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CHAPTER 11
CARDIOVASCULAR SYSTEM
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Chapter 11 Learning Objectives

Define at least 10 terms relating to the
cardiovascular system.

Describe the function of the cardiovascular
system.

Identify at least 10 cardiovascular system
structures and the function of each.
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Chapter 11 Learning Objectives


Identify at least three methods of assessment
used to evaluate the cardiovascular system.
Describe at least five disorders of the
cardiovascular system.
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Structures of the
Cardiovascular System

Cardiovascular system structures
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Heart
• Beats more than 100,000 times each day

Blood vessels
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Functions of the
Cardiovascular System
• Cardiovascular system functions
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Transports nutrients and oxygen to the body
Transports waste products from the cells to the
kidneys for excretion
Distributes hormones and antibodies throughout
the body
Helps control body temperature and maintain
electrolyte balance
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Heart
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Two-sided, double pump
Weighs less than a pound
Slightly bigger than a fist
Located between the lungs in the thoracic
cavity
Positioned slightly to the left of the sternum
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Heart
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Pulmonary circulation
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Systemic circulation
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Right side of heart pumps deoxygenated blood to
the lungs.
Left side of the heart pumps oxygenated blood to
rest of the body.
Blood returns to the right side of the heart from the
body to complete the cycle.
Hepatic circulation

Path of the blood from the intestines, gallbladder,
pancreas, stomach, and spleen through the liver.
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Heart
• Four chambers of the heart
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Atria
• Top two chambers
• Blood enters the heart through the atria.
Ventricles
• Lower two chambers
• Blood leaves the heart through the ventricles.
Septum

Divides the right and left sides of the heart
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Blood Flow Through the
Cardiovascular System
FIGURE 11-1 Blood flow through the cardiovascular system. (From Patton
KT, Thibodeau GA: Anatomy & physiology, ed 7, St. Louis, 2010, Mosby.)
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Heart Valves
• Four valves of the heart
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Prevent blood from flowing back into heart
Atrioventricular valves (2)
• Separate the atria and ventricles
Semilunar valves (2)
• Separate the ventricles from the pulmonary artery and
aorta
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Structures of the Heart
FIGURE 11-2 A, Structures of the heart.
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Tissue Layers of the Heart
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Endocardium
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Myocardium
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Smooth layer of cells lining the inside of the heart
and forming the valves
The thickest layer, consisting of muscle tissue
Pericardium
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Double membrane that covers the outside of the
heart, providing lubrication between the heart and
surrounding structures to prevent tissue damage
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Layers of the Heart
FIGURE 11-2 B, Layers of the heart.
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Heart Function
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Activity of the heart muscle is controlled by
the nervous system.
Function also is affected by the action of
hormones and fluid balance.
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Heart Function
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The heart is the only muscle that can
stimulate its own contractions.
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Sinoatrial cells (SA node) in the right atrium start
the heart.
Atrioventricular node (AV node) sends an impulse
into lower portions of the heart.
AV bundle or bundle of HIS stimulates the
Purkinje fibers.
Purkinje fibers cause the ventricles to contract.
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Path of Electrical Current in the Heart
FIGURE 11-3 Path of electrical conduction in the heart.
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Blood Vessels
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Arteries
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Carry oxygenated blood away from the heart
Have a muscular layer of tissue that helps pump
blood through the body
Aorta
• Largest artery in the body
• Branches into smaller arteries
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Blood Vessels
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Veins
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Venules join together to form veins.
Veins carry blood from the tissues back to the
heart.
• Blood is deoxygenated except for pulmonary vein.
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Veins contain valves that prevent blood from
flowing back.
 Veins have a much thinner muscular layer than
arteries.
 The superior vena cava and inferior vena cava are
the largest veins.
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Blood Vessels
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Arterioles
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Smaller vessels
Blood moves from arterioles to capillaries.
Capillaries
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Carry blood between the arterial and venous
vessels.
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Blood Vessels
FIGURE 11-4 Blood vessels.
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Principal Arteries and Veins
FIGURE 11-5 Principal arteries and veins. (From Sorrentino SA:
Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)
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Path of the Blood Through the Heart
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Assessment Techniques
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Measuring pulse and blood pressure
Listening to heart sounds
Determining cardiac output
Measuring muscle activity with
electrocardiography
Inserting a cardiac catheter
Using echocardiography
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Assessment Techniques
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Pulse
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Surge of blood against the walls of the arteries
Eight pulse points on the body
Normal pulse rate for adults is 60 to 90 beats per minute
Blood pressure
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Force of blood against the walls of the arteries
Systolic pressure
• Ventricles of the heart contract
Diastolic pressure
• Ventricles relax
Normal blood pressure
• 120/80 mm Hg
Blood pressure varies greatly among people.
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Peripheral Pulse Points
FIGURE 11-6 Peripheral pulse points.
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Assessment Techniques
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Heart sounds
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Lub-dub sound of the heart
• Results from opening and closing of the valves
Heard through a stethoscope
Murmurs
• Abnormal or extra sound
• Classified by timing, intensity, location, pitch, and quality
of the sound
• May be benign or indicate a disorder
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Thrill
• Vibration felt by touch over an artery
• Caused by an abnormal flow of blood
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Assessment Techniques
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Electrocardiogram
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The pattern of electrical activity in heart
contractions is measured graphically.
Normal and abnormal heart activities have
characteristic wave patterns.
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Electrocardiography
FIGURE 11-7 Electrical activity of the heart is measured with electrocardiography.
(From Aehlert BJ: Paramedic practice today, St. Louis, 2010, Mosby.)
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Electrocardiogram
FIGURE 11-8 A normal electrocardiogram pattern with descriptions. (From
Grauer K: A practical guide to ECG interpretation, ed 2, St. Louis, 1998, Mosby.)
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Electrocardiogram Patterns
FIGURE 11-9 Electrocardiogram patterns. A, Normal sinus rhythm. B, Unifocal premature ventricular
contractions. C, Atrial fibrillation. D, Ventricular fibrillation. (From Tait C: EZ ECGs booklet, ed 2, St.
Louis, 2001, Mosby.)
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Assessment Techniques
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Cardiac catheterization
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A catheter is used to measure the pressure in the
chambers of the heart, to take blood samples, and
to view obstructions in the vessels.
A tube is inserted through the blood vessels into
the heart.
Dye is then released and traced using x-ray
imaging.
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Assessment Techniques
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Echocardiography (ECHO)
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Uses ultrasonic waves to show the structures and
motions of the heart
Transducer plots the sound echoes to produce a
graphic picture.
Transesophageal echocardiogram
• Used if the image of the echocardiograph is unclear
• Scope with an ultrasonic device is lowered into the
esophagus.
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Assessment Techniques
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Radionuclide imaging (radioisotope scanning)
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Single photon emission computed
tomography (SPECT)
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Uses a gamma camera to create an image after
injection of a radioactive material
Generate three-dimensional computerized images
of the chest
Myocardial perfusion
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Produces images after heart muscle absorbs
radionuclides
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Disorders of the
Cardiovascular System
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Aneurysm
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Atherosclerosis
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Area of a blood vessel that bulges because of a
weakness in the wall
Narrowing of blood vessels caused by deposits of
fatty material containing calcium and cholesterol
Cardiac arrhythmia
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Disturbance of the heart’s rhythm caused by a
defect in the heart’s pacemaker cells or by
damage to heart tissue
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Disorders of the
Cardiovascular System
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Cardiovascular disease
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General term for the combined effects of
arteriosclerosis and atherosclerosis
• Conditions called coronary artery disease
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Coronary artery disease (CAD) may manifest as
•
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•
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Heart attack
Peripheral artery disease (PAD)
Angina
Stroke
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Disorders of the
Cardiovascular System
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Congenital heart disease
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A group of disorders that affect about one in eight
newborns each year in the United States
 Defects include
• Narrowing of vessels (stenosis) to the heart and
atrial or ventricular septal defects
• Coarctation of the aorta and patent ductus
arteriosus (opening between the pulmonary artery
and aorta that does not close at birth)
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Disorders of the
Cardiovascular System
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Congestive heart failure (CHF)
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Inability of the heart to pump blood adequately to
meet the body’s needs
 Usually caused by disease in another body
system
 Leads to inadequate respiratory and kidney
function
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Disorders of the
Cardiovascular System
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Hypertension
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High blood pressure
Primary hypertension
• Cause of hypertension unknown
Secondary hypertension
• Hypertension caused by other conditions, such as kidney
disease and adrenal disorders
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Disorders of the
Cardiovascular System
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Myocardial infarction
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Also known as a heart attack
Results from blockage of the blood vessels to the
heart by a clot (embolism)
Cardiac Arrest
• Occurs when large area of the heart is affected and
may stop functioning
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Automatic External Defibrillator
(AED)
FIGURE 11-10 Many lives can be saved using the automatic external defibrillator (AED) device.
(From Patton KT, Thibodeau GA: Anatomy & physiology, ed 7, St. Louis, 2010, Mosby.)
Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
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Disorders of the
Cardiovascular System
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Phlebitis
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Inflammation of a vein, often with formation of a
clot (thrombus)
Results from damage to the vessel wall or
prolonged sitting or standing
If thrombus breaks free, it may lodge in a small
artery and cause tissue damage or sudden death.
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Disorders of the
Cardiovascular System
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Rheumatic heart disease
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A condition in which the heart muscle and valves
are damaged by a recurrent bacterial infection that
usually begins in the throat
• Bacteria produces a toxin that causes inflammation and
damage to the heart valves
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Varicose veins
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A condition in which veins become enlarged and
ineffective
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Issues and Innovations
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Heart replacement and transplants
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1967 - First heart replacement
• Approximately 2300 heart transplantations are performed
each year in the United States.
• First artificial heart, the Jarvik-7, was connected to an
external power source and pump.
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2001 - AbioCor self-contained artificial heart
• Designed to extend life for people with end-stage heart
failure who had no other clinical options
• Helps provides a good quality of life
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AbioCor Heart
FIGURE 11-11 A, AbioCor heart. B, Placement of AbioCor heart in the body.
(Courtesy ABIOMED, Inc., Danvers, Mass.)
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AbioCor Heart
FIGURE 11-11 A, AbioCor heart. B, Placement of AbioCor heart in the body.
(Courtesy ABIOMED, Inc., Danvers, Mass.)
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Issues and Innovations
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The U.S. Food and Drug Administration
(FDA) approved use of the SynCardia
Temporary Total Artificial Heart in 2005.
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Used in patients with irreversible failure of the
ventricles
Designed to support life functions until a transplant
becomes available.
More than 3000 people are on a waiting list
for a heart transplant.
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46
Issues and Innovations
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Cholesterol
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Waxlike substance
 Used in body to make
• Cell membranes
• Hormones
• Vitamin D
 Carried by proteins (lipoproteins)
 Found in two lipoprotein forms
• High-density lipoprotein (HDL)

Takes cholesterol to the liver
• Low-density lipoprotein (LDL)

Blocks the arteries
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Issues and Innovations
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Harvard research study: LDL versus HDL cholesterol
 Type of fat, not the amount, changes the
cholesterol level.
 Limit intake of saturated fats, and eliminate trans
fats.
 Monounsaturated and polyunsaturated fats were
determined to lower LDL and raise HDL levels.
• Olives, canola oil, avocados, fish, and most nuts
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Saturated fats raise LDL and HDL levels.
• Whole milk, butter, cheese, red meat, chocolate,
and coconut oil
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Trans fats are the worst fats.
• Margarines, vegetable oils, shortening, and most
fast foods
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48
Summary
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Functions of the cardiovascular system
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Transport oxygen, nutrients, waste products,
hormones, and antibodies
Control body temperature and maintain
homeostasis
Structures of the cardiovascular system
include parts of the heart and blood vessels.
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Summary

Assessments of the cardiovascular system
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

Measuring blood pressure and pulse
Listening to heart sounds
Determining cardiac output
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Summary

Disorders of the cardiovascular system
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Aneurysms
Atherosclerosis
Congestive heart failure
Phlebitis
Varicose veins
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