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CAkDICVASCULAk

SS1LM
What |s the Card|ovascu|ar
System?
- Also known as Lhe clrculaLory sysLem
- ls a sysLem of Lhe body comprlsed of Lhe hearL
Lhe blood and Lhe blood vessels
- 8esponslble for LransporLlng blood
- As Lhe cardlovascular sysLem moves blood
LhroughouL Lhe body cells recelve oxygen and
nuLrlenLs Carbon dloxlde and oLher wasLes are
removed from Lhe body as well
1nL 8LCCD VLSSLLS
- 1he cotJlovoscolot system has Lhree Lypes of blood vessels
- Attetles (and ottetloles) carry blood away from Lhe hearL
- coplllotles where nuLrlenL and gas exchange occur
- velos (and veooles) carry blood Loward Lhe hearL
8LCCD VLSSLLS
1he walls of arLerles and velns have Lhree layers 1he lnner layer
ls composed largely of endoLhellum wlLh a basemenL
membrane LhaL has elasLlc flbers Lhe mlddle layer ls smooLh
muscle Llssue Lhe ouLer layer ls connecLlve Llssue (largely
collagen flbers) ArLerles (on lefL) have a Lhlcker wall Lhan velns
because Lhey have a larger mlddle layer Lhan velns Caplllary
walls (cenLer) are onecellLhlck endoLhellum velns (on rlghL)
are larger ln dlameLer Lhan arLerles so LhaL collecLlvely velns
have a larger holdlng capaclLy Lhan arLerles
1he Arter|es
- Attetles and arLerloles Lake blood away from Lhe hearL
- 1he largesL arLery ls Lhe ootto
- 1he mlddle layer of an arLery wall conslsLs of smootb moscle
LhaL can consLrlcL Lo regulaLe blood flow and blood pressure
- Attetloles can consLrlcL or dllaLe changlng blood pressure
1he Cap|||ar|es
- coplllotles have walls only one cell Lhlck Lo allow exchange of
gases and nuLrlenLs wlLh Llssue fluld
- Caplllary beds are presenL ln all reglons of Lhe body buL noL all
caplllary beds are open aL Lhe same Llme
- ConLracLlon of a spbloctet moscle closes off a bed and blood
can flow Lhrough an ottetloveooos sboot LhaL bypasses Lhe
caplllary bed
ANA1CM CI A CAILLAk 8LD
A caplllary bed forms a maze of caplllary vessels LhaL lles
beLween an arLerlole and a venule When sphlncLer muscles are
relaxed Lhe caplllary bed ls open and blood flows Lhrough Lhe
caplllarles When sphlncLer muscles are conLracLed blood flows
Lhrough a shunL LhaL carrles blood dlrecLly from an arLerlole Lo
a venule As blood passes Lhrough a caplllary ln Lhe Llssues lL
glves up lLs oxygen (C
2
) 1herefore blood goes from belng C
2

rlch ln Lhe arLerlole (red color) Lo belng C


2
poor ln Lhe veln
(blue color)
1he Ve|ns
- veooles draln blood from caplllarles Lhen [oln Lo form velos
LhaL Lake blood Lo Lhe hearL
- velns have much less smooLh muscle and connecLlve Llssue
Lhan arLerles
- velns ofLen have volves LhaL prevenL Lhe backward flow of
blood when closed
- velns carry abouL 70 of Lhe body's blood and acL as a tesetvolt
durlng hemorrhage
1nL nLAk1
- 1he beott ls a coneshaped muscular organ locaLed beLween
Lhe lungs behlnd Lhe sLernum
- 1he hearL muscle forms Lhe myocotJlom wlLh LlghLly
lnLerconnecL cells of cotJloc moscle Llssue
- 1he petlcotJlom ls Lhe ouLer membranous sac wlLh lubrlcaLlng
fluld
- 1he hearL has four chambers Lwo upper Lhlnwalled ottlo and
Lwo lower Lhlckwalled veottlcles
- 1he septom ls a wall dlvldlng Lhe rlghL and lefL sldes
1he hearL has four chambers Lwo upper Lhlnwalled ottlo and
Lwo lower Lhlckwalled veottlcles
- 1he septom ls a wall dlvldlng Lhe rlghL and lefL sldes
- Attloveottlcolot volves occur beLween Lhe aLrla and venLrlcles
Lhe ttlcosplJ volve on Lhe rlghL and Lhe blcosplJ volve on Lhe
lefL boLh valves are reenforced by cbotJoe teoJlooe aLLached
Lo muscular pro[ecLlons wlLhln Lhe venLrlcles
Lk1LkNAL nLAk1 ANA1CM
1he superlor vena cava and Lhe pulmonary Lrunk are aLLached
Lo Lhe rlghL slde of Lhe hearL 1he aorLa and pulmonary velns
are aLLached Lo Lhe lefL slde of Lhe hearL 1he rlghL venLrlcle
forms mosL of Lhe venLral surface of Lhe hearL and Lhe lefL
venLrlcle forms mosL of Lhe dorsal surface
CCkCNAk Ak1Lk CIkCULA1ICN
1he coronary arLerles and cardlac velns pervade cardlac muscle
1he coronary arLerles brlng oxygen and nuLrlenLs Lo cardlac cells
whlch derlve no beneflL from blood courslng Lhrough Lhe hearL
assage of b|ood through the neart
- 8lood follows Lhls sequence Lhrough Lhe hearL
superlor and lnferlor vena cava rlghL aLrlum Lrlcuspld
valve rlghL venLrlcle pulmonary semllunar valve
pulmonary Lrunk and arLerles Lo Lhe lungs pulmonary velns
leavlng Lhe lungs lefL aLrlum blcuspld valve lefL
venLrlcle aorLlc semllunar valve aorLa Lo Lhe body
IN1LkNAL VILW CI 1nL nLAk1
1he hearL has four valves 1he aLrlovenLrlcular valves allow blood
Lo pass from Lhe aLrla Lo Lhe venLrlcles and Lhe semllunar valves
allow blood Lo pass ouL of Lhe hearL
- 1he pumplng of Lhe hearL sends ouL blood under pressure Lo
Lhe arLerles
- looJ ptessote ls greaLesL ln Lhe aorLa Lhe wall of Lhe lefL
venLrlcle ls Lhlcker Lhan LhaL of Lhe rlghL venLrlcle and pumps
blood Lo Lhe enLlre body
- 8lood pressure Lhen decreases as Lhe crosssecLlonal area of
arLerles and Lhen arLerloles lncreases
A1n CI 8LCCD 1nkCUGn
1nL nLAk1
1hls dlagrammaLlc represenLaLlon of Lhe hearL allows you Lo Lrace
Lhe paLh of Lhe blood Lhrough Lhe hearL
1he neartbeat
- Lach hearLbeaL ls called a cotJloc cycle
- When Lhe hearL beaLs Lhe Lwo aLrla conLracL LogeLher Lhen Lhe
Lwo venLrlcles conLracL Lhen Lhe whole hearL relaxes
- 5ystole ls Lhe conLracLlon of hearL chambers Jlostole ls Lhelr
relaxaLlon
- 1he beott soooJs lubdup are due Lo Lhe closlng of Lhe
aLrlovenLrlcular valves followed by Lhe closlng of Lhe semllunar
valves
Intr|ns|c Contro| of neartbeat
- 1he 5A (slooottlol) ooJe or pocemoket lnlLlaLes Lhe hearLbeaL
and causes Lhe aLrla Lo conLracL on average every 083 seconds
- 1he Av (ottloveottlcolot) ooJe conveys Lhe sLlmulus and
lnlLlaLes conLracLlon of Lhe venLrlcles
- 1he slgnal for Lhe venLrlcles Lo conLracL Lravels from Lhe Av
node Lhrough Lhe ottloveottlcolot booJle Lo Lhe smaller
lotkloje flbets
Conduct|on system of the heart
1he SA node sends ouL a sLlmulus whlch cause Lhe aLrla Lo
conLracL When Lhls sLlmulus reaches Lhe Av node lL slgnals Lhe
venLrlcles Lo conLracL lmpulses pass down Lhe Lwo branches of Lhe
aLrlovenLrlcular bundle Lo Lhe urkln[e flbers and LhereafLer Lhe
venLrlcles conLracL
Lxtr|ns|c Contro| of neartbeat
- A cotJloc coottol ceotet ln Lhe medulla oblongaLa speeds up or
slows down Lhe hearL raLe by way of Lhe auLonomlc nervous
sysLem branches potosympotbetlc system (slows hearL raLe)
and Lhe sympotbetlc system (lncreases hearL raLe)
- Pormones eploepbtloe and ooteploepbtloe from Lhe adrenal
medulla also sLlmulaLe fasLer hearL raLe
1he L|ectrocard|ogram
- An electtocotJloqtom (LCC) ls a recordlng of Lhe elecLrlcal
changes LhaL occur ln Lhe myocardlum durlng a cardlac cycle
- Attlol Jepolotlzotloo creaLes Lhe l wove veottlcle
Jepolotlzotloo creaLes Lhe Ok5 wove and tepolotlzotloo of Lhe
venLrlcles produces Lhe 1 wove
L|ectrocard|ogram
A normal LCC (lmage from prevlous sllde) lndlcaLes LhaL Lhe hearL ls
funcLlonlng properly 1he wave occurs [usL prlor Lo aLrlal
conLracLlon Lhe C8S complex occurs [usL prlor Lo venLrlcular
conLracLlon and Lhe 1 wave occurs when Lhe venLrlcles are
recoverlng from conLracLlon
venLrlcular flbrlllaLlon (boLLom) produces an lrregular
elecLrocardlogram due Lo lrregular sLlmulaLlon of Lhe venLrlcles
venLrlcular flbrlllaLlon ls of speclal lnLeresL because lL can be caused
by an ln[ury or drug overdose lL ls Lhe mosL common cause of
sudden cardlac deaLh ln a seemlngly healLhy person over age 33
Cnce Lhe venLrlcles are flbrlllaLlng Lhey have Lo be deflbrlllaLed by
applylng a sLrong elecLrlcal currenL for a shorL perlod of Llme 1hen
Lhe SA node may be able Lo reesLabllsh a coordlnaLed beaL
1he Vascu|ar athways
- 1he cardlovascular sysLem lncludes Lwo clrculLs
% lolmoooty cltcolt whlch clrculaLes blood Lhrough Lhe lungs
and
2% 5ystemlc cltcolt whlch clrculaLes blood Lo Lhe resL of Lhe
body
3) 8oLh clrculLs are vlLal Lo homeosLasls
Card|ovascu|ar system d|agram
1he bluecolored vessels carry C
2
poor blood and Lhe redcolored
vessels carry C
2
rlch blood Lhe arrows lndlcaLe Lhe flow of blood
Caplllarles are presenL ln all parLs of Lhe body so no cell ls locaLed
far from a caplllary
1he u|monary C|rcu|t
- 1he polmoooty cltcolt beglns wlLh Lhe polmoooty ttook from
Lhe rlghL venLrlcle whlch branches lnLo Lwo polmoooty ottetles
LhaL Lake oxygenpoor blood Lo Lhe lungs
- ln Lhe lungs oxygen dlffuses lnLo Lhe blood and carbon dloxlde
dlffuses ouL of Lhe blood Lo be expelled by Lhe lungs
- lour polmoooty velos reLurn oxygenrlch blood Lo Lhe lefL
aLrlum
1he System|c C|rcu|t
- 1he systemlc cltcolt sLarLs wlLh Lhe aorLa carrylng C
2
rlch blood
from Lhe lefL venLrlcle
- 1he aorLa branches wlLh an arLery golng Lo each speclflc organ
- Cenerally an arLery dlvldes lnLo arLerloles and caplllarles whlch
Lhen lead Lo venules
- 1he veln LhaL Lakes blood Lo Lhe vena cava ofLen has Lhe same
name as Lhe arLery LhaL dellvered blood Lo Lhe organ
- ln Lhe adulL sysLemlc clrculL arLerles carry blood LhaL ls
relaLlvely hlgh ln oxygen and relaLlvely low ln carbon dloxlde
and velns carry blood LhaL ls relaLlvely low ln oxygen and
relaLlvely hlgh ln carbon dloxlde
- 1hls ls Lhe reverse of Lhe pulmonary clrculL
Ma[or arter|es and ve|ns of the
system|c c|rcu|t
- 1he cotoooty ottetles serve Lhe hearL muscle lLself Lhey are Lhe
flrsL branch off Lhe aorLa
- Slnce Lhe coronary arLerles are so small Lhey are easlly clogged
leadlng Lo hearL dlsease
- 1he bepotlc pottol system carrles blood rlch ln nuLrlenLs from
dlgesLlon ln Lhe small lnLesLlne Lo Lhe llver Lhe organ LhaL
monlLors Lhe composlLlon of Lhe blood
8|ood I|ow
- 1he beaLlng of Lhe hearL ls necessary Lo homeosLasls because lL
creaLes pressure LhaL propels blood ln arLerles and Lhe
arLerloles
- ArLerloles lead Lo Lhe caplllarles where nuLrlenL and gas
exchange wlLh Llssue fluld Lakes place
8|ood I|ow |n Arter|es
- looJ ptessote due Lo Lhe pumplng of Lhe hearL accounLs for
Lhe flow of blood ln Lhe arLerles
- 5ystollc ptessote ls hlgh when Lhe hearL expels Lhe blood
- ulostollc ptessote occurs when Lhe hearL venLrlcles are relaxlng
- 8oLh pressures decrease wlLh dlsLance from Lhe lefL venLrlcle
because blood enLers more and more arLerloles and arLerles
Crosssect|ona| area as |t re|ates to
b|ood pressure and ve|oc|ty
8lood pressure and blood veloclLy drop off ln caplllarles because
caplllarles have a greaLer crosssecLlonal area Lhan arLerles
8|ood I|ow |n Cap|||ar|es
- 8lood moves slowly ln caplllarles because Lhere are more
caplllarles Lhan arLerloles
- 1hls allows Llme for subsLances Lo be exchanged beLween Lhe
blood and Llssues
BIood FIow in Veins
- venous blood flow ls dependenL upon
1) skeleLal muscle conLracLlon
2) presence of valves ln velns and
3) resplraLory movemenLs
- Compresslon of velns causes blood Lo move forward pasL a
valve LhaL Lhen prevenLs lL from reLurnlng backward
- Changes ln Lhoraclc and abdomlnal pressure LhaL occur wlLh
breaLhlng also asslsL ln Lhe reLurn of blood
- votlcose velos develop when Lhe valves of velns become weak
- nemottbolJs (plles) are due Lo varlcose velns ln Lhe recLum
- lblebltls ls lnflammaLlon of a veln and can lead Lo a blood cloL
and posslble deaLh lf Lhe cloL ls dlslodged and ls carrled Lo a
pulmonary vessel
1nL 8LCCD
- 8lood separaLes lnLo Lwo maln parLs plosmo and fotmeJ
elemeots
- lasma accounLs for 33 and formed elemenLs 43 of blood
volume
- lasma conLalns mosLly waLer (9092) and plasma proLelns
(78) buL lL also conLalns nuLrlenLs and wasLes
- Albomlo ls a large plasma proLeln LhaL LransporLs blllrubln
qlobollos are plasma proLelns LhaL LransporL llpoproLelns
Compos|t|on of the 8|ood
When blood ls Lransferred Lo a LesL Lube and prevenLed from cloLLlng lL forms
Lwo layers 1he LransparenL yellow Lop layer ls plasma Lhe llquld porLlon of
Lhe blood 1he formed elemenLs are Lhe boLLom layer
1he ked 8|ood Ce||s
- keJ blooJ cells (etytbtocytes or kcs) are made ln Lhe teJ booe
mottow of Lhe skull rlbs verLebrae and Lhe ends of long
bones
- normally Lhere are 4 Lo 6 mllllon 88Cs per mm
3
of whole blood
- 8ed blood cells conLaln Lhe plgmenL bemoqloblo for oxygen
LransporL hemogobln conLalns beme a complex lron
conLalnlng group LhaL LransporLs oxygen ln Lhe blood
hys|o|ogy of red b|ood ce||s
8ed blood cells move ln slngle flle Lhrough Lhe caplllarles Lach red
blood cell ls a blconcave dlsk conLalnlng many molecules of
hemoglobln Lhe resplraLory plgmenL Pemoglobln conLalns four
polypepLlde chalns (ln blue) 1here ls an lronconLalnlng heme group
ln Lhe cenLer of each chaln Cxygen loosely comblnes wlLh
hemoglobln when oxygenaLed Cxyhemoglobln ls brlghL red and
deoxyhemoglobln ls a dark maroon color
- 1he alr polluLanL cotboo moooxlJe comblnes more readlly wlLh
hemoglobln Lhan does oxygen resulLlng ln oxygen deprlvaLlon
and posslble deaLh
- 8ed blood cells lack a nucleus and have a 120 day llfe span
- When worn ouL Lhe red blood cells are dlsmanLled ln Lhe llver
and spleen
- lron ls reused by Lhe red bone marrow where sLem cells
conLlnually produce more red blood cells Lhe remalnder of Lhe
heme porLlon undergoes chemlcal degradaLlon and ls excreLed
as blle plgmenLs lnLo Lhe blle
- Lack of enough hemoglobln resulLs ln ooemlo
- 1he kldneys produce Lhe hormone etytbtopoletlo Lo lncrease
blood cell producLlon when oxygen levels are low
1he Wh|te 8|ood Ce||s
- Jblte blooJ cells (leokocytes) have nuclel are fewer ln number
Lhan 88Cs wlLh 3000 10000 cells per mm
3
and defend
agalnsL dlsease
- LeukocyLes are dlvlded lnLo qtooolot and oqtooolot based on
appearance
- Cranular leukocyLes (oeottopblls eosloopblls and bosopblls)
conLaln enzymes and proLelns LhaL defend Lhe body agalnsL
mlcrobes
- 1he aganular leukocyLes (mooocytes and lympbocytes) have a
spherlcal or kldneyshaped nucleus
- MonocyLes can dlfferenLlaLe lnLo moctopboqes LhaL
pboqocytlze mlcrobes and sLlmulaLe oLher cells Lo defend Lhe
body
- LymphocyLes are lnvolved ln lmmunlLy
- An excesslve number of whlLe blood cells may lndlcaLe an
lnfecLlon or leokemlo Plv lnfecLlon drasLlcally reduces Lhe
number of lymphocyLes
Macrophage engu|f|ng bacter|a
MonocyLederlved macrophages are Lhe body's scavengers 1hey
engulf mlcrobes and debrls ln Lhe body's flulds and Llssues as
lllusLraLed ln Lhls colorlzed scannlng elecLron mlcrograph 1he
macrophage ls ln red and Lhe bacLerla are ln green
1he |ate|ets and 8|ood C|ott|ng
- 8ed bone marrow produces large cells called meqokotyocytes
LhaL fragmenL lnLo plotelets aL a raLe of 200 bllllon per day
blood conLalns 130000300000 plaLeleLs per mm
3

- 1welve clottloq foctots ln Lhe blood help plaLeleLs form blood
cloLs
8|ood C|ott|ng
- ln[ured Llssues release a cloLLlng facLor called ptotbtomblo
octlvotot whlch converLs proLhrombln lnLo Lhrombln
- 1hrombln ln Lurn acLs as an enzyme and converLs flbrlnogen
lnLo lnsoluble Lhreads of flbtlo
- 1hese converslons requlre Lhe presence of calclum lons (Ca
2+
)
- 1rapped red blood cells make a cloL appear red
8|ood C|ott|ng
laLeleLs and damaged Llssue cells release proLhromblm acLlvaLor
whlch acLs on proLhrombln ln Lhe presence of calclum lons (Ca
2+
)
Lo produce Lhrombln 1hrombln acLs on flbrlnogen ln Lhe presence
of Ca
2+
Lo form flbrln Lhreads 1he scannlng elecLron mlcrograph of
a blood cloL shows red blood cells caughL ln Lhe flbrln Lhreads
nemoph|||a
- nemopblllo ls an lnherlLed cloLLlng dlsorder due Lo a deflclency
ln a cloLLlng facLor
- 8umps and falls cause bleedlng ln Lhe [olnLs carLllage
degeneraLlon and resorpLlon of bone can follow
- 1he mosL frequenL cause of deaLh ls bleedlng lnLo Lhe braln
wlLh accompanylng neurologlcal damage
8one Marrow Stem Ce||s
- A stem cell ls capable of dlvldlng lnLo new cells LhaL
dlfferenLlaLe lnLo parLlcular cell Lypes
- 8one marrow ls moltlpoteot able Lo conLlnually glve rlse Lo
parLlcular Lypes of blood cells
- 1he skln and braln also have sLem cells and meseocbymol stem
cells glve rlse Lo connecLlve Llssues lncludlng hearL muscle
8|ood ce|| format|on |n red bone
marrow
MulLlpoLenL sLem cells glve rlse Lo Lwo speclallzed sLem cells 1he
myelold sLem cell glves rlse Lo sLlll oLher cells whlch become red
blood cells plaLeleLs and all Lhe whlLe blood cells excepL
lymphocyLes 1he lymphold sLem cell glves rlse Lo lymphoblasLs
whlch become lymphocyLes
- AL Lhe arLerlole end of a caplllary waLer moves ouL of Lhe blood
due Lo Lhe force of blooJ ptessote
- AL Lhe venule end waLer moves lnLo Lhe blood due Lo osmotlc
ptessote of Lhe blood
- CsmoLlc pressure ln Lhe blood ls creaLed by Lhe presence of
salLs and Lhe plasma proLelns
- SubsLances LhaL leave Lhe blood conLrlbuLe Lo tlssoe flolJ Lhe
fluld beLween Lhe body's cells
Cap|||ary exchange
AL Lhe arLerlal end of a caplllary Lhe blood pressure ls hlgher Lhan
Lhe osmoLlc pressure Lherefore waLer Lends Lo leave Lhe
bloodsLream ln Lhe mldsecLlon oxygen and carbon dloxlde follow
Lhelr concenLraLlon gradlenLs AL Lhe venous end of a caplllary Lhe
osmoLlc pressure ls hlgher Lhan Lhe blood pressure Lherefore
waLer Lends Lo enLer Lhe bloodsLream
ASSLSSMLN1
n4k1 4u5cuL141lON
AusculLaLlon of Lhe hearL ls noL synonymous wlLh examlnaLlon of
Lhe hearL 1haL ls noL Lo dlmlnlsh Lhe lmporLance or dlfflculLy of
acqulrlng Lhe necessary skllls
LxamlnaLlon of Lhe hearL sLarLs wlLh general lnspecLlon for
cyanos|s dyspnea edema or cachex|a lL ls followed by
assessmenL of [ugu|ar venous pressure (!v) exam|n|ng the pu|se
and checklng blood pressure 1hls lncludes checklng Lhe flngers for
c|ubb|ng or sp||nter haemorrhages Cnly Lhen ls lL Llme Lo move Lo
Lhe chesL and even Lhen lL ls sLlll noL yeL Llme Lo produce Lhe
sLeLhoscope
Mechan|sm of sounds
PearL sounds (normal or paLhologlcal) are caused by LurbulenL
blood flow 1hey lnclude Lhe sound of Lhe closlng valves
omloot flow ls sllenL 1otboleot flow makes a sound A tbtlll ls
Lurbulence or a murmur LhaL ls so marked LhaL lL ls palpable
S|tes for auscu|tat|on
The bell of the stethoscope is better for detecting lower-
frequency sounds whilst the diaphragm is better for higher
frequencies. The bell is usually used to listen to the mitral
valve and the diaphragm at all other sites. Auscultation is
usually performed with the patient sitting up or reclined at
about 45.
M|tra| area
- AL Lhe apex beaL as Lhe lefL venLrlcle ls closesL Lo Lhe Lhoraclc cage
2 1r|cusp|d area
- lnferlor rlghL sLernal margln ls Lhe polnL closesL Lo Lhe valve ln
whlch ausculLaLlon ls posslble
3 u|monary area
- LefL second lnLercosLal space close Lo Lhe sLernum ls where Lhe
lnfundlbulum ls closesL Lo Lhe Lhoraclc cage
4 Aort|c area
- 8lghL second lnLercosLal space close Lo Lhe sLernum ls where Lhe
ascendlng aorLa ls nearesL Lo Lhe Lhoraclc cage
neart Sounds
The intensity of heart sounds and murmurs is graded as
follows on Levine's scale:
- lowest intensity, difficult to hear even by experts.
- low intensity, but usually audible to all listeners.
- medium intensity, easy to hear even by inexperienced
listeners, but without a palpable thrill.
V - medium intensity with a palpable thrill.
V - loud intensity with a palpable thrill. Audible even with
the stethoscope placed on the chest, with the edge of the
diaphragm.
V - loudest intensity with a palpable thrill. Audible even
with the stethoscope raised above the chest.
LlsLen flrsL for Lhe hearL sounds 1hey are called 5 and 52 and are
LradlLlonally descrlbed as lob and Job respecLlvely 1he fltst soooJ
(5% ls caused by closure of Lhe mlLral and Lrlcuspld valves and Lhe
Lwo sounds Lend Lo merge as one When consldered separaLely Lhe
closure of Lhe mlLral and Lrlcuspld valves ls called M and 1
respecLlvely 1he secooJ soooJ (52% ls caused by closure of Lhe aorLlc
and pulmonary valves 1hey are sllghLly aparL wlLh Lhe aorLlc
componenL also called A2 sllghLly afLer Lhe pulmonary closure called
l2
- 1he flrsL sound may be spllL lf Lhere ls pocloq LhaL Lrlggers Lhe
rlghL venLrlcle before Lhe lefL or lf mlLral valve closure ls
delayed by hlgh lefL aLrlal pressure or aLrlal myxoma
- 1he sounds may be sofLer Lhan normal where Lhere ls severe
mlLral regurglLaLlon lmmoblllLy from calclflcaLlon severe aorLlc
regurglLaLlon or left booJle btoocb block
- ltolopseJ mlttol volve or slgnlflcanL mlLral sLenosls may cause a
loud M1
- normally A2 and 2 are so close LhaL Lhey are heard as a slngle sound
alLhough Lhey may spllL sllghLly on deep lnsplraLlon as 2 ls delayed
Some people have slgnlflcanL spllLLlng on lylng down buL lL
dlsappears on slLLlng up 1hls ls a normal varlaLlon
- 8eaL Lo beaL varlaLlon ln Lhe lnLenslLy of S2 occurs wlLh compleLe or
lncompleLe hearL block lf Lhere ls Av dlssoclaLlon
- 2 ls delayed and wlll accenLuaLe spllLLlng ln pulmonary
hyperLenslon pulmonary sLenosls and rlghL bundle branch block
- LcLoplc beaLs and paclng wlll delay A2 and cause reverse spllLLlng of
Lhe sound
Add|t|ona| sounds
- 1he dlfferenLlaLlon of 3rd sounds 4Lh sounds openlng snaps and
wldely spllL S1 or S2 can be daunLlng
- A 3rd sound occurs ln hearL fallure and produces a cadence llke a
galloplng horse
1
Pence Lhe Lerm gallop rhyLhm An lnnocenL 3rd
sound can occur ln chlldren and young adulLs buL never over 30
years old
- A 4Lh sound occurs [usL before Lhe 1sL and ls an abnormal sound of
Lhe Av valves openlng as Lhe aLrla conLracL 1herefore lL cannoL
occur ln aLrlal flbrlllaLlon lL occurs wlLh venLrlcular hyperLrophy
lschaemlc hearL dlsease dllaLed cardlomyopaLhy hyperdynamlc
clrculaLlon arrhyLhmla and hearL block
- 1he Llmlng of an openlng snap ln mlLral sLenosls ls slmllar lL ls
usually of rheumaLlc orlgln Agaln aLrlal sysLole ls essenLlal and
so lL cannoL occur ln aLrlal flbrlllaLlon
- An aLrlal myxoma can plop durlng aLrlal sysLole and cause a
laLe dlasLollc sound
A v|deo demonstrat|ng proper
auscu|tat|on of the heart
Card|ac D|agnost|c 1ests
- Cardlac dlseases are complex ln naLure
- new and advanced dlagnosLlc LesLs and Lools are consLanLly
belng lnLroduced
- lnvolves LesLs used boLh lnslde and ouLslde of body
- Comprehenslve ln naLure
- Slmpllfled Lhe dlagnosls of complex cardlac dlseases
1ests invo/vinq cordioc entymes
- CkM8 (creat|nek|nase myocard|a| musc|e)
An elevaLlon ln value whlch lndlcaLes myocardlal damage
An elevaLlon occurs wlLhln 4 Lo 6 hours and peaks 18 Lo 24 hours followlng an
acuLe lschemlc aLLack
normal value ls 0 Lo 3 of LoLal LoLal Ck ls 26 Lo 174 unlLs/L
- 1ropon|n
1roponln ls composed of Lhree proLelns cardlac proLeln Lroponln l and
Lroponln 1
1roponln l especlally has a hlgh afflnlLy for myocardlal ln[ury lL rlses
wlLhln 3 hours and perslsLs up Lo 7 days
normal values are low wlLh Lroponln 1 normally ranglng from 0 Lo 02
ng/ml and Lroponln l belng less Lhan 006 ng/ml Lhus any rlse can
lndlcaLe myocardlal cell damage
Comp|ete 8|ood Count
RBC decreases in rheumatic heart disease and infective
endocarditis; increases in conditions characterized by
inadequate tissue oxygenation
WBC count increases in infectious and inflammatory
diseases of the heart and after myocardial infarction
because large numbers of WBC are needed to dispose of
the necrotic tissue resulting from the infarction
Decrease in Hgb and Hct indicates anemia
8|ood coagu|at|on factors
- lncrease ln coagulaLlon facLors can occur
durlng and afLer Ml whlch places Lhe paLlenL
aL greaLer rlsk of LhrombophleblLls and
exLenslon of cloLs ln Lhe coronary arLerles
Serum ||p|ds
- 1he llpld proflle measures serum cholesLerol Lrlglycerldes and
llpoproLeln levels
- ls used Lo assess Lhe rlsk of developlng coronary arLery dlsease
- 1he deslrable range for serum cholesLerol ls less Lhan 200
mg/dl wlLh Lhe low denslLy llpoproLeln cholesLerol less Lhan
130 mg/dl and Lhe hlghdenslLy llpoproLeln cholesLerol aL 30 Lo
70 mg/dl
L|ectro|ytes
otass|um Sod|um
Pypokalemla causes lncreased
cardlac elecLrlcal lnsLablllLy venLrlcular
dysryLhmlas and lncreased rlsk of
dlglLalls LoxlclLy
ln hypokalemla Lhe
elecLrocardlogram would show
flaLLenlng and lnverslon of 1 wave Lhe
appearacne of a u wave and S1
deppreslon
Pyperkalemla causes aysLole and
venLrlcular dysryLhmlas
1he serum sodlum level decreases
wlLh Lhe use of dlureLlcs
1he serum level decreases ln hearL
fallure lndlcaLlng waLer excess
Chest krays
- 8adlography of Lhe chesL ls done Lo deLermlne
Lhe slze sllhoueLLe and poslLlon of Lhe hearL
- Speclflc paLhologlcal
changes are dlfflculL Lo
deLermlne vla xray fllm
buL anaLomlcal changes can be seen
L|ectrocard|ogram
uses a compuLer Lo ampllfy and
enhance very small elecLrlcal
lmpulses ln Lhe hearL
Pelps cardlologlsLs predlcL who
may suffer dangerous venLrlcular
(lower chamber) arrhyLhmlas
LkLkCISL 1CLLkANCL 1LS1
- An LkC done whlle you are
exerclslng on a Lreadmlll or
sLaLlonary blcycle
- 8esulLs are compared wlLh Lhose
from when you're aL resL
- 1o show how your hearL reacLs Lo
exerclse and exerLlon
Lchocard|ography
chocardiography uses
the technology to bounce
sound waves off the
heart's chambers and
valves, creating still and
moving images of the
heart.
no|ter Mon|tor|ng
- Also known as conLlnuous LkC or
AmbulaLory LkC monlLorlng
- Wearlng a small porLable baLLery
operaLed LkC recorder called a
PolLer monlLor
- MonlLors Lhe elecLrlcal acLlvlLy of
an ombolototy paLlenL's hearL
whlle Lhe person goes abouL dally
acLlvlLles
- 8ecords conLlnuous LkC
lnformaLlon for one Lo flve days
on a Lape
- 1hls recorded daLa ls Lhen
analyzed by docLors
Magnet|c kesonance Imag|ng
An lmaglng Lechnlque LhaL
produces deLalled accuraLe
crosssecLlonal plcLures
(sllces) of lnLernal organs
and body parLs
8uL lL doesn'L use lonlzlng radlaLlon and has no known blologlcal
rlsks
Suse ln cardlology AorLlc dlsease blockages wlLhln Lhe coronary
arLerles (whlch supply oxygenrlch blood Lo Lhe hearL) and ro
deLermlne a weakened hearL muscle (cardlomyopaLhy)
CAkDICVASCULAk
DISCkDLkS
Congest|ve neart Ia||ure
- CongesLlve hearL fallure ls one of Lhe mosL common condlLlons
affecLlng Lhe hearL Lhus cemenLlng lLs place ln one of Lhe Lop
sloLs of cardlovascular dlseases llsL lL ls Lhe fallure of Lhe hearL Lo
meeL Lhe body demands of adequaLe clrculaLlon for lLs
meLabollzlng Llssues 1he dlfferenL Lypes of congesLlve hearL
fallure are acuLe or chronlc hearL fallure hlgh ouLpuL or low
ouLpuL hearL fallure and lefL slded or rlghL slded blvenLrlcular
fallure 1here can also be compensaLed or uncompensaLed hearL
fallure
Coronary Artery D|sease
- Coronary arLery dlsease along wlLh congesLlve hearL fallure ls
one of Lhe mosL common causes of deaLh Cf all Lhe dlseases ln
Lhls cardlovascular dlseases llsL coronary arLery dlsease
or lschemlc hearL dlsease as lL ls commonly called ls Lhe leadlng
cause of morbldlLy ln mlddle and elderly aged men
Acute Myocard|a| Infarct|on
- Cf all Lhe dlfferenL Lypes of hearL dlseases ln Lhls cardlovascular
dlseases llsL acuLe myocardlal lnfarcLlon whlch ls commonly
known as a hearL aLLack ls one of Lhe mosL common medlcal
emergency condlLlons whlch comes wlLh a hlgh morLallLy raLe
A large number of myocardlal lnfarcLlon cases occur aL resL
durlng sleep or someLlmes afLer heavy exerLlon
nypertens|on
- PyperLenslon ls one of Lhe mosL common condlLlons of all Lhe
condlLlons ln mosL cardlovascular dlseases llsL PyperLenslon ls a
condlLlon whereln Lhe blood pressure of an lndlvldual ls hlgher
Lhan normal blood pressure levels 8lood pressure ls Lhe producL
of Lhe amounL of blood pumped by Lhe hearL and Lhe reslsLance Lo
Lhe flow of Lhls blood by Lhe vessels lL ls mosLly agreed upon LhaL
sysLollc above 160mm of Pg and dlasLollc above 93mm of Pg
ls whaL ls consldered hlgh blood pressure
Card|ac Arrhythm|a
- Any klnd of lrregularlLy ln Lhe hearL beaL ls known as cardlac
arrhyLhmla PearL raLe ls conLrolled by a number of facLors 1hese
lnclude Lhe sympaLheLlc and parasympaLheLlc lmpulses Cardlac
arrhyLhmlas can be very benlgn or can even be llfe LhreaLenlng
1hey can manlfesL as rapld or lrregular hearLbeaLs such as
premaLure beaLs or as venLrlcular Lachycardlas or flbrlllaLlon
Many a Llmes cardlac arrhyLhmlas may be Lhe flrsL manlfesLaLlon
of an underlylng cardlac allmenL
Card|omega|y
- 1he word cardlomegaly llLerally means enlarged hearL 1hls ls
a condlLlon where Lhe slze of Lhe hearL lncreases whlch may
occur due Lo varlous reasons Cf all Lhe condlLlons presenL ln
Lhls cardlovascular dlseases llsL Lhls ls a relaLlvely rare
condlLlon
Ang|na
- aln felL ln Lhe chesL due Lo lnsufflclenL blood supply Lo Lhe
hearL generally as Lhe resulL of arLerlosclerosls of Lhe coronary
arLerles usually experlenced durlng exerclse or sLress
Ang|na
Arrhythm|a
- A dlsrupLlon of Lhe regular rhyLhmlc beaLlng of Lhe hearL
ArrhyLhmla can occur ln a healLhy hearL and be of mlnlmal
consequence lL also may lndlcaLe a serlous problem and lead Lo
hearL dlsease sLroke or sudden cardlac deaLh
Atherosc|eros|s
- A process ln whlch Lhe blood vessels narrow and harden Lhrough
bulldup of plaque ln Lhe walls of arLerles laque ls made up of
deposlLs of faLs cholesLerol and oLher subsLances laque
formaLlons can reduce or close off Lhe blood's flow Lhrough an
arLery When a plaque formaLlon becomes lnflamed and unsLable lL
may rupLure seLLlng loose a blood cloL LhaL can narrow Lhe arLery
or compleLely block lL
Atherosc|eros|s
Lndocard|t|s
- lnfecLlon of Lhe hearL's lnner llnlng (endocardlum) and valves
8acLerlal endocardlLls occurs when bacLerla ln Lhe bloodsLream
(bacLeremla) lodge on abnormal hearL valves or oLher damaged
hearL Llssue 1hls can occur durlng denLal and perlodonLal
surglcal procedures
neart attack (coronary thrombos|s
myocard|a| |nfarct|on MI)
- When Lhe hearL muscle or myocardlum sLops funcLlonlng due
Lo loss of blood flow nuLrlenLs or elecLrlc slgnal
nypercho|estero|em|a]hyper||p|dem|a
- Are Lhe Lerms used Lo descrlbe chronlc hlgh levels of
cholesLerol ln Lhe blood largely exacerbaLed by dleL Small faL
deposlLs beneaLh Lhe skln can slgnal hypercholesLerolemla
lamlllal hypercholesLerolemla ls a rare geneLlcally lnherlLed
dlsorder LhaL causes severe hlgh cholesLerol beglnnlng aL blrLh
and ls unrelaLed Lo dleL
M|tra| va|ve pro|apse
- 1he mlLral valve lles beLween Lhe hearL's lefL aLrlum (upper
holdlng chamber) and lefL venLrlcle (lower pumplng chamber)
1he mlLral valve has Lwo flaps or cusps MlLral valve prolapse ls
when one or boLh valve flaps are enlarged and some of Lhelr
supporLlng sLrlngs may be Loo long
M|tra| va|ve pro|apse
Stroke
- AffecLs Lhe arLerles leadlng Lo and wlLhln Lhe braln SLrokes
occur when blood vessels LhaL carry oxygen and nuLrlenLs Lo
Lhe braln are elLher blocked by a cloL (Lhrombosls or embollsm)
or bursL When LhaL happens parL of Lhe braln can'L geL Lhe
blood (and oxygen) lL needs so lL sLarLs Lo dle MosL sLrokes are
caused by Lhrombosls or embollsm Lhese are called lschemlc
sLrokes 8upLured blood vessels cause hemorrhaglc or bleedlng
sLrokes
Stroke

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