Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory

Cardiovascular System

Heart: The human heart is an organ that pumps blood throughout the body via the circulatory system,
supplying oxygen and nutrients to the tissues and removing carbon dioxide and other wastes.

Heart wall:
3 Layers of the Heart
1. Epicardium: Outer Layer
2. Myocardium: Cardiac Muscle
3. Endocardium: Endothelium

❖ Enclosed by Pericardium
2 Layers
1. Viceral pericardium
2. Parietal pericardium

Chambers
Valves of the Heart
2 types of Cardiac Valve:
A. AV: Artrioventricular valve
1. Tricuspid
2. Bicuspid(mitral)
B. Semilunar Valve
1. Aortic
2. Pulmonic
Open during ventricular systole and diastole
Chordatendinae cordis :
1.Anchored to the ventricular wall by papillary muscles
2.Supports the AV valve during ventricular systole to prevent prolapse

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 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory

Coronary Arteries
Two main Coronary arteries
1. LCA
1. CCA
2. LADA
2. RCA
1. RA
2. RV

Conduction System

Cardiac cycle? Review!!!!!!

TERMS
Cardiac Output
➢ CO: the volume of blood ejected from the left ventricle into the aorta per minute
➢ CO= Stroke Vol x HR
➢ CO= 70 mlsx 70 bpm
➢ CO= 4900 mls (Apprx 5L)
Stroke Volume (SV)
Amount of blood ejected by the left ventricle into the aorta per beat (apprx 70 mls)

Stroke Volume is determined by:

1. Preload:
• Degree of myocardial fiber stretch before contraction
• Related to the volume of distending the ventricles at the end of diastole
• Determine by the amount of venous return

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 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory
2. Frank- Starling Law of the Heart:
• Conceptualizes that the greater the myocardial stretch, with in physiologic limits, the more forceful
the ventricular contraction, thereby increasing stroke volume
3. After load:
• Afterload, also known as the systemic vascular resistance (SVR), is the amount of resistance the
heart must overcome to open the aortic valve and push the blood volume out into the systemic
circulation.

Autonomic Influence on Cardiac Activity

Autonomic Nervous System:
ANS: Provides influence on myocardial contractility and rate
1. Sympathetic Nervous System
2. Parasympathetic Nervous System

Baroreceptors:

Carotid and aortic bodies

• Pressure sensitive structures.
In Decrease BP
➢ Reflex in SNS response
o Increase pulse rate
o Increase contractility
o Vasoconstriction
o Increase BP

Chemoreceptors

Medulla Oblongata
: Major chemoreceptor of the heart
➢ Decrease in pH or pa02 lead to SNS response resulting in:
• Tachycardia
• Vasoconstriction
• And increase myocardial contractility
➢ Decrease in paC02 and increase pH lead to passive vasodilation

Cardiac Index
Is an accurate indicator of tissue perfusion.it represents the cardiac output in terms of liters per minute per
square meter of the body surface area, N:2.4 to 4.0L/min

Physiologic Changes in the Heart with Aging

1. Decrease myocardial contractility. Reduce cardiac reserve.
2. General thickening of endocardium and valves.
3. Conducting fibers are replaced by fibrous tissue. this reduces the effectiveness of pacemaker
cells, decreases conductivity and leads to dysrythmias

KENPOGI
 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory

Assessment of the Client with Cardiovascular Disorder

Nursing History
Risk Feactors of CVD
Non-Modifiable
• Age • Gender
• Heredity • Race
Modifiable
• Stress • Hyperlipedimia
• Diet • DM
• Exercise • Obesity
• Smoking • Personality Type or Behavioral
• Alcohol • Contraceptive Pills
• HPN
Physical Examination
Inspection
• Skin Color
• NVD
• Respiration
• PMI
• Peripheral Edema
Palpation
• Peripheral Pulse
• Apical Pulse
Percussion
• Pulmonary Edema
Auscultation: Heart Sound
1. S1 (“lubb’)
2. S2(“dub”)
3. S3
4. S4
5. Murmurs
6. Pericardial Friction Rub
Common Manifestation of CVD
1. Dyspnea: SOB
1. DOE
2. Orthopnea
3. Paroxysmal Nocturnal Dyspnea
2. Chest Pain
3. Edema
4. Syncope
5. Palpitations
Occurs during mild exertion may indicate
-Heart failure
-Anemia
Thyrotoxicosis
6. Fatigue

Laboratory and Diagnostic Tests Related to Cardiovascular Function

Laboratory Tests:
1. Complete Blood Count
2. Erythrocyte Sedimentation Rate
Normal Range
M: 15-20 mm/hr
F: 20-30 mm/hr
3. Blood Coagulation Test
• Prothrombin Time (PT,Pro Time)
Normal range is 11-16 secs.
• Partial Thromboplastine Time (PTT)
• Activated Partial Thromboplastine Time (APTT)
4. .Blood Urea Nitrogen(BUN)
• N:10-20 mg/dL
KENPOGI
 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory
5. Blood Lipids
• Serum Cholesterol
• NPO 10-12 hours
• N: 150 to 200 mg/dL
6. Serum Tryglycerides
• Fasting 10-12 hours
• N: 140-200mg/dL
7. Blood Cultures
• Infectious disease of the heart (e.g. Pericarditis)
• Caution is taken to prevent contamination of the specimen. To Ensure accuracy of result
8. Serum Enzyme Studies
a. Aspartate Amino Transferase (AST)
• SGOT
• Elevated=tissue necrosis
• Most cardiac specific enzyme
• Accurate indicator of myocardial damage
• NoRa
• M: 50-325 mu./ml
• F: 50-250 mu./ml
b. Lactic Dehydrogenase (LDH)
• LDH isoenzymes, LDH1 is the most sensitive indicator of myocardial damage
9. Hydroxybutyrate Dehyhydrogenase (HBD)
• Elevation is always accompanied by LDH
• Detects Silent MI,remains elevated elevate
• NoRa: 140 – 350 u

10. Troponin
• Most specific laboratory test to detect MI
• Troponin has three components I,C,T
11. Urinalysis
• CVD related to renal function
• Albuminuria
• Myoglobinuria
12. Blood Uric Acid (BUA)
• This test reflects adequacy of renal tissue perfusion thereby glomerular filtration
metabolites
• NoRa: 2.5-8 mg/dl
13. Serologic Test
• VDRL helps indicates presence of syphilis.this disease involves development of aortic
disorder
• Serum Electrolytes:
• Electrolytes affects cardiac contractility,specifically Na , K Ca
• NoRA ranges are follows:
1. Na 135-145 mEq/L
2. K 3.5-4-5 mEq/L
3. Ca 4.5 – 5.5 mEq/L or 8.6-10 mg/dL

14. Electrocardiography (ECG,EKG)

• Graphical recording of the electrical activities of the heart.
• Painless (no electrocution or shock)
• Waves, complexes and intervals.
• P wave depolarization of the atria.0.04 t0 0.11 secs
• PR interval. Time of transmission from the SA node to the AV node.0.12 to 20 secs.
• ST segment. Represents the plateau phase of the action potential
• T wave: Ventricular repolarization
Common ECG changes
• Hypokalemia:
• U-wave
• Depressed ST segment
• Short T wave
• Hyperkalemia
• Prolong QRS Complex
KENPOGI
 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory
• Elevated ST segment
• Peaked T wave
• MI
• Elevated ST segment
• Interted T wave
• Pathologic Q wave
15. Holter Monitoring
• Continues (24 hours) monitoring ECG Monitoring
• The portable monitoring system: telemetry unit
Invasive hemodynamic monitoring
16. Central Venous Pressure
• Monitors the pressure with in the right atrium
17. Pulmonary Artery pressure (PAP) and Pulmonary Capillary Wedge Pressure
• Swan-Ganz catheter is inserted is inserted via antecubital vein into the right side of the heart and is
floated into the coronary artery. It reflects pressure in the left heart. LHCHF may lead to pulmonary
Edema.
Sonic Studies
Echocardiography
• Uses UTZ to assess cardiac structure
• No special preparation is required
• Painless (30-60 minutes)
Transesophageal Echocardiography (TEE)
• Allows ultrasonic imaging of the cardiac structures and great vessels via esophagus
Phonocardiography
• Involves the use of electrically recorded amplified cardiac out comes.
• It is helpful in assessing the exact timing and characteristics of murmurs and extra heart sounds
Laboratory and Diagnostic Tests Related to Cardiovascular Function
Stress Testing or Exercise Testing:
• ECG is monitored during exercise during exercise on a treadmill or a cycle-like device.
• The purpose of stress test are as follows:
• Identify ischemic heart disease
• Evaluate patient with chest pain
• Evaluate effectiveness of therapy
• Develop individual fitness program during rehabilitation.
Laboratory and Diagnostic Tests Related to Cardiovascular Function
Radiologic Test
Chest Roentgenograms (X-Rays)
• To determine overall size and configuration of the heart and size of the cardiac chamber
Cardiac Fluoroscopy
• Facilitates observation of the heart from varying views while the heart is in motion
Cardiac Catheterization
• Assess oxygen levels, pulmonary blood flow, cardiac, output, heart structures
1. RS Heart Catheterization: insertion of catheter via cut down into a large vein, e.g. medical cubital or brachial
vein
2. LS Heart Catherization: passing a catheter via the brachial and femoral artery:

Nursing Intervention.
Before the Procedure
1. Provide Psychological Support, Allay Anxiety
2. Assess for allergy to iodine/seafoods (Contrast medium.
3. Obtain baseline VS
4. NPO b4 the procedure (N and V)
5. Have client void, Promote Comfort
6. Sedate
7. Mark distal pulse
After the procedure:
1. Bed rest until VS is stable
2. Monitor VS (peripheral pulse)
3. Monitor ECG, note for dysrhythmias
4. Apply pressure dressing and small sand bag or ice over the puncture wound site. To prevent
bleeding
5. immobilize affected extremity in extension
KENPOGI
 Handout 5

Cardiovascular System Overview

Care of Clients with Problems in Oxygenation, Fluid and Electrolyte Balance, Infectious Inflammation and Immunity
Response, Cellular Aberration NCM 112 Theory
6. Do not elevate HOB more than 30 degrees if femoral site was used: Acute Hip Flexion (Cir Imp)
7. Monitor extremities for color, temperature, pulse and sensation. Impaired circulation in the
affected extremities is manifested by pallor or cyanosis, cold skin, diminished pulse or
pulselessness, and numbness or tingling sensation
Angiography/Arteriography
• Involves introduction of contrast medium into the vascular system to outline the heart and blood vessels.
• May be done during cardiac catheterization
• Nursing interventions are similar to that cardiac catheterization
• Observe for hypotension after the procedure because the contrast medium used in angiography may
cause profound diuretic effects.
Magnetic Resonance Imaging
• Strong magnetic field and radio waves are used to detect and define differences between healthy
and disease.
• MRI can actually show the heart beating and the blood flowing in any direction. It can image over
three spatial dimensions and overtime.
• It is used for examination of the aorta, detection of tumors, cardiomyopathties and paricardiac
disease.
Nursing Intervention:
• Secure written consent. Consent is required for diagnostic test that involve use of contrast medium MRI,
gandolinium is commonly used.
• Inform the procedure may last 45-60 minutes. The client is less anxious when he knows what to expect.
• Assess for claustrophobia
• Remove metal items
• Instruct the client MRI unit makes a loud, knowing noise.
• CAUTION: clients with pace makers, prosthetic valves are recently implanted clips or wires are not
available for MRI scans

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