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The

Cardiovascular System
& Cardiovascular
Emergencies

Supplies oxygenated blood to


all cells in the body!!

Components

Heart pumps blood

Vessels Arteries carry blood away


from the heart and veins carry
blood back to the heart

Blood fluid that carries nutrients


essential to cell function

The Heart

Located in the thoracic cavity


2nd intercostal space at right sternal
border
5th intercostal space at left midclavicular
line

about size of your clenched fist


In mediastinum

The Heart
4 chambers
2 sided - divided by septum
2 upper called atria
2 lower called ventricles
surrounded by pericardium
system of one way valves

Path of blood flow (Systemic


circulation)

left ventricle
aorta
arteries, arterioles, capillaries, etc ...
Vena cava (superior and inferior)
Right atrium

Path of blood flow (Pulmonary


circulation)

right ventricle
pulmonary artery
lung ( pulmonary capillaries)
Pulmonary veins
Left atrium

The Circulatory System

Blood Flow Through the Heart

The Heart
Electrical

System

independent
stimulates

contractions of heart
normally initiated in right atrium
if initiated from other areas =
abnormal

Electrical Conduction

Sinoatrial (SA) node


Atrioventricular node
Bundle of His
(AV bundle)
Bundle branches
Purkinje fibers

Vessels
Arteries
Arterioles
Capillaries
Veinioles
Veins

Vessels
Vasoconstriction
Effect on Blood Pressure?
Vasodilation
Effect on Blood Pressure?

Major Arteries and Veins


Aorta
Pulmonary
Carotid
Femoral
Brachial
Radial

Superior vena cava


Inferior vena cava
Pulmonary

Look Up in TEXT!

coronary arteries Supply


blood to heart muscle itself

The two main


coronary arteries
have
openings
immediately
above the aortic
valve
at the beginning of
the

Blood

Liquid Portion - Plasma

Solid Portion
Red blood cells
White blood cells
Platelets

Blood
Plasma - transports solids
It is basically a salt solution

Blood
Red Blood cells - carry oxygen
AKA - Erythrocytes
Hemoglobin is the substance that
combines with oxygen in a red blood
cell

Blood
White Blood cells - fight infection
AKA Leukocytes
almost all blood cells (red or white)
are made in the bone marrow.

Blood

Platelets are essential for formation


of blood clots. They perform
coagulation.
AKA - thrombocytes

average amount of blood


in an adult is 4-6 liters.

note

Systemic Vs pulmonary circulation


Pulmonary artery
Pulmonary vein
Coronary arteries
Pericardium
Myocardium

If

the cardiovascular system is


working as it should ...

You getPerfusion
Definition

Adequate flow of
blood through body tissue or
organs to meet the needs of the
cell.

Cardiovascular Emergencies

Abnormal Heart Conditions

Angina Pectoris
Myocardial Infarction
Congestive Heart Failure

Angina Pectoris

Decreased blood flow to heart muscle results in


ischemia- lack of oxygen
Causes mild to moderate pain
Pain may radiate
Usually lasts 3-8 minutes (rarely longer than 15
mins)
IT GOES AWAY with no permanent damage to
heart muscle
Can be difficult to differentiate from heart attack

Acute Myocardial Infarction

decreased flow of blood to the myocardium


leading to death of tissue
may not be provoked
moderate to severe pain
Can last between 30 minutes and several hours
May not go away with rest, O2 or nitroglycerin
Immediate transport is essential

AMI

Signs and Symptoms

Sudden onset of weakness, nausea, and


diaphoresis
Chest pain or discomfort
dyspnea
irregular pulse
Pain in lower jaw, arms, or back
Sudden fainting
Pulmonary edema
Sudden death
Feeling of impending doom

there are always exceptions ...

Referred pain

Atypical pain

No pain

Congestive Heart Failure

Causes
diseased heart valves and
damaged ventricles
Chronic hypertension
obstructive pulmonary disease
(emphysema, chronic bronchitis)
often a complication of an MI

CHF

Heart tries to compensate.

Increased heart rate

Enlarged left ventricle

The heart can not efficiently pump the amount of


fluid in the body and CHF develops

Fluid backs up into lungs or body as heart fails


to pump

Signs & Symptoms of CHF


Pedal edema
JVD
Ascites

Critical CHF & Pulmonary Edema


dyspnea
rales & audible rales
pink frothy sputum
tachycardia
cyanosis
anxiety, restlessness

Vascular emergencies
Atherosclerosis & arteriosclerosis
Thrombus
Embolus
Aneurysm

Athero/arterio -sclerosis

build up of fatty deposits & calcium

causes narrowing of the lumen

can create rough inner surface that


can lead to clot

Athero/arterio -sclerosis

Results in:

restricted blood flow

high blood pressure

AMI

Thrombus

formation of clot and debris in vessels


from plaque
can become large enough to occlude
vessel
partial blockage = distal reduction of O2
complete blockage = distal tissue death

Embolus

a thrombus that breaks off from vessel


wall.
flows through blood vessels
may partially or completely occlude
smaller artery
occlusion will result in decreased oxygen
to tissue or tissue death

Aneurysm

is a ballooning out of a weakened section


of an artery

Possibility of rupture

Ruptured aneurysm

Is a bursting of an aneurysm

can result in rapid, life threatening internal


bleeding

Abdominal Aortic Aneurysm


(AAA)

Signs & Symptoms

Tearing abdominal or back pain


Pulsating mass in midline of abdomen
Unequal femoral pulses
Syncope

AAA Treatment

Rapid transport
High flow O2
Treat for shock

Other Considerations

other causes of chest pain

pacemakers
defibrillator implants
CABG coronary artery bypass graft

RX for all
High flow oxygen
(ventilate patient if needed!)
Position of comfort
Rapid transport

medications
Lasix
Digoxin
Lanoxin
Inderal

NTG = nitroglycerin

Cerebral Vascular Accidents


AKA

Stroke
Brain Attack

CVA - Cerebral Vascular Accidents

sudden change in neurological status


caused by interference with blood supply
to brain

obstructive
hemorragic

CVA signs & symptoms

hypertension
altered mental status
hemiparesis & hemiparalysis
headache, blurred vision
one sided facial droop
aphasia
incontinence

Transient Iscemic Attack

TIAs
AKA mini-stroke
can have symptoms of CVA

temporary

The end
Questions?