THE CARDIOVASCULAR SYSTEM

EMERITA C. MENDOZA, R.N., M.D.

LOCATION OF THE HEART
• Hollow, muscular organ • PMI is at the 5th left MCL • Weighs 1 lb.

FUNCTIONS
• Transports O2 from the lungs to tissues of the body • Delivers nutrients from the GIT to all systems • Carries wastes from tissues to the excretory system • Serves as a route for hormones, enzymes, and other chemicals to reach target tissues

LAYERS OF THE HEART
3 layers within a sac: • Endocardium
(Inner)

• Myocardium
(Middle)

• Epicardium or
visceral pericardium (Outer) • surrounded by parietal pericardium

• Myocardium is the thickest layer • Unique because of the presence of INTERCALATED DISCS allows a single stimulation to cause all cardiac muscle fibers to contract.

MUSCLES WITHIN THE CHAMBERS
• PAPILLARY MUSCLES - found within the chamber walls • Extend into CHORDAE TENDINAE attached to valves

BLOOD FLOW THROUGH THE HEART
• Left LUNGS LA mitral valve opens LV mitral valve closes LV muscles contract AV opens aorta  distribution • Right BODY RA tricuspid valve opens RV tricuspid valve closes RV muscles contract pulmonary valves open lungs

HEART SOUNDS
• Aortic valve: second ICS(intercostal space) R PSL(parasternal line) • Pulmonic valve: second ICS L PSL • Tricuspid valve: fourth ICS L PSL • Mitral valve: fifth ICS L MCL(midclavicular line)

HEART SOUNDS
• S1 : closure of mitral and tricuspid; “lub” sound • S2: closure of aortic and pulmonic; “dub” sound • S3: ventricular gallop • S4: atrial gallop

CONDUCTION SYSTEM
• Sympathetic ( increase in CR, norepinephrine or epinephrine is increased) • Parasympathetic ( decrease in CR) • Creates an electrical impulse/activity

ELECTROCARDIOGRAM
• Measures the electrical activity of the heart • 3 major limb leads: AVR, AVL, AVF (right & left wrists, left foot); V1 to V6 (precordial leads) • Normal cycle: NSR(normal sinus rhythm) • P wave (atrial contraction), QRS complex (ventricular contraction)

When the heart contracts

When the heart relaxes

Cardiac Rate and Pulse Rate
• CR obtained via auscultation; PR is palpated. • Most common pulses: - Radial pulse - Carotid pulse - Femoral pulse - Dorsalis pedis

BLOOD PRESSURE
• Pressure when the heartbeat can be heard (Systolic = contraction pressure) • Pressure when the heartbeat disappears (Diastolic = relaxation pressure) • BP is expressed as systole/ diastole

JNC VII (Joint National Committee on the Prevention, Detection, Evaluation & Treatment of High BP)
SYSTO LIC NORMAL <120 PREHYPERTE 120NSION 139 STAGE I 140159 STAGE II >/= 160 CATEGORY DIAST OLIC <80 80-89 90-99 >/= 100

STARLING’S LAW OF THE HEART
• All venous return is accommodated by contractility of the cardiac muscle fibers. • May be called EJECTION FRACTION (EF) percentage of blood pumped into the aorta from the left ventricle • Cardiac output= stroke volume x cardiac rate

PULSE RATE
• Place the tips of digits 2 and 3 (index and middle fingers) over the surface where the artery is found • Feel the pulse and count per minute • Normal adult PR: 60-100 bpm (beats per minute) • < 60 = Bradycardia • > 100 = Tachycardia

THE VASCULAR CIRCULATIONS
• Blood flow through the • The Hepatoportal circuit is a subdivision of the body is the Systemic systemic that serves the circulation liver • Blood flow through the • The Circle of Willis is the lungs is the Pulmonary systemic circuit at the base of the brain circulation

• Fetal circulation differs from an adult

General Plan of the Systemic & Pulmonary Circulations