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Cardiovascular System R. Martinson Revision June 2015 Heart Muscle • Heart Muscle is unique from all other muscles because it can create and conduct electrical impulses. • The lining of the heart is the ENDOCARDIUM • The thick muscular middle is called the MYOCARDIUM. The myocardium must be very strong to pump blood to the extremities. • The outer protective covering is called the PERICARDIUM Blood flow through the heart • Video on normal blood flow through the heart courtesy of the Children’s Hospital of Philadelphia • http://www.youtube.com/watch?v=JA0Wb3gc4mE Blood flow • In GENERAL… • ARTERIES carry oxygenated blood AWAY from the heart. • VEINS carry de-oxygenated blood TOWARDS the heart. THE BIG EXCEPTION • The big exception to this rule is PULMONARY circulation. Wherein deoxygenated blood is carried from the heart to lungs through arterial blood flow and oxygenated blood is sent back to the heart through veins. Path of blood • Blood LOW IN OXYGEN (“deoxygenated”) enters the RIGHT ATRIUM through the SUPERIOR (top) and INFERIOR (bottom) VENAE CAVAE, the body's largest veins. • The RIGHT ATRIUM contracts, forcing blood through the TRICUSPID VALVE and into the RIGHT VENTRICLE. • The right ventricle contracts, sending blood through the PULMONARY SEMILUNAR VALVE and into the PULMONARY TRUNK. • The pulmonary trunk divides into PULMONARY ARTERIES, which take the deoxygenated blood to the capillaries of the LUNGS. • At the lungs, carbon dioxide diffuses out of the blood, and, oxygen diffuses into it. The blood is now OXYGENATED. • The oxygenated blood feeds into the PULMONARY VEINS, which take it from the lungs to the LEFT ATRIUM. • . • The left atrium CONTRACTS, forcing blood through the bicuspid valve into the LEFT VENTRICLE • The left ventricle CONTRACTS, forcing blood through the AORTIC SEMILUNAR VALVE into the AORTA, the body's largest artery. • The aorta divides into smaller arteries, which carry oxygenated blood to all BODY TISSUES. • IN REALITY, cardiac blood flow doesn't happen in a linear sequence. Instead, the two atria contract SIMULTANEOUSLY, and the two ventricles also contract simultaneously. Septum • Because of the atrial and ventricular septums deoxygenated blood NEVER MIXES with oxygenated blood. Electrical Conduction • The heart is a muscular organ made up of Cardiac Muscle. Cardiac Muscle is unique because it generates and conducts electrical impulses. • This special quality is why hearts can be shocked into sinus rhythm with an AED • Also, it’s the reason we can diagnose certain heart problems by using an ECG machine. Electrical conduction • Electrical impulses starting in the heart cause the muscles to contract and the heart to beat. • The right and left sides of heart work together in a cycle to produce a heartbeat Intercalated discs • At the junction of each cardiac muscle fiber is a section called an intercalated disc. This disc serves to function as a connection between fibers and allows contractions and electrical impulses to flow rapidly between fibers. Sinoatrial Node – initiates impulses 70-80 times per minute – establishes basic rhythm of the heartbeat – called the pacemaker of the heart – impulses move through atria causing the two atria to contract. – at the same time, impulses reach the second part of the conduction system Atrioventricular Node – cells in the AV node conduct impulses more slowly, so there is a delay as impulses travel through the node – this allows time for atria to finish contraction before ventricles begin contracting Atrioventricular bundle “Bundle of His” – From the AV node, impulses travel through to the right and left bundle branches – These branches extend to the right and left sides of the septum and bottom of the heart. – These branch to form the Purkinje fibers that transmit the impulses to the myocardium (muscle tissue) – The bundle of His, bundle branches and Purkinje fibers transmit quickly and cause both ventricles to contract at the same time – After the ventricles complete their contraction phase, they relax and the SA node initiates another impulse to start another cardiac cycle. Systemic Circulation • Blood Vessels • Outside of the heart, blood is carried throughout the body in blood vessels. The body contains three basic types of blood vessels. • Arteries carry blood away from the heart. • Veins carry blood back to the heart. • Capillaries are microscopic vessels that carry blood between the arterial and venous vessels. Pulse Rate • The number of beats per minute • Varies with each individual depending on age, sex and body size – Adults: 60 – 90 bpm – Adult men: 60 – 70 bpm – Adult women: 65 – 80 bpm – Children over 7: 70 – 90 bpm – Children 1 to 7: 80 – 110 bpm – Infants (less than 1): 100 – 160 bpm Pulse Rate • Bradycardia: pulse rates under 60 bpm • Tachycardia: pulse rates over 100 bpm (except in children) • Any variations or extremes in pulse rates should be reported immediately Pulse Rhythm • Should be noted along with rate • Refers to the regularity of the pulse or the spacing of the beats • Described as regular or irregular • Arrhythmia – Irregular or abnormal rhythm – Usually caused by a defect in the electrical conduction pattern of the heart Pulse Volume • Should be noted along with rate and rhythm • Describes the strength or intensity of the pulse • Described by words such as strong, weak, thready or bounding Basic Principles for Taking Radial Pulse • Position pt’s arm supported comfortably with palm of hand turned down • Use tips of 2 or 3 fingers to locate pulse site on thumb side of wrist • Count pulse for 1 full minute • Note rate, rhythm and volume of pulse • Record info as: – 12/01/2014, 0830, P 82 strong and regular, Sally Smith, NAC The Cardiac Cycle • Systole – The period in which the heart contracts, pushing blood from the ventricles into pulmonic and systemic circulation • Diastole – The period in which the heart relaxes, causing the heart to again fill with blood Blood Pressure • ‘Normal’ blood pressure for adults is 120/80 • Systolic • Diastolic Systolic pressure is the pressure against vessels as the heart contracts, Diastolic is the pressure against vessels as the heart relaxes Hypertension • Hypertension is high blood pressure. • This disease is often called the “silent killer” because it may not show any symptoms. If left untreated, it can lead to permanent damage to the heart, blood vessels, and kidneys. • Risk factors that contribute to this condition are family history, race, obesity, smoking, stress, age, and a diet high in saturated fat. • There is no cure. Treatment involves medication to control the blood pressure and to remove excess body fluids, reducing stress, avoiding tobacco, improving diet, and exercise. Hypertension video • http://www.youtube.com/watch?v=ATLXgeKG 9y0 Congestive Heart Failure (CHF) • Congestive heart failure (CHF) occurs when the heart is unable to pump enough blood to supply the needs of the body. It may strike suddenly, or it may progress over a period of time. • Symptoms include swelling, shortness of breath, fatigue, low blood pressure, and a rapid pulse. • Treatment involves medication for the heart and to remove excess body fluids, elastic support hose, and oxygen therapy. In addition, rest and lifestyle changes are needed to relieve symptoms. Congestive Heart Failure • http://www.youtube.com/watch?v=GnpLm9fz YxU Elastic Stockings • https://www.youtube.com/watch?v=7MxWFJ 1_vdA