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Chapter 11 CARDIOVASCULAR SYSTEM The heart is a muscle that pumps blood. Blood vessels carry the blood. PRACTITIONERS Cardiology (cardi/o = heart) Cardiologist Interventional cardiologist Performs procedures and inserts devices Cardiac surgeon Cardiovascular surgeon (vascul/o = vessel) Treats vessels HEART FACTS Located in center of thoracic cavity Between the lungs & behind the sternum Size of your fist Points (bottom, apex) left Three-layered wall Pericardium – outer layer of fibrous tissue Myocardium – middle layer of thick muscle (my/o) Endocardium – inner layer of epithelial cells Anatomy & Physiology of Heart and Surrounding Structures HEART ANATOMY Septum (sept/o = partition) 4 chambers Separates the two sides of the heart (L & R) Atria (atrium) – 2 upper chambers (atri/o) Ventricles – 2 lower chambers (ventricul/o) Valves connect upper and lower chambers Bicuspid valve – left side (bi = two) Also called mitral valve Tricuspid valve – right side Open and close together Prevent blood from flowing back into the atria HEART ANATOMY (con’t) 2 additional valves in ventricles Pulmonary valve –opening of pulmonary artery Aortic valve –opening of the aorta Work at the same time Name the valves (#5 is not a valve) 1. Pulmonary Valve 2. Tricuspid Valve 3. Mitral (Bicuspid) Valve 4. Aortic Valve 5. Heart Apex Check your labels! INTERNAL VIEW OF HEART HEART ACTION Heart contracts to pump blood Systole – contraction phase Diastole – relaxation phase Heartbeat consists of: Contraction by atria, then ventricles Together = cardiac cycle Average heart beat is 72/min Cardiac output = volume of blood pumped in 1 min. Regulation of Cardiac Cycle - controlled by the cardiac center within the medulla oblongata. The cardiac center signals heart to increase or decrease its rate according to many factors that the brain constantly monitors. •Muscle Activity •Body Temperature •Blood ion levels (potassium & calcium) BLOOD FLOW THROUGH THE HEART Pulmonary circulation Right side of heart carries blood to lungs Return of de-oxygenated blood from the body Blood flow to pick up oxygenated blood in lungs Systemic circulation Left side of heart carries blood to body Oxygenated blood returns from lungs Oxygenated blood sent out to body cells via aorta CONDUCTION SYSTEM Works like an electrical circuit Signal flows from SA node –begins process Pacemaker of heart Determines rhythm AV node Right and left bundle branches (Bundle of His) Purkinje fibers CONDUCTION SYSTEM Parts of the Blood Plasma (55% of the blood) A straw-colored fluid which is about 90% water and 10% dissolved gases, salts, nutrients, enzymes, hormones, waste products and plasma proteins Cells (45% of the blood) RBC’s Most numerous (5-6 million) WBC’s (leukocytes) (4,000-10,000) Contain hemoglobin, which is the iron-containing protein that binds oxygen They are the army of the circulatory system May increase dramatically when the body is fighting an infection Platelets (250,000 – 400,000) Help in blood clotting by clumping together at the injury to prevent blood from flowing out of the cut BLOOD VESSELS Vessel Vas/o Angi/o Arteries (arteri/o) Carries blood away from the heart Largest artery is the aorta Get smaller – form arterioles (arteriol/o) Arterioles change into capillaries Nutrients and gases are exchanged VESSELS (con ‘t) Venous system Carries blood back to heart Capillaries form into tiny venules Veins (ven/o , phleb/o) Largest = superior and inferior venae cavae Veins have one-way valves to prevent back flow of blood Lumen: central opening of vessel Pulse: artery expanding and contracting Arterial system helps maintain body’s blood pressure: constrict and dilate to keep an even pressure gradient PULSE POINTS (palpable pulses) HEART FACTS Heart has a circulatory system to nourish the heart muscle Called coronary circulation (coron/o = circle or crown) Right and left coronary arteries Decreased blood flow leads to heart tissue death Myocardial infarction (heart attack) Blood pressure (BP) Hypertension = Elevated BP Hypotension Increased resistance in vessels – Poor blood flow Too little blood flowing to organs Read: systolic pressure (#) /diastolic pressure (#) Goal is ~ 120/80 WELLNESS & ILLNESS Listen to the heart with a stethoscope Lub - dub = S1, S2 S1 – closing of AV valves as ventricles contract (systole) S2 – closing of semilunar valves closing in relaxation diastole Listen to specific areas of heart for: Abnormal heart sounds Valve defects Heart Sounds - Opening and Closing of Valves, "Lub Dub" Stethoscope - instrument to listen and measure heart sounds FETUSES & NEWBORNS At birth, lungs inflate and aeration begins Congenital heart defects Impaired cardiac function ASD: opening between atrium VSD: opening between ventricles PDA: persistent fetal circulation Coarctation of aorta: narrowing of descending portion of aorta CHILDREN Murmurs Innocent murmurs Functional murmurs ADULTS –Risk Factors Risk factors for heart disease Cannot be controlled: Age, family history, gender Can be modified/treated/controlled: Smoking Physical Activity Body mass Index: keep less than 25 (weight) Blood pressure: keep less than 120/80 Blood glucose: keep less than 140 (random) Cholesterol Keep total below 200 HDL, LDL, triglyceride levels ADULTS PROBLEMS Arteriosclerosis (scler/o = hardening) Affects walls of small vessels Angina pectoris Severe pain in chest (and may radiate) Decreased blood flow to heart Abnormalities in vessels Aneurysm Ballonlike swelling of an artery Atherosclerosis (ather/o = pasty material) Blockage caused by lipid deposits SENIORS Aging changes Elevated BP Coronary heart disease Poor pumping ability of heart – poor body perfusion Arrhythmias (rhythm = beat) General term Congestive heart Failure Normal calcification of vessels Irregular heart rhythm Ectopic beats (ecto = outer) Heartbeat outside regular rate and rhythm Outside SA node regulation GENERAL TERMS Bradycardia (brady = slow) Tachycardia (tachy = rapid) Cardiomegaly (megal/o = enlargement) Vasoconstriction Vasodilation Narrowing of a vessel Widening of a vessel Varicose Vein Dilated and twisted veins, usually in legs TESTS Blood testing − lipid risk panel Electrocardiogram (ECG) Ultrasound of heart EKG Tracing electrical activity of the heart Identify heart muscle changes Interpreting EKGs An EKG is printed on paper covered with a grid of squares. Notice that five small squares on the paper form a larger square. The width of a single small square on EKG paper represents 0.04 seconds. - A common length of an EKG printout is 6 seconds; this is known as a "six second strip." HEART RHYTHMS EKG tracings PROCEDURES Interventional cardiology Cardiac catheterization (angiogram) To determine flow of blood through heart and main vessels Balloon Angioplasty (PTCA) Use catheter and dye Balloon catheter inserted into blocked coronary artery, then inflated to push plaque against vessel walls Endarterectomy Removal of plaque from an artery Common in carotids Coronary bypass graft (CABG) Cardiac vessels replaced with healthy ones DRUGS Improve function of heart muscle Eliminate access fluid Anticoagulants Decrease blood pressure Diuretics (Lasix) – CHF Ensure flow of blood through vessels Beta-blockers, antiarryhythmics, Digoxin Antihypertensives Decrease serum cholesterol levels Hypolipidemics