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Cardiovascular System Medical Assisting Transportation System O2 Nutrients CO2 Waste products Cells need transport system Closed circuit of vessels Pump Circulatory Systems Closed system Interlinked Pulmonary Systemic Coronary Quick Stats 4,000 gallons of blood a day is pumped 40 miles per hour Heart beats 60 – 100 times a minute Averages 100,000 beats a day 40,000,000 beats a year Never stops! More Stats The heart pumps about 5-6 liters (1.5 gallons) of blood per minute One drop of blood contains a half a drop of plasma, 5 MILLION Red Blood Cells, 10 Thousand White Blood Cells and 250 Thousand Platelets. Your blood vessels could be wrapped around the equator TWICE! Even More Stats There are over 60,000 miles of blood vessels in children Over 100,000 miles in adults The average three-year-old has two pints of blood in their body; the average adult at least five times more! Keep your heart healthy...it's going to have to beat about 3 BILLION times during your lifetime! Four Main Parts Pump – Heart Plumbing – blood vessels – arteries, veins, and capillaries Fluid – blood Auxiliary fluid – lymphatic system The Heart Normal Anatomy Triangular shaped Size of a fist Behind sternum - lower part of mediastinum 2/3 on left Between lungs This is the external appearance of a normal heart. The epicardial surface is smooth and glistening. The amount of epicardial fat is usual. The left anterior descending coronary artery extends down from the aortic root to the apex. Heart Heart Heart Anatomy Lies on the diaphragm pointing to the left 5th ICS at L MCL Positioned between sternum and thoracic vertebrae Useful - CPR Heart Heart Anatomy Several layers of muscle Spiral Circular Contraction = blood squeezed out of chambers Relaxation = blood fills chambers from great veins Walls are myocardium Heart Anatomy Change in size relative to contraction or relaxation Systole - contraction Diastole – relaxation Upper and lower chambers are opposite Contraction of ventricles produces a pulse External Anatomy Sac around heart = pericardium Fibrous tissue with small space between Parietal- outer layer, like a loose fitting sac Visceral- epicardium Pericardial fluid Pericarditis- trauma, infection, tumors Causes friction, pain External Anatomy Coronary Arteries/Veins Blood supply to heart muscle itself Arise from aorta Return to right atrium Myocardium Internal Heart Anatomy Hollow organ 4 chambers (cavities) Upper 2 – atria Lower 2 – ventricles Septum 4 valves Heart Chambers Atria- smaller, thinner walls, less muscular Receiving chambers- blood enters here through veins Ventricles- larger, strong, muscular walls Discharging chambers- blood exits heart into arteries Internal Heart Structures Endocardium – lines the heart, valves, vessels (Endocarditis- roughens- clots {thrombus} form) Double pump Blood from either side of the heart does not mix Septum- interatrial, interventricular Always a one-way street!!! Heart Anatomy Heart Diagram Cardiac Cells\Heart Anatomy Cardiac muscle – striated Automaticity Contractility Involuntary Cells joined end-to-end Single nucleus The Tricuspid Valve The tricuspid valve is located between the atrium and ventricle on the right side of the heart. When this valve is open, blood passes from the right atrium into the right ventricle. The tricuspid valve prevents the reverse of blood flow back into the atrium by closing during ventricular contraction. As its name suggests, the tricuspid valve is made up of three leaves, or cusps. Tricuspid Valve Normal anatomy The Pulmonary Valve With the tricuspid valve closed, the only outlet for blood in the right ventricle is through the pulmonary trunk. The pulmonary trunk splits into the left and right pulmonary arteries, which connect to the left and right lungs, respectively. The entrance to the pulmonary trunk is guarded by the pulmonary valve. The pulmonary valve is made up of three leaves that open when the right ventricle contracts, and close when this chamber relaxes, allowing blood to flow from the right ventricle into the pulmonary arteries but not the reverse. Pulmonary Valve Semilunar The Bicuspid Valve The bicuspid or mitral valve regulates the flow of blood from the left atrium to the left ventricle. Like the tricuspid valve, the bicuspid valve closes during ventricular contraction. The bicuspid valve is composed of two leaves. The Bicuspid Valve Mitral The Aortic Valve The aortic valve consists of three leaves found at the entrance to the aorta. This valve lets blood out of the left ventricle as it contracts, and blocks the pathway of blood from the aorta back into the left ventricle when this chamber relaxes Aortic Valve Normal anatomy Valves Papillary muscles – contract with the atria to assist in opening the valves between the chambers (bicuspid and tricuspid) Semilunars – aortic and pulmonary Pulmonary Circulation Blood from right heart goes to lungs for gas exchange Pulmonary Circulation Vena Cavas Right atrium Tricuspid Right ventricle Pulmonary semilunar Pulmonary arteries (2) Arterioles Pulmonary Circulation Capillaries Gas exchange Venules Veins Pulmonary veins (4) Left atrium Bicuspid Left ventricle Heart Physiology Both sides pump simultaneously Must always move in a forward direction Atria contract together Ventricles contract together Each set of contractions is a heartbeat Heart Sounds Lubb – S1 – Apex – valves between chambers closing (bicuspid and tricuspid) Dupp – S2 – 2nd intercostal space at the sternal borders – pulmonary and aortic semilunar valves closing Heart Sounds Abnormal Sounds S3 S4 Murmurs Rubs Heart Action/Sounds http://www.nhlbi.nih.gov/health/dci/Diseas es/hhw/hhw_pumping.html http://www.blaufuss.org/ Pacemaker SA Node Right atrium AV node Bundle of HIS Purkinje fibers Pacemaker Sets rate and rhythm O2 NA, K, CA, Phos, Mg Nutrients Electrical signal sent from SA node to start beat Pacemaker Atria stimulated by the SA – contract simultaneously Blood sent into ventricles Triggers AV node (between atria and ventricles) No direct connection Bundle of HIS – Left and Right branches Purkinje network NSR Sinus rhythm Rhythm Disturbances ECG (EKG) – diagnostic tool Heart Block – 1st through 3rd degree Atria will beat at 60-100 bpm Ventricles will beat independently at 30-40 bpm Arrhythmias Any deviation from normal rhythm Ectopic Atrial (PAC) Ventricular (PVC) Junctional (PJC) Bigeminy Trigeminy Artificial Pacemaker Heart block override Electrodes threaded through Vena Cava to atrium and ventricle (internal) Fluro used Permanent or temporary Internal or external Fixed or demand Artificial Pacemaker Pacers Defibrillators Implanted into chest wall Dick Cheney Shocks heart back to normal Lethal if untreated Rate Control Vagus – slows down Accelerator – speeds up Stimulated by many things – emotions Electrolytes O2/CO2 Tachycardia - >100 Bradycardia - < 60 Blood Vessels Arteries Arterioles Capillaries Venules Veins Vessel Structure Vessels Comparison – Arteries/Veins Arteries Always carries blood AWAY from the heart Fresh, O2 rich blood ONE exception – pulmonary arteries Layers of elastic fibers – expand/recoil Causes wavelike effect – pulse Felt when pressed over bony prominence Arteries Anatomy Arteries Lumens Major Arteries - UE Aorta Carotid Pulmonary Brachial Radial Ulnar Major Arteries - LE Common iliac Femoral Tibial Dorsalis pedis Arteries High pressure Arterioles Connect arteries to capillaries Similar structure to arteries Smaller branches Capillaries One cell thick – vast network Trickle of blood to allow nutrients/O2 and wastes to diffuse Fluid filled tissue spaces between cells Intracellular, interstitial, plasma (extracellular) Capillaries Sphincters to control flow Order of importance – CNS, muscular system (fight/flight), internal digestive organs Take O2 to cells Pick up CO2 and wastes to take for disposal Venules Connect capillaries to veins Deoxygenated Same structure as veins Smaller Veins Similar to arteries Deoxygenated blood No elastic fibers for vasoconstriction Lower pressure Valves Major Veins Tibial Saphenous Femoral Common iliac Vena cava Jugular Brachial Cephalic Pulmonary Lymphatic System Lymph Nodes Vessels Spleen Tonsils Thymus Lymphatic System Lymph Blood plasma that filters out of capillaries Contains lymphocyes, hormones, cellular activity products Fills spaces between cells – interstitial Bridge between cells and capillaries Lymph Vessels Valves like veins No pump One-way system Many lymph vessels – flow to heart Lymph Nodes Small round, or oval structures Clusters in various areas Avilla Inguinal Abdominal Head/neck Metastasis Spleen Lymphatic tissue – huge lymph node Left side, below diaphragm Produces lymphocytes Stores RBC’s Destroys old RBC’s Blood RBC WBC Platelets Plasma Blood 8-10 pints in adult Loss greater than 2 pints is poor Plasma – 55 % Cells – 45% Plasma Seeps in and out of capillaries Serum, lymph Interstitial fluid In and out of lymphatic system Straw colored 90% water Minerals (10%) – Ca, NA, K, Phos, Bicarb Plasma Minerals also called electrolytes – acid/base balance Vitamins Hormones Enzymes Nutrients – glucose, fatty acids, amino acids O2, CO2, wastes Plasma 3 proteins Fibrinogen Serum albumen – water osmosis Serum globulin – forms antibodies Red Blood Cells RBCs Erythrocytes Biconcave disks – very thin centers, can fold over to flow into narrow spaces 25 trillion (5million per cubic millimeter) 4 month life span Produced – 1 million/second RBCs Bone marrow produces – wear out at same rate they are produced Hemoglobin – red color, made from iron + protein Hemoglobin carries O2/CO2 White Blood Cells WBCs Leukocytes 5,000 – 9,000 per cubic millimeter One per 600-700 RBCs 2x size of RBCs Defend body against foreign substances Leukocytes 2 types Granulocytes Agranulocytes Exudate – (pus) – lymph, bacteria, dead wbcs Platelets Thrombocytes Smallest 200,000-400,000 per cubic millimeter Formed in bone marrow Clotting Only active with cut vessel – must be fairkt small Bleeding Time PT PTT Bleeding time Blood Types A B AB O Rh factor Rh factor - +/- antigen Pregnancy issues Injection given to prevent antibody formation Cholesterol Metabolism of fats Accumulates in arteries - plaques Total - <200 LDL <130 HDL >60 Diagnostics Arteriograph (angiograph) Cardiac cath Doppler/ultrasound Echo ECG Holter monitor Stress testing – thallium TEE Heart Disease Leading cause of death in the United States Diseases Anemia Aneurysm Cardiac Arrest Arrhythmia Arteriosclerosis Atherosclerosis CVA Disease CHF CAD Embolism Hypertension Leukemia Murmur MI Phlebitis