CARDIOVASCULAR

ANAPHY, structure
AB N

dictates Fxn
#boot-shaped -

tetralogy Fallot
of hallmarks/sx

-.
tuman Hearl hypertrophy cardiomegaly( i size
* heart
of

hyperplasia - cells
*

ANA Oz demands
*
~ Tenergy > ATP

~ left-sided pain
MI5Angina,
cone-shaped O2 probs
*

H
* -
PM1 6 ICS
-

Midaxillary Line
Fist-sized &Displaced PMI

Failure
* -> x strength to
pump

3 I

center thorax
of tilted slightly towards I left

location of MitaLV, essentine

5th ICS MCL :
Apex location PMI- "cardiac pulse
Center orethorax
Within e Mediastinum
Bone Protection:

↓ Sternum

2. Intercostal cartilages, I resistance - Fractures

3. Ribs

PHYS 10
1. Deliver Oz to blood, it all parts of
body
·Phases of
cardiac cycle:
1. systole, ventricular contraction -> ejects blood

2. Diastole, relaxation, Filling

stroke volume: amt. bloodejected by 1/ heartbeat

>N:70mL

cardiac output camt. bloodejectedby D/min.

>N:4-t / min.

RS
LAY =
1. Endocardium sinner clines evalues

Stenosis. Failure to open properly

>prolapse ballooning
 2. Myocardium, muscular layer, MI, Angina
3. Epicardium, outer layer
Cardiac Tamponade
*

akavisceral pericardium ataencases 30mL+ y peri Fluid

isceral Pericardium, inner, covers viscera I contraction t

Pericardial Fluid protectst lubricates (30mL)

* relaxation

Parietal Pericardium, outer

CHAMBERS & VALVES

1.2 A + V Oz blood * Atrium, minor pump

2. R A +V,XOz blood ventricles, majorpump

VALVES -> prevents backflow blood

or

2 Atrioventricular -> atrium-ventricle

R Tricuspid (R. Atrium - R.ventricle S1
Bicuspid: L. atrium-L. ventricle Club>
more commonly affected by
diseases murmurs
* ->
wooshing
AbN

valvular ds.

<Shlub
C AVds.
2 semilunar c ventricle -
major artery <lubssh ,SLdS.
primonic
R
Pulmonary
R.
ventricle->Paeary S2
Aortic "L.ventricle->Aorta (dub)

BLOOD FLOW
>x02
vein >arterioles
·
artery
↓ -

superion - brain, Face

vena cava aorta
inferior-61 tract, limbs
I capillaries
-

aortic

R.trium L. ventricles Gas Exchange

Stricuspid
↓ picuspid -

R.
ventricle L. atrium no 02

prlmonivalve
↓
T -

Pulmo. Artery >Lungs =O2 <prlmonic vein vein

Gas Exchange
 RIGHT -
SIBED LEFT-SIBED
2 FAILURE 2 FAILURE
1. systemic venous congestion 1.dyspnea Respi
2. Hepatomegaly 2. cough
3. Splenomegaly 3. crackles
4. 4.
Pitting edema pulmonary edema
5.Jugular vein distention 5. Frothy sputum

CORONARY ARTERIES
>provides O2 to 4, branches of
aorta
·receives blood during diastole
> THR - 102/blood in 17 - angina

1. Left main coronary artery

most 4 LeFt >

common
Anterior supplies
site OF
obstruction L.V.
-> supplies
Descending , PIM
↳ side Artery
2. Right main coronary artery
supplies Right side

supplies SA, main electrical

3. Circumplex
artery
supplies some parts ofFront, lateral, back

·encircles

CARDIAC CONDUCTION SYSTEM

ELECTROLYTES -
movement stimulates cardiac muscle contract
to

T
Nat
1. SA
* node ->
primary pacemaker
2. Kt >sinoatrial

3. (a + +
-
60-100bpm
>where electricity will start

↓
SINUS RHYTHM Anode-> 20 pacemaker
*

normal ECG , atrioventricular

·48-60/min

it a

S
sisegment
* LaR Bundle branches

Purkinje Fibers
*

P wave-atrial depolarization attack/M1, Bsply prop.

heart
*

QRS complex, ventricular dep. I contraction cardiac arrest

* -> electrical prob.
-

wave, ventricular repolarization

ST segment - Flat/isoelectric
MI- STEMI
-

>iF

HEART SOUNDS
1. S1- closure of AV-lub-Apex Diaphragm

3
2. S2 closure or SL-dub-Base> 2nd-3rdICSR SB ↑ pitch Yet
3. S3:CHF-late diastole club-dub-dub- 1 inchildren
Bell
pressure

4. 54, uncontrolled Hypertension club-ins-dub - I pitch

Position:LeFt-lateral
*

brings a closer to chest wall

wooshing sound 7

murmur -> (t) back Flow or blood Si

>valvular heart ds. 34 34
congenital heart ds.
52"

CARDIAC DX IMAGING
. Cardiac catheterization w/
coronary
angiogram
cardiac catheter, insert to peripheral artery
>iodine

>dye, visualization Femoral artery, brachial artery

s
visualizing obstructions in CA > iodine dye
inject
PR E -
OP
1. NPO "prepped For surgery
2. consent
basedon amt. iodine
of
3. Obtain baseline vs9ht./wt. to give
4. Allergies:iodine:seafood:antihistamine steroids
(48-72H
· run during surgery, stop
iF >24 48H
-

(1-3 days
before +
MetFormin coral hypoglycemic hold med. after
med.)
, metFormin iodine
lactic acidosis
!Acute kidney injury

5. Open IV line
6. Sterile

INTRAOP
1. Supine POs.

2.
a. Flushing sensation a. chest pain

b. FEOF b. difficulty breathing

of

c. urge to void c. pruritus

d. Poundingin d. arrhythmias
3.Cardiac Monitoring

POST-OP
1. supine/horizontal pos.
·bedrest 6H

2. Fluidintake 6H

3. Monitor puncture site

4. ECGIVS
DISEASE:ANGINA
pain
chest myocardial ischemia Natural vasodilator:ie
*
(NO)
> A BIOOd FIOw
primary
x ds > O2 Hypoxia
=

cause: coronary atherosclerosis

>
-
arteriosclerosis streak, causes irritation
<Fatty
sinjury
, atheroma
I
hardening Istiffening ↑clotting
↓Nitric Oxide >4 WBC
Platelets
↑
>

Blood supply & demand prob.

RISK FACTORS
1. Lifestyle
~ Diet

/smoking/Alcoholism
exercises
↓

~obesity
2. Diabetic
↑ viscosity-glucose in blood

TFA in cells,
X
bIC OF glucose compensatory mechanism

3. Hypertension
~ C
O2 demand OF

~pressure in BV

4. Men
~ Estrogen, cardioprotective hormone
5. Old Age

TRIGGERS
5ES
Excessive Exercise
1.

2. Excessive Eating
3. Excessive smoking
4. Emotional Stress

Exposure to Cold
5.
 PATHOPHYSIOLOGY
-> DM -atherosclerosis - supply
I

exercise
↑

demand
-

emotional stress

anaerobic
energy in E absence of
creation of 02
metabolism

↓ ↓
lactic energy
acid
↓
pain

TYPES
1. Stable, predictable, triggered by 5Es, easiest to manage

>Restt Nitroglycerin

2. Unstable preinFarction/crescendo - time pain, angina I

at rest

> A.K.A. prinzmetals

3. Variant, Vasospasm of CA, closed/very constricted artery
muscle contraction
>hypercalcemia, (a:
. Tx: calcium channel blocker (-dipine)

4. Silent -X chest pain:Eco-T-wave inversion we

-

ischemia:I wave inversion

infarction:ST segment elevation

DM

>Old Age

SISX
chest pain
1. P osition -> L sided/substernal/retrosternal

2. Quality pressing, rise-like, heaviness

3. R adiation jaw, neck, shoulder, arm, hand, Fingers
4. Relief, rest nitroglycerin
*

5. Severity, mild/moderate
** 6. Time/Duration: 15 min.
most
# important/clear differentiator
DIAGNOS IS
R
Twave inversion
ECG
~ufe
1. P

as T

2. Cardiac
Enzymes
Troponin I
notic rule out
CKMB MI

Myoglobin

MANAGEMENT
1.Rest 'workload, or demand,
2. Oz via cannula, 2L-physician - order 4 to bL

3. nitroglycerin c#1 venodilator

Vanti-anginal 2 vasodilator
#

~photosensitive
~ shelf life: Gmos.

~ S. E.'headache -
give acetaminophen
~ Hypotension: assess BP

SUBLINOUAL PATCHES
1. Tablets ↓ intact, hairless skin

2. Under tongue 2. Hair - trim, clip

3. Can crush 3. 10-12H - x

tolerance

give before
4.
pain
chest

5. max:3 closes at 5 min interval