ABUNDO, Esther Ellise P.

BSN III-A

● Cardiac Electrophysiology

Electrophysiology is the heart’s electrical system or activity. The

normal pacemaker of the heart is the sinoatrial node (SA node). The SA
node triggers electrical impulses at a rate of 60 to 100 bpm. It starts each
heartbeat and sets the pace for the whole heart. From the SA node, the
impulse reaches through the atrium to the AV node. This causes the
atrium to contract. The impulse of the AV node is delayed for a short time
to give the atria time to finish contracting. Then it passes swiftly through
the AV bundle, the bundle of his and the purkinje fibers resulting in a
contraction of the ventricles that begins at the apex of the heart and
moves toward the atria. This effectively ejects blood superiorly into the
large arteries leaving the heart.

● Heart Circulation

Deoxygenated blood from the body comes to the heart through the
superior vena cava and enters the heart at the right atrium, then passes
through the tricuspid valve entering the right ventricle. The pulmonic valve
then allows blood to enter the pulmonary artery and the blood travels all
the way to the lungs for oxygenation. Oxygenated blood from the lungs
passes through the pulmonary vein to the heart and then makes its way to
the left atrium. Blood then passes through the mitral valve all the way to
the left ventricle. From the left ventricle, it will pass through the aortic valve
and make its way to the aorta to carry oxygenated blood to the body.

Although the chambers of the heart always contain blood, the blood
does not nourish the myocardium. The coronary arteries branch from the
base of the aorta and encircle the heart in the coronary sulcus at the
junction of the atria and ventricles. The coronary artery has a few major
branches, anterior interventricular artery and circumflex artery on the left,
and posterior interventricular artery and marginal artery on the right. They
are compressed when the ventricles are contracting and filled when the
heart is relaxed. The myocardium drains into several cardiac veins which
empty into the coronary sinus. The coronary sinus drains into the right
atrium.

● Gerontologic Considerations

As people age, there are corresponding changes to the heart and

the cardiovascular system as a whole. There is a decrease in heart rate,
there is thickening of the left ventricular walls which result in an overall
increase in oxygen demand. The left atrium increases in size and aortic
distensibility and vascular tone decrease. All of these changes decrease
muscle contraction of the myocardium resulting in decreased cardiac
 output. According to Huether, McCance, Brashers and Rote (2017), an S4
heart sound commonly occurs in older adults, and about 50% of older
adults have a grade 1 or 2 systolic murmur (Jett, 2008).

● Gender Considerations

Females have a lower incidence of cardiovascular disease than

males. Premenopausal women have higher levels of estrogen and
estrogen has a beneficial effect on lipoproteins. It lowers low density
lipoprotein LDL (“bad cholesterol”) and increases high density lipoprotein
HDL (“good cholesterol”). After menopause, estrogen levels drop and this
causes development of atherosclerosis.

Males are more prone to cardiovascular disease during their

younger years (before 65 years old), affected by their hobbies and lifestyle
mostly because of high cholesterol, drinking, high blood pressure,
diabetes, and physical activity.