Cardiovascular

• Hollow muscular organ

  Heart
• Location of the heart

  • Mediastinum (thoracic cavity, center of chest)
• Chambers of the heart


  • Right atrium (RA)
  • Right ventricle (RV)
  • Left atrium (LA)
  • Left ventricle (LV)
• Major blood vessels

  • Superior vena cava
  • Inferior vena cava
  • Pulmonary trunk
  • Aorta
• Septum

  • Interatrial septum (separates RA and LA)
  • Interventricular septum (separates RV and LV)
• Anchor the AV valve flaps to papillary muscles within the ventricles


  • Chordae Tendineae
• Records only the electrical activities of the heart


  Electrocardiogram (ECG)

  
• ECG waves

  • P wave (atrial depolarization/contraction)
  • QRS complex (ventricular depolarization/contraction, atrial repolarization masked)
  • T wave (ventricular repolarization/relaxation)

  
• Used to know the structural defects of the heart

  2D echocardiogram
• Enlargement of the heart, ventricles increase in size due to malfunction, can be detected by ECG


  Cardiomegaly
• Filling and emptying the heart chambers, repetitive contraction and relaxation of heart chambers

  Cardiac cycle
• Contraction of atria or ventricles, known as emptying 


  • Systole
• Pulmonary circulation


  • Purpose - oxygenate the blood
  • Managed by the right side of the heart
  • Moves blood from heart to lungs
  • Has lower pressure compared to systemic circulation
• Systemic circulation


  • Purpose - transport oxygenated blood to the body
  • Managed by the left side of the heart
  • Moves blood from heart to body
• Heart sounds

  • S1 (lub, closure of AV valves, beginning of systole)
  • S2 (dub, closure of SL valves, beginning of diastole)
  • S3 (ventricular gallop, early diastole)
  • S4 (atrial gallop, late diastole)
  • Murmurs (pathologic heart sounds produced when blood is pumped across a heart valve)
• Cardiac output


  The volume of blood ejected by the ventricles in one minute

  Stroke volume x HR = 5 to 6 L/min
• Amount of blood ejected from the left ventricle with each contraction, approximately 70 ml


  Stroke Volume
• Heart rate


  Number of beats per minute, 60 to 100 bpm
• Factors affecting stroke volume

  • Preload (volume of blood in ventricles at end of diastole)
  • Afterload (resistance left ventricle must overcome to pump blood to system/aorta)
  • Synergy contraction
  • Compliance or distensibility of ventricles
  • Contractility of myocardium
  • Autonomic nervous system stimulation (sympathetic and parasympathetic)
• Located between trachea and SCM, centrally located arterial pulse

  • Carotid artery pulse
• Internal jugular veins


  • Runs parallel to the carotid artery
• Jugular venous pressure (JVP)


  Reflects right atrial pressure, determines central venous pressure (CVP)
• Cranial nerve that stimulates the parasympathetic stimulation

  Vagus Nerve(CN X)
• Doctors directly place catheters on the right atrium to detect the central venous pressure to determine if the patient has heart failure
• Rheumatic fever


  History of tonsillitis (treated or not / recurrent) - if left untreated, the microorganisms that cause tonsillitis may travel to other parts of the body and can lead to rheumatic heart disease (RHD)
• Elevated cholesterol levels (Triglycerides, LDL, VLDL, cholesterol)


  Dyslipidemia
• Coronary artery disease (CAD)

  • Atherosclerosis - Plaque of fat in arteries
  • Arteriosclerosis - Hardening of arteries
• Patients with diabetes may also have hypertension because there is increase in blood viscosity = increase in BP


  Diabetes mellitus (DM)
• Abnormal findings: Distended neck veins

  • Increased CVP
  • Right sided HF
  • Pulmonary hypertension - increase pressure in the BV in the lungs
  • Pulmonary emboli
  • Cardiac tamponade
• Assessing neck vessels: Auscultation

  1. Always auscultate the carotid arteries before palpating

  2. Auscultate the carotid arteries if the patient is middle-aged or older, or if you suspect cardiovascular disease

  3. Auscultate for bruits
• Pulse amplitude scale

  • 0 - Absent
  • 1+ - Weak
  • 2+ - Normal
  • 3+ - Increased
  • 4+ - Bounding
• At Erb's point, all heart sounds can be heard
• Apical impulse felt on anterior axillary line

  May indicate cardiomegaly
• Locations to hear valve sounds


  • Aortic area (2nd ICS right parasternal border)
  • Pulmonic area (2nd ICS left parasternal border)
  • Tricuspid area (4th ICS left parasternal border)
  • Mitral area (5th ICS left midclavicular line)
  • Erb's point (3rd ICS left parasternal border)
• Normal heart rate

  60 to 100 bpm
• Bradycardia


  Less than 60 bpm
• Tachycardia


  More than 100 bpm
• Normal apical-radial pulse difference

  Less than 5 bpm
• If breath sounds are very confusing, inform the patient to do shallow breathing
• Auscultate for extra heart sounds and murmurs

  Change position of patient (left lateral/left side-lying, sitting upright, leaning forward)