressuresystem Pulmonaryvenoussystemislowpressuresystem RightAtriumRightVentriclePulmonaryArteriesPulmonaryArterioles(smallerarteries)Capillaries PulmonaryVenules(smallerveins)PulmonaryVeinsLeftAtriumLeftVentricle REMEMBER:thisistheonlyinstancewhenvenous(deoxygenated)bloodiscarriedbyatrialsystem Andwhenarterial(oxygenated)bloodiscarriedbyvenoussystem

3.3 SystemicCirculation Suppliesthewholebodywithoxygenandnutrients SystemicArterialsystemisaHIGHpressuredsystem SystemicVenoussystemisalowpressuredsystem LeftAtriumLeftVentricleAortaSystemicArteriesArteriolesCapillaries(bodytissue)Venules VeinsRightAtrium

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CardiovascularSystem

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CardiovascularSystem

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Module5 3.4 CardiacOutput CardiacOutput=StrokeVolumexHeartRate

3.4.1 StrokeVolume

CardiovascularSystem

StrokevolumeisthevolumeofbloodpumpedoutofONEVENTRICLEinSINGLEheartbeat Adultatrest: +70mlfromoneventricleandsingleheartbeat Heartrate72bpm CO(CardiacOutput) SV(StrokeVolume) HR(HeartRate) CO=SVxHR CO=70mlx72bpm CO=5000ml CO=5L/min Cardiacoutputcanbegreatlyincreasedtomeetdemandsofexercisetoaround25L/min Andinathletes35L/min
3.4.2 NormalHeartRates

Adults Children Toddlers Newborns

60100bpm 80100bpm 100120bpm 120140bpm

3.5 BloodPressure Bloodpressureismeasuredinmillimetresmercury(mmHg) Determinedbycardiacoutputandperipheralresistance: BloodPressure=CardiacOutputxPeripheralresistance

3.5.1 PeripheralResistance

Peripheralresistanceisconstrictionanddilationofarterioles. Vasoconstrictioncausesbloodpressuretoriseandvasodilationcausesbloodpressuretofall Normalvalves: Malept. Age+100=SystolicBP 40+100=140 DiastolicBP=2/3ofsystolicBP 90100 Femalept. Age+90=SystolicBP 30+90=120 DiastolicBP=2/3ofsystolicBP 80 3.6 Bodyfluidcompartments Humanbodymadeupof60%waterbyweight I.e.manweighing70kgconsistsof+42Lofwater Fluidiscontainedincompartments Twomaincompartments: ExtracellularCompartments(20%bodyweight) IntracellularCompartments(40%bodyweight)

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3.6.1

CardiovascularSystem

ExtracellularCompartments(20%bodyweight)

Extracellularmeansoutsidethecell Extracellularfluidismadeupof o Allfluidinthebloodvessels(Intravascular) o +4%ofintravascularfluidisintheformofplasma Plasmaisbetweenthecellsandthebodytissue(Interstitial) 14Loffluidisfoundinextracellularcompartments 6Lofthe14Lisblood

IntracellularCompartments(40%bodyweight)

3.6.2

3.6.3

Intracellularmeansinsidethecell Thisincludesallthecellsofthebody 28Loffluid Intracellularfluid(ICF)

Bloodvessels

Comprisesofarteries,veinsandcapillaries Arteries Veins Carrybloodawayfromtheheart Carrybloodtowardstheheart Usuallycarriesoxygenrichbloodexceptpulmonary Usuallycarriesdeoxygenatedbloodexceptforthe arteries pulmonaryveins Thickwalled Thinwalled Novalves Valves Capillariesaresmallerveinsandarteriesthatconnectvenulesandarterioles.

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Module5 3.7

CardiovascularSystem

BasicCompositionofblood Bloodfluidcomposedof o Yellowishtransparentfluidknownasplasma o Andfloatinginthefluidaredifferenttypesofcells Therearethreemaintypesofcells o Erythrocytes(redbloodcells) o Leucocytes(whitebloodcells) o Thrombocytes(platelets)

Erythrocytes

3.7.1

3.7.2

Erythrocytescontainsubstancecalledhaemoglobinabletotransportoxygen Erythrocytesandhaemoglobincombinetoformoxyhaemoglobin Bulkofoxygeninbloodistransportbyoxyhaemoglobintocellsinthebody Oxyhaemoglobinisresponsibleforpinkcolourofpt.mucousmembrane Inabsenceofoxygenhaemoglobinwillcombinewithcarbondioxidetoforcarboxyhaemoglobin Carboxyhaemoglobinresponsibleforbluishcolourofpt.mucousmembrane(cyanoticpt.)

Leucocytes

3.7.3

Leucocytesresponsibleforprovidingbodywithdefenceagainstinvadingmicroorganism Leucocytesengulfandattempttodestroyanyforeignorganism
Thrombocytes

Thrombocytesareverysmallcells Playimportantroleinclottingofblood Mechanismcalledcoagulation(clottingoftheblood)happens/reactswhen o Whenbloodvesselisdamagestopreventbloodloss o Whenbloodescapesfromwoundthrombocytesgatheratsite o Andtogetherwithothersubstancesformaplugtoclosethewound Summaryofmainfunctionofblood o Bloodtransportsoxygenasoxyhaemoglobinfromlungstotissuecells o Andreturnscarbondioxidefromcellstolungsascarboxyhaemoglobinforlungexcretion o Bloodtransportsallnourishmenttocells o Bloodtransportsallwasteproductsfromthetissuestocertainorganse.g.kidneys,liver. o Bloodtransportshormonesandenzymestotheirtargetorgans. o Bloodassistsinthedefenceofthebodyagainstmicroorganism. o Bloodhelpstomaintainbodytemperature.Playsaroleinacidbasebalance

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CardiovascularSystem

ClinicalCardiacConditions
Manytypesofpainoccurinthechest Painmayarisefromstructureinchestwall/withinthoraciccavity Paintheariseswhenheartisdeprivedofoxygenismostoftenduetodiseaseinarteries(coronary arteries) Thesesupplytheheartwithoxygenandnutrients

Duringassessmentofchestpain(oranypain)pt.historyisVERYimportant Thistodeterminecauseofchestpain Asktheflowingquestions:OPQRST Onset Whendidthepainstart/begin? Provokes Whatprovokesthepain? E.g.wasthept.exercising? Quality Whatisthequalityofpain? Crushing/stabling/feelslikesomeoneissittingontheirchest Radiation/Radiating Isthepainradiating? i.e.tothejaw,arms,abdomen,back Severity Howseveristhepain? Scaleof110?10beingtheworsethept.haseverfelt Time Howlonghasthepainlasted? 1hour Andisthepainconstantordoesitcomeandgoandforhowlong Thenask:SAMPLE SignsandSymptoms Signsissomethingyousee Symptomsiswhatthept.tellsyou Allergies Askareyouallergictoanythinglikemedicationlikeaspirinorfoodlike peanuts Medication Areyouonchronicmedicationortakingmedicationforanythinglikefluor heartproblems Pastmedicalhistory Thisquestionneedstoincludethept.aswellasthept.family (pt.maynothavepastheartproblemsbutpt.parentsorfamilymayhaveheart problems) Lastmeal Whenwasthelasttimethept.ateorhadsomethingtoeat Eventsleadinguptothe Whatwasthept.doingbeforethepainstarted event

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Module5 4.1 AnginaPectoris

CardiovascularSystem

AnginaDiseaseofthecoronaryarteries o Causesnarrowingofthelumen(innerdiameterofvessels)totheextentthatbloodflow decreases Narrowingofthelumenisduetoplaqueformation Whenthept.isatrestnarrowingisnotaproblemassoonastheyexertthemselvesemotionallyor physicallyheartrequiresmoreoxygentocopewithincreaseloadofworkithastoperformtosupply exercisingmuscleswithoxygenandnutrients Heartisamuscleneedsoxygenandnutrientsifitneedstoworkharder Asone/morecoronaryarteriesmaybenarrowedthislimitsbloodflowthroughthemandheart muscleisdeprivedofoxygenandnutrients o CausespainduetoANGINA
StableAngina

4.1.1

Predictableafterexertionwithpredictablelocation/intensity
4.1.2 UnstableAngina

Unpredictable Changeslocationintensityandduration GreaterdegreeofobstructionanditsusuallyasignofanAMI

4.1.3 CharacteristicsofAngina:

Broughtonbyexertion(StableAngina) Relievedrapidlybyrestwithinafewminutesinmostcases(StableAngina) Painusuallyoccursincentralchestbehindsternum o Classicallymayradiatetoneck,jawandbotharms

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CardiovascularSystem

Painistypicallycrashing o maybedescribedasheavy/squeezing/pressure/someonesittingontheirchest Alsorelievedinminutesbycertainmedication(tablets)putunderthetongueTNT/Nitro-glycerine (spray or tablet)

4.1.4 ManagementofAngina

History(takehistoryasfastaspossible) ABC Oxygen60%(preferredPartialrebreather) Reassurept. Positionpt.incomfortableposition(semifowlers/fowlers) Entonox(IFNOCONTRAINDICATIONS) Callforassistance(ifpt.doesnotimprove)/callforbackupifneeded Transportpt. DONTletpt.walk

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Module5 4.2

CardiovascularSystem

MyocardialInfarction(MI) Coronaryartery(ormorethanone)becomescompletelyblockedbycoronaryarterydisease o E.g.Atherosclerosis,bloodclot Thatpartoftheheartbeyondsiteofblockage(occlusion)nolongerreceivesblood o Deprivesheartmuscleineffectedareaofvitaloxygenandnutrientsleadingtocelldeath o (infarction/ischemia)celldiesduetolackofoxygen o (myocardial)heartmuscle o ThisisknownasMyocardialInfarction(deathofheartmuscles) AMI(AcuteMyocardialInfarction)quickonset PainproducebyMIisidenticaltoangina o Howeverpainismorepersistent o Moreseverepain o Maylastforseveralhours o Unlessrelievedbypainkingdrugs
CharacteristicsofMI:

4.2.1

4.2.2

Chestpainsubsternal,radiatingtoneckandleftarm(andrightarmsometimes) Mayoccuratrest NOTrelievedbyrestormedication Maylastforhours Coldandclammyskinandpalegreycomplexion Sweating o Pt.becomeshypoxic Nauseaandsometimesvomiting Dyspnea Dizzinessandfeelingfaint Ifsevere,cardiogenicshockmaybepresent Pulsevariesfromnormaltoweak,rapidandirregular Feelingofimpendingdoom(pt.willtellyoutheyaredying)
ManagementofMI

History(takehistoryasfastaspossible) ABC Oxygen60%(preferredPartialrebreather) Reassurept. Positionpt.incomfortableposition(semifowlers/fowlers) Entonox(IFNOCONTRAINDICATIONS) Callforassistance(ifpt.doesnotimprove)/callforbackupifneeded Transportpt.rapidwithoutsirens DONTletpt.walk DifferencesbetweenAnginaandMI Angina MI Broughtonbyexertion Mayoccuratrest(anytime) Relievedrapidlybyrestormedication NOTrelievedbymedicationorrest Paintendstobecrushing Feelingofimpendingdoom Maylastshortwhile(comeandgo) Maylastforhours

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Module5 4.3
4.3.1

CardiovascularSystem

Congestivecardiacfailure(CCF) Occurswhenheartisunabletopumpfast/hardenoughtocompletelyemptyitschambers o Causethebloodtobackupintosystemic/pulmonarycirculation

Leftheartfailure

4.3.2

Leftheartmosteasilydamaged o Leftpumpsharderagainstresistance Bloodbacksupinlungsandcausespulmonaryoedema Dyspneaoccursresultofdecreasedoxygen Pt.becomestachypnoeic(above24breathesp/min)totryandincreaseoxygenlevels Hyperresonant/ralesonthechest(canbeheard) Haemoptysis(Pt.maycoughuppinkfrothysputum) Mayhavedecreasedlevelofconsciousness

Rightheartfailure

4.3.3

Usuallyoccursafterleftheartfailure o Afterfluidhasbackuptolungs o Rightlunghastoworkhardtopumpbloodintolungs o Eventuallybecomestooweaktocopewithdemand Bloodstartstobackupinvesselssupplyingdeoxygenatedbloodtoheart Jugularveinsaredistendedandperipheraloedemaispresent

CharacteristicsofCCF:

4.3.4

Dyspnea(resultoffluidinalveoli) Pt.insittingposition(duetodyspnea) Distress/agitatedhypoxia(duetopoorcardiacoutput) Peripheraloedema/Sacraloedema(Swollenlegsandorsacrum) o Resultoffluidaccumulatingintissues

ManagementofMI

History(takehistoryasfastaspossible) ABC Oxygen60%(preferredPartialrebreather) Reassurept. Positionpt.incomfortableposition(semifowlers/fowlers) Callforassistance(ifpt.doesnotimprove)/callforbackupifneeded Transportpt.rapidwithoutsirens DONTletpt.walk

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CardiovascularSystem

4.4 CardiacTamponade CardiacTamponadecausedby: Severeblowtothechest Diseasei.e.tuberculosis Penetratinginjurytohearti.e.stabbedheart

4.4.1 Mechanism

4.4.2

Pericardialsacfillswithblood o Inhibitingmechanicalactionofheartasresultofinwardpressure Thisreducesvolumecarryingcapacityofcambersandinhibitselectricalactivity Whencausedbydisease/contusionpulmonaryoedemamayresult Whencausedbystabwoundpulmonaryoedemadoesnotusuallydevelop o Asbloodescapesbyentrancewound Cardiacarrestresults Whenresultoftraumaonsetisrapidnormallylethal Whenresultofdiseaseonsetusuallyslowerandcanbetreated

CharacteristicsofCCF:

Bruising/penetratinginjuryinchest(acute) Dyspnea Tachycardia Reducedbloodpressure Chestpain Severeanxiety ReducedGSC Hypoxia Beckstriad o Muffledheartsounds o Distendedneckveins(duetobackupofliquids) o ReducedlevelbetweensystolicanddiastolicBP
ManagementofMI

4.4.3

ABC Oxygen60%(preferredPartialrebreather) Reassurept. Positionpt.inshockposition o Trendelenburgandmonitorclosely Vitalsigns History Coverpt.withspaceblanket CallforbackASAP Monitorvitalsignscontinuously Transportpt.rapidwithoutsirens DONTletpt.walk

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