Cardiovascular System

By
M Mwanza
 CARDIOVASCULAR SYSTEM

• Heart
• Vasculature
 HEART

• Pericardium
• Cardiac muscle
• Chambers
• Valves
• Cardiac vessels
• Conduction system
• Nerves
FIGURE 17.1 LAYERS OF THE HEART.
STRUCTURAL COMPONENTS OF THE HEART.
VALVES OF THE HEART.
 PERICARDIUM

• Thin Sac Composed of Fibroserous Material That

Surrounds the Heart
• Outer layer
• Inner layer
• Fluid between the layers
 HEART MUSCLE

• Base
• Apex
• Epicardium
• Myocardium
• Endocardium
 CHAMBERS IN THE HEART

• Left and right atria

• Left and right ventricles
 VALVES

• Permit the Flow of Blood Between Chambers and

Into Blood Vessels
• Atrioventricular (AV)
• Tricuspid
• Mitral
• Semilunar
• Pulmonary
• Aortic
 HEART SOUNDS

• S1
• S2
HEART SOUNDS IN SYSTOLE AND DIASTOLE.
 TABLE 17.1
CHARACTERIS
TICS OF HEART
SOUNDS
 TABLE 17.3
DISTINGUISHI
NG HEART
MURMURS
 CONTRACTION AND RELAXATION
PHASES OF THE HEART
• Systole
• Diastole
PULMONARY AND SYSTEMIC CIRCULATION. THE LEFT SIDE OF THE HEART PUMPS OXYGENATED BLOOD
(INDICATED IN RED) INTO THE ARTERIES OF THE SYSTEMIC CIRCULATION, WHICH PROVIDES OXYGEN AND
NUTRIENTS TO THE CELLS. DEOXYGENATED BLOOD (INDICATED IN BLUE) RETURNS VIA THE VENOUS
SYSTEM INTO THE RIGHT SIDE OF THE HEART, WHERE IT IS TRANSPORTED TO THE PULMONARY ARTERIAL
SYSTEM TO BE REOXYGENATED.
 CIRCULATION OF THE HEART

• Coronary arteries
• Left main
• Right coronary
• Left anterior descending
• Circumflex
VESSELS OF THE HEART. A. ANTERIOR.

A
(CONTINUED) VESSELS OF THE HEART. B. POSTERIOR.

B
CONDUCTION SYSTEM OF THE HEART

• Sinoatrial (SA) node

• Intra-atrial pathways
• AV node
• Bundle of His
• Right and left bundle branches
• Purkinje fibers
CONDUCTION SYSTEM OF THE HEART.
 CARDIAC CYCLE

• Contraction and Relaxation of the Chambers

THE CARDIAC CYCLE.
 CARDIAC CYCLE

• Ventricular filling
• Ventricular systole
• Isovolumetric relaxation
THE CARDIAC CYCLE

1) alternating periods
of contraction
(systole), during which
the heart is pumping
blood, and
2) relaxation
(diastole), during
which the heart's
chambers are filling
with blood.

An average adult has a

heart rate of about 70
beats per minute.

At this rate, a complete

cardiac cycle takes
roughly 0.8 seconds to
complete.
1) 0.1s is atrial systole,
2) followed by about
0.3s of ventricular
systole,
3) followed by about
0.4s of atrial and
ventricular diastole.
• Arteries:
• Carry blood away from the heart always.
• Have thick muscular walls
• Have a pulse
• Deep under the skin
• Have no valves

• Veins:
• Carry blood to the heart.
• Have thin walls
• Do not have a pulse
• Near surface of the skin
• Have valves to stop back-flow of blood.

• Capillaries:
• Are small blood vessels acting as veins and arteries.
• The walls of capillaries are only one cell thick so substances
(Food or cells) can easily get through them and into the
blood or out.
 ELECTROCARDIOGRAM (ECG)

• Paper Recording of Deflections That Represent

the Cardiac Cycle
• Electrical deflections
• P wave
• PR interval
• QRS interval
• T wave
ELECTROCARDIOGRAM WAVE.
 CARDIAC FUNCTION

• Stroke volume
• Amount of blood that is ejected with each heartbeat
• Cardiac output
• Amount of blood ejected from the left ventricle over 1
minute
• Cardiac index
• Measurement accounting for an individual’s weight when
evaluating the pumping action of the heart
 PUMPING ACTION OF THE HEART

• Preload volume overload

• Afterload pressure overload

•Cardiac output: stroke volume x heart rate

•Blood pressure: cardiac output x systemic
vascular resistance
A. PRELOAD IS RELATED TO THE AMOUNT OF BLOOD AND STRETCHING OF THE VENTRICULAR
MYOCARDIAL FIBERS.

A
(CONTINUED) B. AFTERLOAD IS THE PRESSURE THAT THE VENTRICLES MUST OVERCOME IN ORDER TO
OPEN THE AORTIC AND PULMONIC VALVULAR CUSPS.

B
 LANDMARKS FOR CARDIAC
ASSESSMENT
• Sternum
• Clavicles
• Ribs
• Second through fifth intercostal spaces
SMALL ANIMAL
LANDMARKS FOR CARDIOVASCULAR ASSESSMENT.
 FOCUSED INTERVIEW

• General questions
 FOCUSED INTERVIEW

• Specific questions
• Illness
• Symptoms
• Behaviors
• Infants and children
• Pregnant female
• Older adult
• Environment
 EQUIPMENT

• Examination gown
• Stethoscope
• Metric rulers
• Doppler
 OTHER CONSIDERATIONS

• Age
• Gender
• Language
• Culture
 PHYSICAL ASSESSMENT OF THE
CARDIOVASCULAR SYSTEM
• Techniques
• Inspection
• Palpation
• Percussion
• Auscultation
 SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• Inspection of the face, lips, ears, and scalp
• Inspection of the jugular veins
• Inspection of the carotid arteries
• Inspection of the hands and fingers
• Inspection of the chest, abdomen, legs, and
skeletal structure
 JUGULAR VENOUS PRESSURE (JVP)
AND PULSATIONS

• Recall that jugular veins reflect right atrial

pressure
• Steps for examination
• Raise the head of the bed or examining table to 30°
• Turn the patient’s head gently to the left
• Identify the topmost point of the flickering venous
pulsations
• Place a centimeter ruler upright on the sternal angle
• Place a card or tongue blade horizontally from the top of
the JVP to the ruler, making a right angle
• Measure the distance above the sternal angle in
centimeters: a 3- to 4-centimeter elevation is normal
 SPECIFIC AREAS OF THE
CARDIOVASCULAR ASSESSMENT
• Palpation of the chest, including the following
• Precordium at the right and left second intercostal spaces
• Left third intercostal space
• Left fourth intercostal space
• Left fifth intercostal space at the midclavicular line
 MYOCARDIAL AND PUMP DISORDERS

• Myocardial ischemia
• Myocardial infarction
• Congestive heart disease
• Ventricular hypertrophy
 VALVULAR DISEASES

• Mitral, aortic, tricuspid, and pulmonic stenosis

• Mitral and aortic regurgitation
• Mitral valve prolapse
MITRAL STENOSIS.
AORTIC STENOSIS.
MITRAL REGURGITATION.
PULMONIC STENOSIS.
TRICUSPID STENOSIS.
MITRAL VALVE PROLAPSE.
AORTIC REGURGITATION.
 SEPTAL DEFECTS

• Openings between the right and left atria or right

and left ventricles
VENTRICULAR SEPTAL DEFECT.
ATRIAL SEPTAL DEFECT.
 CONGENITAL HEART DISEASES

• Coarctation of the aorta

• Patent ductus arteriosus
• Tetralogy of Fallot
COARCTATION OF THE AORTA.
PATENT DUCTUS ARTERIOSUS.
TETRALOGY OF FALLOT.
(CONTINUED) TETRALOGY OF FALLOT.
ELECTRICAL RHYTHM DISTURBANCES

• Ventricular tachycardia
• Ventricular fibrillation
VENTRICLE TACHYCARDIA.
VENTRICULAR FIBRILLATION.
 OBJECTIVES OUTLINED IN HEALTHY
PEOPLE
• Coronary heart disease
• High blood cholesterol
 KEY OBJECTIVES FOR CORONARY
HEART DISEASE
• Screening for risk factors
• Individual, community, culturally linguistically
appropriate education and counseling
• Education about symptoms and emergency care
• Weight reduction programs
• Programs to increase physical activity
 KEY OBJECTIVES FOR HIGH TOTAL
BLOOD CHOLESTEROL
• Education about risks
• Education about diet and exercise
• Education about screening
 GLOSSARY
• Atrioventricular Valves Valves that separate the atria from the
ventricles.
• Bruit A loud blowing sound, an abnormal finding, most often
associated with a narrowing or stricture of the carotid artery
usually associated with atherosclerotic plaque.
• Bundle Branches Expressways of conducting fibers that spread
the electrical current through the ventricular myocardial tissue.
• Bundle of His Atrioventricular Node Nodes that are
intricately connected and function to receive the current that has
finished spreading throughout the atria.
• Cardiac Conduction System The heart's conduction system
which can initiate an electrical charge and transmit that charge
via cardiac muscle fibers throughout the myocardial tissue.
• Cardiac Cycle The events of one complete heartbeat, the
contraction and relaxation of the atria and ventricles.
• Cardiac output The amount of blood ejected from the left
ventricle over 1 minute.
• Diastole The phase of ventricular relaxation in which the
ventricles relax and are filled as the atria contract.
 GLOSSARY
• Electrocardiogram (EKG) Electrical representations of the cardiac
cycle are documented by deflections on recording paper.
• Endocardium The innermost layer of the heart, a smooth layer
that provides an inner lining for the chambers of the heart.
• Heart An intricately designed pump composed of a meticulous
network of synchronized structures.
• Infective Endocarditis A condition caused by bacterial
infiltration of the lining of the heart’s chambers.
• Left Atrium Forms the posterior aspect of the heart.
• Left Ventricle Egg shaped, most muscular chamber of the
heart, located behind the right ventricle and forms the left border
of the heart.
• Marfan's Syndrome A degenerative disease of the connective
tissue, which over time may cause the ascending aorta to either
dilate or dissect, leading to abrupt death.
• Mediastinal space The area where the heart sits obliquely
within the thoracic cavity between the lungs and above the
diaphragm.
 GLOSSARY
• Myocardium The second, thick, muscular layer of the heart, made
up of bundles of cardiac muscle fibers reinforced by a branching
network of connective tissue fibers called the fibrous skeleton of the
heart.
• Pericardium A thin sac composed of a fibroserous material that
surrounds the heart.
• Purkinje Fibers Fibers that fan out and penetrate into the
myocardial tissue to spread the current into the tissues themselves.
• Right Atrium A thin-walled chamber located above and slightly to
the right of the right ventricle that forms the right border of the
heart.
• Right Ventricle Part of heart formed triangularly and comprises
much of the anterior or sternocostal surface of the heart.
• S1 The first heart sound (lub), is heard when the AV valves close.
Closure of these valves occurs when ldrslt the ventricles have been
filled.
• S2 The second heart sound (dub), occurs when the aortic and
pulmonic valves close, they close when the ventricles have emptied
their blood into the aorta and pulmonary arteries.
• Semilunar Valves Valves that separate the ventricles from the
vascular system.
 GLOSSARY
• Sinoatrial Node The node located at the junction of the
superior vena cava and right attrium that initiates the
electrical impulse.
• Sternum The flat, narrow center bone of the upper
anterior chest.
• Stroke Volume The amount of blood that is ejected with
every heartbeat.
• Systole The phase of ventricular contraction in which the
ventricles have been filled, then contract to expel blood
into the aorta and pulmonary arteries.
• Visceral Layer The inner layer, which lines the surface of
the heart.
• Xanthelasma Yellowish cholesterol deposits seen on the
eyelids and are indicative of premature atherosclerosis.