The Cardiovascular System Lecture.sp10ca

The Cardiovascular System : 

The Cardiovascular System Chapter 9

Anatomy and Physiology Overview : 

Anatomy and Physiology Overview Through the CV system, blood is circulated to all parts of the body by the action of the heart. This process provides the body’s cells with O2 and nutritive elements and removes waste materials and CO2. The cardiovascular system includes: The heart Arteries Veins Capillaries

The Heart : 

The Heart A four-chambered, hollow muscular pump that circulates blood throughout the cardiovascular system. It lies slightly to the left of the midline and has three linings: Endocardium The inner lining of the heart. Myocardium The muscular, middle layer of the heart. Pericardium The outer, membranous sac surrounding the heart.

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Figure 9.1 Tissues of the heart.

Heart Chambers Animation : 

Heart Chambers Animation

The Heart : 

The Heart The heart is divided into right and left heart by a partition called the septum. Each side has an upper and lower chamber: Atria, or upper chamber Ventricles, or lower chambers

The Heart : 

The Heart Right atrium is located at the right upper portion. It is a thin-walled space that receives blood from all body parts except the lungs. Two large veins, superior and inferior vena cavae, bring the blood to the right atrium.

The Heart : 

The Heart Left atrium is located at the left upper portion. It receives blood rich in O2 as it returns from the lungs via the right and left pulmonary veins.

The Heart : 

The Heart Right Ventricle Located at the right lower portion, it receives blood from the right atrium through the atrioventricular (AV) valve and pumps it through a semilunar valve to the lungs. Left Ventricle Located at the left lower portion, it receives blood from the left atrium through the atrioventricular (AV) valve and pumps it through a semilunar valve to a large artery known as the aorta and from there to all parts of the body except the lungs.

The Heart : 

The Heart Heart Valves Tricuspid or right atrioventricular Pulmonary semilunar Bicuspid or mitral Aortic semilunar

The Heart : 

The Heart The Tricuspid or Right Atrioventricular Valve Guards the opening between the right atrium and right ventricle. The tricuspid valve allows the flow of blood into the ventricle and prevents its return to the right atrium. The Pulmonary Semilunar Valve The exit valve for blood leaving the right ventricle is located between the right ventricle and the pulmonary artery. It allows blood to flow from the right ventricle through the pulmonary artery to the lungs.

The Heart : 

The Heart The Bicuspid or Mitral Valve Also known as the left atrioventricular, it is located between the left atrium and left ventricle. It allows blood to flow to the left ventricle and closes to prevent its return to the left atrium.

The Heart : 

The Heart The Aortic Semilunar Valve The exit point for blood leaving the left ventricle is located between the left ventricle and the aorta. It allows blood to flow into the aorta and prevents its return to the ventricle.

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Figure 9.2 Valves of the heart.

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Figure 9.3 Coronary circulation. (A) Coronary vessels portraying the complexity and extent of the coronary circulation. (B) Coronary vessels that supply the anterior surface of the heart.

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Figure 9.3 Coronary circulation. (A) Coronary vessels portraying the complexity and extent of the coronary circulation. (B) Coronary vessels that supply the anterior surface of the heart.

Vascular System of the Heart : 

Vascular System of the Heart The heart has its own vascular system. The coronary arteries supply the heart with blood, and the coronary veins, draining into the coronary sinus, collecting the blood and returning it to the right atrium.

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Figure 9.4 The functioning of the heart valves and blood flow.

The Flow of Blood : 

The Flow of Blood Blood flows through the heart, to the lungs, back to the heart, and to various parts of the body.

The Flow of Blood : 

The Flow of Blood Blood from the superior and inferior vena cavae enters the right atrium. Blood passes through the tricuspid valve into the right ventricle. Right ventricle pumps blood through the pulmonary semilunar valve into the left and right pulmonary arteries.

The Flow of Blood : 

The Flow of Blood Pulmonary arteries carry blood to the lungs where the blood gives up waste and takes on O2 as it passes through capillaries (microscopic blood vessels with thin walls that allow the passage of O2 and nutrients to the body and lets the blood pick up waste and CO2) and into veins.

The Flow of Blood : 

The Flow of Blood Blood leaves lungs through the left and right pulmonary veins carrying it to the left atrium.

The Flow of Blood : 

The Flow of Blood The oxygenated blood passes through the bicuspid or mitral valve into the left ventricle. The blood is pumped through the aortic valve and into the aorta. The aorta supplies a branching system of smaller arteries that connects to tiny capillaries throughout the body.

Heartbeat : 

Heartbeat The heartbeat is controlled by the autonomic nervous system and is generated by specialized neuromuscular tissue of the heart. The average heartbeat (pulse) is between 60 and 100 beats per minute for the average adult. The heart rate may be affected by emotions, smoking, disease, body size, age, stress, the environment, and many other factors.

Heartbeat : 

Heartbeat Sinoatrial Node (SA Node) Also known as the pacemaker of the heart, is located the upper chamber of the right atrium, just below the opening of the superior vena cava. It consists of a dense network of Purkinje fibers (atypical muscle fibers), considered to be the source of the impulses initiating the heartbeat. Electrical impulses discharged by the SA node are distributed to the right and left atria and cause them to contract.

Heartbeat : 

Heartbeat Atrioventricular Node (AV Node) Located beneath the endocardium of the right atrium, the AV node transmits electrical impulses to the bundle of His. Extends from the AV node into the intraventricular septum, where it divides into two branches within the two ventricles. The Purkinje fibers include the bundle of His and the peripheral fibers, which end in the ventricular muscles, where the excitation of the muscle is initiated, causing contraction.

Electrocardiogram(ECG or EKG) : 

Electrocardiogram(ECG or EKG) Record of the electrical activity of the heart, which provides valuable information in the diagnosing of cardiac abnormalities.

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Figure 9.5 Conduction system of the heart.

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Figure 9.6 Electrocardiogram (ECG [EKG]).

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Figure 9.7 Major arteries of the systemic circulation.

Arteries : 

Arteries Consist of a branching system of vessels that transport blood from the right and left ventricles of the heart to all body parts. All arteries have a pulse, which reflects the rhythmical beating of the heart.

Arteries : 

Arteries Following is a list of points commonly used to check the rate, rhythm, and condition of arterial walls: Radial Brachial Carotid Temporal

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Figure 9.8 Primary pulse points of the body.

Arteries : 

Arteries Following is a list of points commonly used to check the rate, rhythm, and condition of arterial walls: Femoral Popliteal Dorsalis pedis

Blood Pressure : 

Blood Pressure The pressure exerted by the blood on the wall of the vessels. The term most commonly refers to the pressure exerted in large arteries at the peak of the pulse wave. Sphygmomanometer Stethoscope

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Figure 9.9 Blood pressure measurement.

Veins : 

Veins The vessels that transport blood from the peripheral tissue and from the lungs to the heart.

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Figure 9.10 Major veins of the systemic circulation.

Capillaries : 

Capillaries Microscopic blood vessels with single-celled walls that connect arterioles (small arteries) with venules (small veins).

Capillaries : 

Capillaries Blood passing through capillaries gives up O2 and nutrients carried to this point by arteries and picks up waste and CO2 as it enters veins.

Life Span Considerations:The Child : 

Life Span Considerations:The Child Development of the fetal heart is usually completed during the first two months of gestation. It is completely formed and functioning by 10 weeks. Most congenital heart defects develop before the 10th week of pregnancy. If using a fetoscope, the fetal heart can be heard at 16 weeks.

Life Span Considerations:The Child : 

Life Span Considerations:The Child Oxygen is received by the fetus through fetal circulation and discontinues when the umbilicus is clamped. Pulse, blood pressure, and respiration will vary according to age.

Life Span Considerations:The Older Adult : 

Life Span Considerations:The Older Adult Lifestyles have a direct effect on the circulatory system of the older individual. The normal aging heart is able to provide an adequate cardiac output. In some older adults, the heart must work harder to pump blood because of: Arteriosclerosis Atherosclerosis Heart failure

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Figure 9.11 Signs and symptoms of a patient with heart failure.

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Figure 9.13 Abdominal aortic aneurysm.

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Figure 9.14 Infarction angioma. (Courtesy of Jason L. Smith, MD)

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Figure 9.15  Temporal arteritis. (Courtesy of Jason L. Smith, MD)

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Figure 9.16 A permanent epicardial pacemaker. The pulse generator can be placed in subcutaneous pockets in the subclavian or abdominal regions.

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Figure 9.17 Schematic of an automated external defibrillator (AED) attached to a patient.

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Figure 9.18 Cardiomyopathy.

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Figure 9.19 Defibrillator (cardioverter).

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Figure 9.20 How microorganisms enter bloodstream and affect heart lesions, which could result in bacterial endocarditis.

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Figure 9.21 Hemangioma. (Courtesy of Jason L. Smith, MD)

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Figure 9.22 Sclerosing hemangioma. (Courtesy of Jason L. Smith, MD)

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Figure 9.23 Pulse oximetry with the sensor probe applied securely, flush with skin, making sure that both sensor probes are aligned directly opposite each other.

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Figure 9.24 Balloon angioplasty. (A) The balloon catheter is threaded into the affected coronary artery. (B) The balloon is positioned across the area of obstruction. (C) The balloon is then inflated, flattening the plaque against the arterial wall (D).

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Figure 9.25 Pericardiocentesis.

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Figure 9.26 Raynaud’s phenomenon. (Courtesy of Jason L. Smith, MD)

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Figure 9.27 Symptoms of a patient in shock.

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Figure 9.28 Placement of a balloon expandable intracoronary stent. (A) The stainless steel stent is fitted over a balloon-tipped catheter. (B) The stent is positioned along the blockage and expanded. (C) The balloon is deflated and removed, leaving the stent in place.

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Figure 9.29 Telangiectasis. (Courtesy of Jason L. Smith, MD)

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Figure 9.30 Thrombophlebitis. (Courtesy of Jason L. Smith, MD)

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Figure 9.31 Thrombus formation in an atherosclerotic vessel depicting: (A) the initial clot formation, and (B) and (C) the varying degrees of occlusion.

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Figure 9.32 Development of varicose veins.

Drug Highlights : 

Drug Highlights Digitalis Drugs Strengthen the heart muscle, increases the force and velocity of myocardial systolic contractions, slows heart rate, and decreases conduction velocity through the AV node. Antiarrhythmic Agents Used to treat cardiac arrhythmias (irregular heart rhythms).

Drug Highlights : 

Drug Highlights Vasopressors Cause contraction of the muscles associated with capillaries and arteries, thereby narrowing the space through which the blood circulates. This narrowing results in the elevation of blood pressure; used to treat patients suffering from shock.

Drug Highlights : 

Drug Highlights Vasodilators Cause relaxation of blood vessels and lower blood pressure. Coronary vasodilators are used to treat angina pectoris.

Drug Highlights : 

Drug Highlights Antihypertensive Agents Used to treat hypertension. Antihyperlipidemic Agents Used to lower abnormal high blood levels of lipids when other treatment regimens fail. Antiplatelet Drugs Help reduce the occurrence of and death from vascular events such as heart attacks and strokes.

Drug Highlights : 

Drug Highlights Thrombolytic Agents Also known as tissue plasminogen activator (tPA, TPA), act to dissolve an existing thrombus when administered soon after its occurrence. These agents dissolve the clot, reopen the artery, restore blood flow to the heart, and prevent further damage to the myocardium, thus reducing the chance of dying after a myocardial infarction by 50 percent.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Angiography The x-ray recording of a blood vessel after the injection of a radiopaque substance; used to determine the condition of organs, tissues, or blood vessel being studied. Cardiac Catheterization Diagnostic procedure whereby a tiny catheter is inserted in an artery and manipulated to the heart. It is used to locate any blockages in the arteries supplying the heart.

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Figure 9.33 Cardiac catheterization.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Cardiac Enzymes Blood test performed to determine cardiac damage in an acute myocardial infarction (AMI). Alanine Aminotransferase Test (ALT) Levels begin to rise 6 to 10 hours after a MI and peak at 24 to 28 hours. Aspartate Aminotransferase Test (AST) Levels begin to rise 6 to 10 hours after a MI and peak at 24 to 48 hours.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Creatine Phosphokinase Test (CPK) Used to detect the area of muscle damage. Creatine Kinase (CK) Levels may be 5 to 8 times the normal level following. Creatine Kinase Isoenzymes Used to indicate area of damage CK-MB – heart muscle CK-MM – skeletal muscle CK-BB – brain

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Cholesterol Blood test to determine the level of cholesterol in the serum. Elevated levels may indicate an increased risk of coronary heart disease. Any level greater than 200 mg/dL is considered too high for good heart health.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Echocardiography (ECHO) Used to analyze the size, shape, and movement of structures inside the heart. Usually two echoes are taken, one with the heart at rest and another with the heart under stress. Comparison of the two images helps pinpoint abnormal valves or areas that are not receiving enough blood. Intracardiac Electrophysiology Study (EPS) Invasive cardiac procedure that involves the placement of catheter-guided electrodes within the heart to evaluate and map the electrical conduction of cardiac arrhythmias.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Holter Monitor A method of recording a patient’s ECG for 24 hours. The device is portable and small enough to be worn by the patient during normal activities. Lipid Profile A series of blood tests including cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides. Used to determine levels of lipids and to assess risk factors of coronary heart disease.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Lactic Dehydrogenase (LD or LDH) Intracellular enzyme present in nearly all metabolizing cells, with the highest concentration in the heart, skeletal muscles, RBCs, liver, kidney, lung, and brain. Magnetic Resonance Imaging (MRI) The use of a magnet that sets the nuclei of atoms in the heart cells vibrating. The oscillating atoms emit radio signals, which are converted by a computer into either still or moving 3-D images. The scan can reveal plaque-filled coronary arteries and the layer of fat that envelopes most hearts.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Stress Test (Exercise Test, Exercise Stress Test, or Treadmill Test) Method of evaluating cardiac fitness. The ECG is monitored while the patient is subjected to increasing levels of work using a treadmill or ergometer. The test helps doctors assess blood flow through coronary arteries in response to exercise at various lengths of time on a treadmill.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Thallium-201 Stress Test X-ray study that follows the path of radioactive potassium carried by the blood into heart muscle. Damaged or dead muscle can be defined, as can the extent of narrowing in an artery. Triglycerides Blood test to determine the level of triglycerides in the serum. Elevated levels may indicate an increased risk of coronary heart disease and diabetes mellitus.

Diagnostic and Lab Tests : 

Diagnostic and Lab Tests Ultrasonography Test used to visualize an organ or tissue by using high-frequency sound waves. Used as a screening or diagnostic tool to determine abnormalities of the aorta, arteries, veins and the heart. Ultrafast CT Scan Used to diagnose heart disease and can take multiple images of the heart within the time of a single heartbeat.

Coronary Heart Disease : 

Coronary Heart Disease Is the most common form of heart disease and is also referred to as Coronary Artery Disease (CAD). There is narrowing of coronary arteries that supply blood to the heart. It is a progressive disease that increases the risk of myocardial infarction (MI) and sudden death.

Coronary Heart Disease : 

Coronary Heart Disease Symptoms may include: Angina or chest pain. Chest pain may radiate to the neck, jaw, or left arm. Shortness of breath (SOB) signifying heart failure.

Coronary Heart Disease : 

Coronary Heart Disease Coronary heart disease is the leading cause of death in the United States for men and women.

Coronary Heart Disease : 

Coronary Heart Disease Conditions that contribute to CHD include: Atherosclerosis. Combination of unhealthy lifestyle choices and genetics. High levels of VLDL and LDL lipoproteins are associated with cholesterol and triglyceride deposits in arteries. Obesity. Diabetes mellitus. Hypertension.

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Figure 9.34 Blood vessels: (A) normal artery, (B) constriction, and (C) arteriosclerosis and atherosclerosis.

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Figure 9.35 Atherosclerotic artery.

Peripheral Artery Disease : 

Peripheral Artery Disease A condition in which fatty deposits build up in the inner linings of the artery walls. The blockages restrict blood circulation, mainly in arteries leading to the kidneys, stomach, arms, legs, and feet.

Peripheral Artery Disease : 

Peripheral Artery Disease Symptoms include: Claudication: dull cramping pain in the hips, thighs, calves, or buttocks. Numbness or tingling in the leg, foot, or toes Impotence Sores or infections that do not heal Weakness in legs or arms

Dysrhythmia : 

Dysrhythmia An abnormality of the rhythm or rate of the heartbeat. It is caused by a disturbance of the normal electrical activity within the heart.

Dysrhythmia : 

Dysrhythmia The symptoms of dysrhythmias can include: Dizziness Palpitations Shortness of breath Fatigue Weakness Angina Fainting

Dysrhythmia : 

Dysrhythmia Most are caused by heart disease such as endocarditis and heart failure. They can be life threatening if they decrease the pumping action of the heart. There are two types: Tachycardias: rapid heartbeat of over 100 beats/minute. Bradycardias: slow heartbeat of less than 60 beats/minute.

Hypertension : 

Hypertension Known as the silent killer, describes blood pressure higher than normal. With HBP, the blood vessels can become tight and constricted, causing the blood to press on the vessel walls with extra force.

Hypertension : 

Hypertension Hypertension can be controlled by: Taking BP medication as prescribed Establishing healthy eating habits Exercising Avoiding stress Making lifestyle changes Regular check-ups

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Figure 9.36 Uncontrolled hypertension can lead to stroke, eye damage, heart attack, kidney failure, and peripheral artery disease.